How can frequent, quality family time promote relationships and permanency?

Family time is essential for healthy child development, especially for children in foster care, as it helps to maintain parent-child attachment, reduce a child’s sense of abandonment, and preserve a sense of belonging as part of a family and community. Family time offers reassurance for children and their parents, opportunities to strengthen cultural and kinship connections, and motivation for parents to enroll in treatment or meet other permanency plan requirements. Although there is no generally accepted way to structure family time to optimize chances for reunification,1 families that spend time together regularly have a greater likelihood of timely reunification, and frequent family connections may also decrease depression, anxiety, and externalizing problem behaviors in children.2,3

A right, not a privilege

Family time is not a special or elective service, nor is it to be used as a bonus or reward; it is a fundamental right for all children and youth in foster care, and their families. There are very few instances in which family connections should be curtailed, restricted or terminated.4 Even when parents are engaged in the process of alcohol and drug use treatment, family time should be supported. (See the Kentucky Safe Families in Recovery Drug Testing White Paper, which asserts that a positive drug test should not be used to cancel time between parents and their children since this can be harmful to a child and affect bonding and attachment; and the Texas Department of Family and Protective Services’ Child and Family Visitation Best Practice Guide, which does not consider drug or alcohol use prior to family time a reason to cancel, but rather a reason to assess level of supervision, location, and family support needed.) Amidst natural disasters or public health emergencies, family connections are even more important to mitigate child and family stress, and agencies may need to use a variety of creative approaches to sustain family time, such as more frequent telephone and video calls, front lawn/front porch visits, and meetings in open parks or walking trails.

Family time and connection, not visitation

While most agency policies, state laws, and court decisions have focused on family visits or visitation, family time” and “family connection” are more appropriate terms and goals. “Visits” and “visitation” are terms more often associated with hospitals, prisons, treatment facilities, or other involuntary settings. Family time and family connection, on the other hand, reflect positive connotations and values, including that time spent with family members is fundamental.

Parent-child connections are essential for a child’s well-being and, perhaps more so than any other intervention, correlate with successful reunification. Research reveals that family time has a number of additional benefits for both children and their parents.

Consequences for children and parent(s) who do not maintain regular, frequent family time include:

While family time is considered the heart of reunification, even when reunification is unlikely, parents, siblings, and extended family continue to be important in a child’s life, and hence visits can and should continue regardless of permanency plan.

Federal context

Creating meaningful plans for families to spend time together is in keeping with the Adoption and Safe Families Act (ASFA), which included provisions that encourage the participation of parents and other family members in case planning to preserve family connections. ASFA emphasized the need for family visits to begin as soon as possible after removal, encouraged communication between birth and foster parents, shifted the focus of visits from monitoring parents to building their strengths, and recommended involving foster parents or parents with previous child welfare experience as visit mentors. More recently, the federal Children’s Bureau issued an Information Memorandum further emphasizing the importance of family time by outlining the research, sharing examples of innovative programs, and offering recommendations to attorneys, judges, caseworkers, and child welfare leaders.

Structuring family time

Although there is variation in how child protection agencies approach family time, typically the goal is to increase the number and length of family visits while reducing agency oversight until the family is ready for reunification. Several factors can enhance family time to accomplish this goal.

First visit

Given the trauma that removal causes both children and their parents, it is important for family time to occur as soon as possible, ideally within 24 to 48 hours. The actual timing may depend on the parents’ circumstances and safety factors. While full assessments of parents and children may not be complete and a plan may not yet be in place, early family time can still occur safely and go a long way toward providing comfort to both children and parents.

Location

Family time should occur in places that provide as homelike and familiar of a setting as possible, while also maintaining safety. The visiting space should be comfortable, clean, relatively quiet, and include age-appropriate toys and activities. While many families meet in child protection agency offices, many jurisdictions are moving away from such sterile settings, instead hosting family time in the homes of birth parents, relatives, or foster parents, or at community centers, libraries, parks, or other neighborhood settings. Other jurisdictions use family centers or visit houses, where families participate in routine daily activities, such as meal preparation. In Providence, R.I., the Families Together program allows parents time with their children at the Providence Children’s Museum where therapists guide families in having fun together with hands-on exhibits.

In rural areas where children are often placed far away from their families, or in cases where circumstances require a creative approach to making sure parents and children spend time together, virtual family time by video or phone can be a useful way to maintain connection.

Supporting family time in Washoe County, Nev.

First visits are scheduled as soon after removal as possible and occur at the county’s Family Engagement Center, a warm and inviting space for parents and children. The Center offers many opportunities for recreation and family activities, including cooking and enjoying meals in the dining room, and special rooms for infants, toddlers, and children needing a low-sensory environment.

Based on Fostering Relationships, trained engagers initially meet with both birth and foster parents before family time to talk about how the children are doing, share information, prepare for the visit, and plan an ongoing family time schedule. Foster parents are trained and encouraged to support the family and be part of these family connections.

Source: Interview with Jesse Brown, Jesse Brown, Family Engagement Center, Washoe County, Nevada, on March 6, 2020

Frequency

Family time should occur as often as possible, especially at the outset. As family time continues, the age of the child is a significant factor in determining how often children should see their parents. Infants and young children may need short visits daily or every other day to maintain their connection with a parent; young children of school age may need slightly less frequent visits if they are able to connect with parents on the phone each day. And older school-aged children and teens may be able to go a few more days between visits, such that longer time with parents once or twice a week may work better.

Visit Coaching came out of the limitations of traditional, supervised visits. We started to think creatively — if visits were designed to meet children’s needs, what would that look like?

– Marty Beyer, Ph.D, Visit Coaching Developer

Involving the right people

In recent years, many agencies have moved from strictly monitored visits, to quality family time that promotes bonding and improved parenting skills. Coaches, mentors, advocates, foster parents, and others may now play a role in family time visits and that role can, at times, extend beyond family reunification.

Preparing for visits

Many family time programs include a preparation component to help parents get ready to spend time with their children. In some cases, specially trained visit coaches work with parents to set realistic expectations, suggest parenting strategies, and offer guidance on structuring the visit. In other cases, caseworkers or foster parents help to prepare parents.

Visit coaches

Specially trained visit coaches can provide instruction and support to parents before, during, and after visits. In 2015, San Diego County used the Title IV-E waiver to initiate Family Visit Coaching (FVC) for families with complex needs, and is in the process of expanding the program countywide.6 Visit coaches are trained to work with parents to prepare for visits, develop realistic expectations, and put the child’s needs first. The visit coach is actively involved in each family time to build the parent’s strengths and help focus the parent on meeting the child’s needs. At the conclusion of each visit, coaches provide additional feedback, and the transparency of the feedback process helps to build trust between the parent and the coach. In a recent evaluation by the National Council on Crime and Delinquency, 47% of the families that were referred to FVC and chose to participate in the program ultimately reunified, compared to 30% of the families that were referred but did not to participate. Parents who participated in the program also exhibited an improvement in parenting skills. To date, Visit Coaching/Family Time Coaching training has been provided to child protection staff and private providers in 26 states.

Strive7 is a five-week, evidence-informed, low-cost program developed by Partners for Our Children in which a visit navigator meets weekly with a parent to address a particular topic, provide training before the visit, monitor and guide practice during the visit, and engage the parent in a debrief after the visit. A new topic is tackled each week, and there is a progression from connecting, through play and problem solving, to healing and celebrating.8 Researchers drew on the experiences and feedback from parents involved with the child protection system to develop the program. While the initial version of Strive is for parents with children ages 0 to 8, researchers have developed the program for families with older children (9 to 14 years old). Initial results from a pilot of more than 100 families showed that Strive parents were more likely to show up for visits than parents not involved with Strive, and were generally enthusiastic about the program and their visit navigator. Future research will look at how Strive affects the quality of visits and other outcomes.

Adapted from the Safe Babies Court Team™ approach, Cradle to Crayons (C2C) in Maricopa County, Ariz., operates through centers that offer child-parent psychotherapy, trauma therapy, and Family Time Coaching. C2Cs’ approach emphasizes valuing parents, supporting shared parenting by parents and foster parents, and understanding the unique needs of children in care, including how they experience trauma and how to intervene. Research by the Arizona State University Center for Child Well-Being found that Family Time Coaching was significantly associated with reunification, and trauma therapy in combination with Family Time Coaching, or Family Time Coaching in combination with resource coordination, had even higher correlations with reunification.

Parent-child interactions during family time

What happens during family time depends on many factors, including the identified case goals, the age of the child, how long the visits have been happening, the location of the visit, and even the time of year. Case plans for parents to reunify with their children usually include a parenting skills component, so the interaction during the visit may be a chance for the parent to practice new ways to engage his or her child. Safety surveillance during visits is often unnecessary and, whenever possible, unsupervised visits or opportunities for the parent to accompany the foster parent on a visit to the child’s doctor or a school event can further enhance the connection between parents and their children.

The Joan Sherman Program for Resilient Children9 was developed by SCAN (Stop Child Abuse Now) and the Devereux Center for Resilient Children in late 2014.10 This six-step supervised program focuses on increasing both the protective factors of children and the skills of the parent to reduce maltreatment risk. Parents receive coaching at the beginning of each family time session to help build their competency in four key areas: being positive, watching and describing, naming feelings, and being supportive. During family time, parents and their children engage in one of 40 activities that can be adapted for the age of the child. A trained caseworker conducts an assessment at each visit, and parents complete a resiliency assessment of their child at baseline and every tenth visit. While maintaining safety remains paramount, staff at Ireland Home Based Services in southern Indiana credit the program with helping the agency move to a structured, hands-on coaching approach for family time. The program is currently gathering outcome data to evaluate the impact on child resiliency and parenting ability.

We want parents to be successful in this space and time. And we want to instill hope by letting them know there are other parents who have been in their position and have gotten their kids back.

– Laura Orlando, Director, Partners for Our Children

Parent mentors

Parents with child welfare experience are in a unique position to serve as allies and mentors to parents whose children have been removed. These Parent Mentors have the shared experience of losing their children temporarily, but they are also able to tell the story of their own family reunification and how they accomplished it. A number of jurisdictions have hired parents who successfully navigated the child protection system and trained them to work as parent partners and advocates. In Ohio, this program is known as HOPE (Helping Ohio Parent Effectively) and is one of a number of parenting programs that match advocates with those in need.

Advice from families with experience

In partnership with parents and frontline staff in New York City, Rise Magazine created a series of handouts, videos, and posters offering tips for supporting parents in supervised visits.

Caregiver involvement

Caregivers can help children prepare for visits and transition afterward. They may transport children to and from visits and, in some cases, monitor the visits or offer ongoing coaching or support. When foster and birth parents work as parenting partners, both during and outside of visits, the benefits include more normalcy for children, sharing of information, easing of children’s concerns about friction between foster and birth parents, and a greater chance for successful reunification.

Fostering Relationships11 was adapted from the Attachment and Biobehavioral Catch-up (ABC), an evidenced-based home visiting intervention for caregivers of infants and young children who have experienced trauma. Parents work closely with a trained mentor (not the caseworker) to prepare for how their young child may react during the visit and how to respond in a nurturing and sensitive manner. In addition, the mentor trains the foster parent in the principles and techniques of ABC, how to develop empathy for birth parents, and how to give compliments to birth parents during the visits that reinforce the parents’ sensitive interactions with their children. Results from early research suggest that parents who experienced Fostering Relationships were more sensitive to their children and participated in more following-the-lead behavior during visits with their children than parents who had not been exposed to the program.

Comfort calls and icebreakers

Comfort calls between birth and foster parents soon after children have been removed give birth parents the opportunity to share important information about their children, and foster parents the opportunity to offer reassurance about how their children will be cared for. Icebreaker meetings are face-to-face meetings between parents and foster parents fairly soon after children are removed, and they serve a similar purpose — building a partnership between birth parents and foster parents.

Like several jurisdictions around the country, Clark County, Nev.,12 introduced Fostering Relationships as part of its Quality Parenting Initiative to build healthy relationships between parents and children so that families can be reunified. In some cases, a bond grows between the adults, which allows the foster parents to continue to support the family after reunification. Clark County has also found that if the birth and foster parents are partnering successfully, the family can move to community visits more quickly and, ultimately, achieve faster reunification. Shorter time in care translates to less trauma for children and cost savings for the county.

About six years ago, Ventura County, Calif.,13 moved from a traditional one-size-fits-all supervised visits setup to the current family time program. The introduction of Safety Organized Practice and the California Child Welfare Core Practice Model helped the county incorporate the voices of parents and children into safety planning. Building a safety network around the family that drew on natural support became a goal, and this carried over into family time. Visit tools were introduced, such as automatic reviews every three weeks to determine whether visiting could be liberalized to allow families less supervision. Foster families or other members of the family’s safety network partnered with parents and were often involved in monitoring visits, which provided opportunities more visits in natural settings. These partnerships also gave parents the chance to observe and learn about parenting skills. In some cases, the partnerships continued after reunification, so that the family had continued support. Ventura County has noted an increase in family preservation and a drop in the numbers of children in care since this shift in practice.

1 Fanshel, D. (1975). Parental visiting of children in foster care: Key to discharge? Social Service Review, 49(4), 493-514.
2 McWey, L. M., Acock, A., & Porter, B. E. (2010). The impact of continued contact with biological parents upon the mental health of children in foster care. Children and Youth Services Review, 32(10), 1338-1345.
3 Cantos, A. L., Gries, L. T., & Slis, V. (1997). Behavioral correlates of parental visiting during family foster care. Child welfare, 76(2), 309.
4 For example, in cases of intra-familial sexual abuse, Munchausen syndrome by proxy, significant domestic violence, etc., where a clinical expert has determined that even high supervised family time would be contrary to a child’s psychological or physical safety and well-being.
5 Burry, C. L., & Wright, L. (2006). Facilitating visitation for infants with prenatal substance exposure. Child welfare, 85(6), 899.
6 Interview with Marty Beyer, Visit Coaching Developer, and Jorge Cabrera, Casey Family Programs, March 9, 2020.
7 Interview with Susan Barkan and Laura Orlando, University of Washington Strive program, February 3, 2020.
8 Orlando, L., Barkan, S., & Brennan, K. (2019). Designing an evidence-based intervention for parents involved with child welfare. Children and Youth Services Review, 105. Retrieved from https://doi.org/10.1016/j.childyouth.2019.104429
9 Interview with Mandi Barger and Nick Miller, Ireland Home-Based Services on February 3, 2020.
10Tobin Smith, G., Shapiro, V. B., Sperry, R. W., & LeBuffe, P. A. (2014). A strengths-based approach to supervised visitation in child welfare. Child Care in Practice, 20(1), 98-119. Retrieved from https://doi.org/10.1080/13575279.2013.847056
11 Interview with Caroline KP Roben, University of Delaware, February 4, 2020.
12 Interview with Julie Abston and Denise Parker, Clark County, Nev., March 5, 2020.
13Interview with Michelle Calder, Ventura County, Calif., March 12, 2020.

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