Minnesota and Nevada

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Minnesota and Nevada Strategies
Additional Minnesota Strategies
IECMH for Vulnerable Children: Quality Parenting Initiative

The Youth Law Center (YLC) launched the Quality Parenting Initiative (QPI) in 2008 to strengthen foster care by refocusing on excellent parenting for all children in the foster care system. QPI began with advocacy and policy and practice changes designed to meet the particular developmental needs of infants and young children in out-of-home care. While the importance of this period of development has been widely recognized for some time, child welfare policy and practice often contradicts what research has demonstrated these children need. QPI applies the research of developmental science to child welfare practice and policy. This profile provides an overview of QPI and information about implementation in Washoe County, Nevada, and in Minnesota.

Initially adopted by three pilot sites, QPI now has a presence in 10 states and over 80 sites across the country. QPI transforms foster care through a network of families, youth, agency leaders and staff, judicial leaders, and community organizations committed to developing and sharing research and solutions, advocating for and implementing policy and practice changes, and changing the culture of child welfare to focus on excellent parenting for every child and youth in care.

With leadership from child welfare agencies or courts, each site develops its own approach to prioritizing quality parenting for all children in foster care. To become a QPI site, agency leadership must commit to QPI’s principles and to the staff time and resources to implement QPI systems change. The lead agency initially brings together a steering committee comprised of a broad stakeholder group, including birth parents, foster parents, youth, caseworkers, attorneys, court personnel, and representatives from schools, health departments, and faith communities, to develop expectations for excellent parenting for children in out-of-home placements. The steering committee reviews child development research and then identifies policy and practice changes that are research-informed and will meet expectations for excellent parenting. The most common areas of policy and practice that sites address are developmentally appropriate transitions (e.g., adoption, reunification), improving birth and foster parent relationships, improving parent involvement as a respected, valued partner in the child’s case plan, increased sharing of information and participation in decision-making, and visitation. Each QPI site must also have a QPI lead, or liaison, who is a lead agency employee responsible for ongoing QPI implementation at the site.

YLC provides training, technical assistance, and support for QPI sites and the local QPI site liaison; builds a strong national network that can organize for change; shares and tests innovation, including maintaining a resource bank with model practices and policies; develops materials to capture and disseminate learning; connects with experts for training and policy development; and coordinates advocacy responses. The national QPI team at YLC holds monthly topical webinars featuring child welfare, child development, and other experts, and peer practice exchanges, with recent topics including two-generation approaches, faith-based approaches, supporting Indigenous children, and supporting Black children and families. The national team also convenes QPI site cohort groups to share information in areas such as kinship foster care and visitation. An annual conference serves as another way for sites to share best practices and engage with the broader research and policy communities.

In 2020, YLC launched a new QPI Champions program, which employs a community organizing model to train groups of local foster parents, staff, youth, and birth parents as leaders who will take responsibility for leading and sustaining change in the child welfare system. This new model invests in local leadership, ensures QPI incorporates diverse views and cultures, and provides continuity when there is child welfare agency leadership change. YLC educates these Champions through a six-part series of lectures, coaching sessions, and discussion sessions that focus on the principles behind QPI, the developmental science of attachment and relationships, techniques for organizational change, communication skills, facilitation, and strategic analysis. The QPI Champions have primary responsibility for leading change in their own sites and disseminating to others.

Financing

The primary ongoing cost for QPI sites is the salary of the local QPI liaison. YLC requires that agency funds support QPI in each jurisdiction. Many sites use federal Title IV-E Foster Care Court Improvement Program funds or grants from local foundations. Each site reviews its QPI contract annually, which requires jurisdictions to regularly renew their commitment to the approach. Funding for reforms adopted by QPI sites, such as trainings for child welfare agency, court staff or resource parents also come from federal Title IV-E Foster Care or Court Improvement Program funds and other existing state and local child welfare funding. Funding for strengthening the national network and supporting innovation and dissemination comes primarily from philanthropic sources.

Monitoring and Evaluation

The EC PRISM (Early Childhood Precision, Innovation, and Shared Measurement) team at the University of Oregon Center for Translational Neuroscience has created a QPI Measurement & Evaluation Toolkit. This toolkit offers sites a flexible framework with which to develop individualized plans for evaluation. Individual QPI sites currently also collect their own data for evaluation, monitoring, and quality improvement purposes.

Additionally, QPI has tested and implemented a new approach, Quality Parenting Outreach (QPO), to allow systems to regularly gather “customer service” data from families to provide immediate feedback to agencies on the families’ needs and experiences. Data gathered through QPO has been used by child welfare agencies to identify priorities for change, develop action steps, and measure the impact of current reform efforts.

Washoe County, Nevada, QPI

Washoe County, Nevada, which includes the city of Reno, has a population of approximately 466,000 people. The children in foster care and the foster caregivers are approximately 63 percent Caucasian, 25 percent Hispanic, and 5 percent African American. This is closely proportionate to the population in Washoe County. The number of children in foster care averages over 700, and there are roughly 200 foster homes and 70 relative foster homes. Washoe County Human Services Agency (WCHSA) has been a Nevada QPI site for more than eight years and in that time has adopted a number of policies and practices focused on quality parenting through its involvement in QPI. Foster and adoptive parents, as part of their licensing process, participate in 40 hours of preservice training, including education on trauma, visitation, reunification, coparenting, and poverty. Training also includes Fostering Relationships, an adaptation of the evidence-based Attachment and Biobehavioral Catch-up (ABC) dyadic treatment model, which aims to improve visitation by strengthening the relationship between foster and birth parents, helping birth parents have successful visits to encourage repeat visits, and increasing foster and birth parents’ use of sensitive parenting behaviors.

When a child is removed from the biological home, the new caregiver and the child welfare case worker facilitate a Comfort Call to the birth parent to learn about the child’s likes and dislikes. Within 48-72 hours a first visit is arranged at the Washoe County visitation center. Engagers, who are WCHSA Children’s Division employees trained in Fostering Relationships and motivational interviewing, work separately with the birth parent and foster parent to learn about family likes, dislikes, routines, culture, and medical appointments. This information is included in a Partnership Plan that each parent receives. The Partnership Plan is part of the engagement process to build a coparenting relationship and includes scheduling the first visits, contact information for all parties, and information on the child including medical, educational, and behavioral needs. Peer support parents, who are skilled foster or birth parents identified by Engagers for additional training, are matched with new foster parents as an additional resource. Birth parents also attend a Family Solution Team Meeting to discuss reasons for removal, family needs and strengths, and the child’s needs.

The WCHSA Children’s Division also has an in-house clinical mental health unit, and all children in foster care receive an initial medical and mental health assessment. The clinical mental health unit can provide assessments and treatment, as well as refer to additional services in the community. The county’s Safe Babies Court [see the Florida PRiSM profile for more information on the infant toddler court approach] provides additional supports, such as monthly child and family team meetings, and case workers also refer families to services such as counseling and Circle of Security-Parenting (COS-P), an evidence-based parenting program.

Washoe County works toward kinship (relative) placements when possible, and in all cases tries to match children based on language and culture to support stability and longevity of placements. While a cultural match is not always possible because of a shortage of foster parents, the county has ongoing efforts to enlist diverse foster families. For example, recruitment for foster parents is conducted in the zip codes with high rates of children entering foster care, at LGBTQ events, and at events where Spanish is a primary language.

The QPI national office conducts site visits and has identified Washoe County as a master site for other jurisdictions as part of its Champions program.

Financing

WCHSA’s QPI partnership with YLC is through a contract paid with federal Title IV-B(2) grant funding. Engagers and the clinical unit are permanent employees of WCHSA. The tangible services provided to caregivers and birth families are supported through federal Title IV-B(2) and Adoption Incentive Payments program funds, as well as philanthropic grant funds (e.g., Casey Family Programs), available within Washoe County Children’s Services.

Evaluation and Monitoring

The WCHSA’s Continuous Quality Improvement (CQI) unit is responsible for gathering and analyzing data on the efficacy of policy and case management, as well as ensuring case practices meet the standards of state and federal Child and Family Services Reviews (CFSR). The review, which happens annually for WCHSA, examines 18 items that cover safety, permanency, and well-being of children involved in the child welfare system and helps determine whether the state will be put on a Performance Improvement Plan. As part of the review, cases are randomly selected and interviews with key case participants, including foster parents, are conducted. QPI supports for positive relationships between foster/relative caregivers and birth parents (e.g., comfort calls, icebreaker meetings, including birth parents in team meetings and decision-making, setting visitation schedules together) contribute to a number of items rated in the CFSR, including ensuring frequent and high-quality visitation, maintaining positive relationships between the child and their birth parents, involving parents in case planning, and addressing children’s mental health needs.

Minnesota QPI

In Minnesota, at the end of FY2019, 40 percent of the 8,400 children in foster care were under five years old.[1] Among children under 18 in foster care, 21 percent were American Indian/Alaska Native and 15.1 percent were Black, both of which are an over-representation compared to their percentage in the general population of children under 18 (1.5 percent and 10.1 percent, respectively).[2] QPI was brought to Minnesota in 2017 at the invitation of community-based foster care organizations in partnership with St. David’s Center for Child and Family Development, an early childhood services agency. While the level of QPI involvement varies by county, it now operates as a statewide network of counties, agencies, and individuals.

QPI helped to pass state legislation in 2020 requiring Initial Calls, similar to Comfort Calls, between foster and birth parents to share information about the child’s and families’ backgrounds. In several parts of the state, QPI has supported preservice training for foster parents that covers attachment, trauma, and self-reflection. Scott County trains foster parents using Fostering Relationships, and Hennepin County, the state’s largest, is developing a parenting program informed by the Fostering Relationships shared parenting principles. Inservice supports have increasingly focused on the role of formal and informal peer mentors for foster caregivers, such as one-to-one mentorship and in-person and online support groups. The QPI national office uses its vast experience to offer supports to local agencies and foster caregivers working with cross-cultural placements.

Minnesota places 60 percent of children in out-of-home care with relatives. Through QPI, agencies have been working to offer more substantial resources to caregivers at the start of these placements, such as Walmart gift cards to help with the expenses of setting up a home for the child or assistance with driving the child to appointments during the first month. These tangible, just-in-time resources aim to reduce the disruptions and trauma that can come from placements with caregivers who are not adequately prepared and supported.

Led by a number of QPI Champions, Minnesota QPI has also helped agencies explore ways to build relationships with communities to address mistrust and trauma historically associated with involvement in the child welfare system. Shana King, a QPI Champion from the Indian Child Welfare Act Law Center (ICWA Law Center), a legal service and advocacy organization, has helped more than 200 Native American families, supporting them in court, meeting with social workers, and assisting them with case plans, leading to increased participation of Indigenous birth parents and Indigenous leaders as QPI Champions and steering committee members. She also led the development of a training webinar, Supporting Cultural and Relational Connections for Indigenous Children, which was disseminated within Minnesota and to QPI sites nationwide. Darlene Bell, another QPI Champion who is a Community Voice Advocacy Coordinator and has served as a foster parent for more than 30 years, has worked to engage communities of color. Darlene holds a vital role with her husband, Curtis Bell, and Shana King as Racial Equity Leaders for QPI-MN, meeting with legislative, state, and county leadership to elevate the experience and voices of BIPOC families involved in child welfare.

In Minnesota, children in foster care receive an initial developmental screening administered by a public health nurse that includes the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) [see the PRiSM Minnesota profile for more information on the state’s comprehensive system of SE screening]. In the case of positive screens, families can be referred to mental health service providers that have ties to county child welfare agencies. Several QPI member agencies have established these relationships. For example, in Hennepin County, the St. David’s Center can offer Attachment and Biobehavioral Catch-up, Child-Parent Psychotherapy, Circle of Security-Parenting, and Parent-Child Interaction Therapy. The particular service offered to a family will depend on their particular needs and situation. Families may also be referred to a home visiting program, such as Parents as Teachers or Healthy Families America.

IECMH consultation is available to some child welfare agencies. The St. David’s Center foster care unit includes a clinical team, which can offer case consultation to other members of the unit. Family Alternatives has monthly meetings with an African-American mental health consultant who is able to help staff support the predominantly African-American population the agency serves. Other agencies offer reflective supervision to staff through arrangements with a local mental health agency.

Financing

Philanthropic funding supports QPI in Minnesota, covering the QPI liaison position, the contract with YLC, paid time for parents and youth to participate in planning, staff participation in the annual QPI conference, and some marketing and trainings. Mental health services for children in foster care are paid for by Medicaid, private insurance, or county funding if neither of those are available.

Monitoring and evaluation

QPI Minnesota data collected from private foster care agencies in 2018, 2019, and 2020 showed positive trends in benchmarks related to foster caregiver retention, diversity, and representativeness of foster caregivers. For example, the rate of culturally diverse foster homes increased from 37 percent to 49 percent from 2018 to 2020.

Minnesota has been participating in QPI’s national QPO data collection pilot efforts to survey parents via text message in order to immediately identify areas of need. One example during COVID found that parents in rural counties in northern Minnesota were facing challenges accessing food. The local agency was then able to send information to parents on the location of food collection points. Two private foster care agencies participating in another survey are examining foster and birth parents’ experiences of the Initial Calls. These data can be used both for quality improvement efforts and also to advocate for the use of the Initial Calls approach in other QPI sites. 

Special thanks to the following individuals for providing information for and/or reviewing this profile: Jennifer Rodriguez, Executive Director, Youth Law Center; Carole Shauffer, Senior Director, Strategic Initiatives, Youth Law Center; Amy Sandvick, Children’s Services Coordinator, Washoe County Human Services Agency; Kylee Spring, QPI Liaison, Washoe County Human Services Agency; Laura Caprioli, QPI Recruitment and Training, Washoe County Human Services Agency; and Kate Rickord, QPI Minnesota Coordinator, St. David’s Center for Child and Family Development.

Last updated December 2021

References

[1] U.S. Children’s Bureau. (n. d.). Child Welfare Outcomes data report: Minnesota. https://cwoutcomes.acf.hhs.gov/cwodatasite/pdf/minnesota.html

[2] Ibid.