Changing a Critical Practice

How can policy and practice improve visits between parents and their children in care?

By Meghan Williams

This is the first of two articles about changes to parent-child visits.
“In the name of safety, sometimes a child’s well-being can get lost in the mix,” says Tanya Krupat. She’s seen it happen–Krupat is currently the director of the New York Initiative for Children of Incarcerated Parents at the Osborne Association, and the author of Taking ‘the Village’ Seriously: The Importance of Attachment, Continuity, and Expanded Family Networks for Children and Families in the Child Welfare System. Her experience working in New York City’s child welfare system showed her that no matter the reason for removal, a child is apt to panic after being taken from a parent’s care. “Often the child is being removed from the person they know the best, and who is their whole life … the parent-child relationship is critical.”

Maintaining that relationship is necessary, regardless of the final permanency plan. “I don’t know of any case where reunification happened and visits didn’t happen,” Krupat says. Even when reunification will not happen, visits help children and parents adjust. “We talk a lot about parent engagement, and visiting is a great way to bring them into the process.”

The process is what interests Peg Hess. She’s an independent child welfare consultant; recently, she has worked primarily with the National Resource Center for Family-Centered Practice and Permanency Planning (NRCFCPPP) and Children’s Rights. Her early research was a primary source for many of the programs that have evolved to address concerns about visiting practice. “I’ve been working on this area of visitation practice really since the late 1970s, and I have seen some changes, but I’m troubled by the areas in which we are not seeing change,” she says.

‘A Look at Current Policy’

In 2003, Hess completed a study that evaluated states’ policies on parent visits, Visiting Between Children in Care and Their Families: A Look at Current Policy. She compared legal guidelines from the 37 responding states. She found general consensus in the requirement for a written visit plan, and for that plan to be included in the case record, as well as a common understanding that visits may include not only parents and siblings, but also the child’s relatives, friends, and former caregivers. A majority of states addressed the frequency of visits and specified a minimum number of visits, which varied but on average was one per week. Around half recommended that visits occur in the most homelike atmosphere possible.

Of the 30 content areas Hess identified, only seven were addressed by a majority of states, and for some areas the policies were vague. There was variation in all areas, particularly in documentation and supervision of visits. Consequently, Hess’s conclusion highlighted the need for more policy, more specificity and more uniformity. “When you don’t address something, then you do condone variation and staff discretion,” she explains. “You give your staff great latitude when you’re not specific. You can say that there must be regular visits, as often as possible, [but] people want to know those specifics.” Without details, people implementing the policy use personal feelings to help them make decisions. “Education and training do not fully prepare them–they rely on their own values and their own views of parenting children,” she says.

Krupat says caseworkers need more support; they have “a very difficult to impossible job.” With large caseloads and other pressure, visiting requires extra investment: “Visiting does take a lot of time and expertise and can be very, very difficult,” she says. “It can require a real deep knowledge of family dynamics.” She agrees with Hess that sometimes even advanced training doesn’t make the job easier. “It’s really hard and I have an MSW, and there are caseworkers who don’t,” she explains. “I feel for them, because it can be very challenging to interact with a family, particularly if they’re resistant or if there’s a mental health issue.”

Hess maintains that good policy can lead to better practice. She knows there’s a “vulnerability a state has when it’s working on a policy,” but encourages jurisdictions to codify future goals rather than at-the-moment capabilities. “Where possible, policy should reflect the standards you want to be reaching for,” she says. The fear of lawsuits over being unable to deliver on better practice policy tends to stagnate policy. But Hess’s report includes a method to move forward: her appendix is a checklist of 30 content areas, which jurisdictions can use to ensure they have specific guidelines for visits. “Whatever jurisdiction is developing policy that regulates staff practice, at that level, that policy should be reviewed to see whether it is specific enough that it’s actually providing guidance,” Hess says.

In particular, she sees room for improvement in statements about visit frequency. Seven states require visits “regularly” or “as often as possible,” and 11 of the responding states (30%) did not address frequency at all. This lack of attention “didn’t shock me, but it really troubled me,” Hess says.

Krupat’s proposal to improve the way parents interact with their children is to add more people and more interactions to that relationship. She advocates the idea that “it takes a village to raise a child”; she wants to see the child welfare system become less like a system and more like the village of that African adage. “Building a support network around a parent and child is really important,” she says. “Even in the best of families, everyone can benefit from more support.”

The primary person giving support to the child, and by extension the family, is the foster parent, and Krupat has seen bonds form between foster parents and birth parents. “I’ve been on visits where the parent, actually with the foster parent, gave the child permission to love the foster parent,” she says.

Three ongoing projects are among those looking for different ways to create that support–by working directly with families, creating tools for caseworkers, and redefining what a visit is.

‘How Do We Improve Family Visiting?’

Wendy Negaard works with Family Alternatives, a small foster care agency that serves the Minneapolis-St. Paul area. Family Alternatives works mostly with adolescents who will return to their families, and Negaard wanted to make those reunifications more successful. For two years, she ran the Family Connect pilot project, which drew on the experiences of social workers, birth parents, foster parents, and children in care to help create user-friendly workbooks on visiting for the latter three groups.

The project started with a small group and a basic question, Negaard explained. “We just said: How do we improve family visiting?” They soon realized they needed to expand to a real research study. “We really felt like we needed more information,” she says. “We came up with more questions than answers.”

The broader study included those involved with two child welfare systems, in urban Hennepin County and the more rural Olmstead County. Negaard said they wanted ideas from diverse families in different systems to help ensure their final recommendations would be widely applicable. She said the workbooks are a compilation “of the best practices that we heard.” For two months, families in Hennepin County have used the books, testing their information and offering suggestions.

One particular area Negaard hopes to improve is children’s transitions to and from visits, as they go from foster parents to birth parents and back. “We didn’t hear a lot of foster parents who felt prepared to transition kids in an empathetic way,” she says. Foster parents “resented the visits because the kids would come home upset.” She described a foster parent who said she was scared to meet the birth parents of a child she was caring for, because visiting with them caused the child such tension. Listening to the responses from the parents and having the information in the workbook changed her point of view. “She was one of the few people who said ‘it pushed me to look at how I interact [with the birth parents] and pushed me out of my comfort zone,'” Negaard says. She was glad to see participants beginning to realize what she knows to be true: that agencies cannot support children in care “apart from their relationships with their families.”

‘Designing Visits from Best Practice’

Independent consultant and trainer Rose Marie Wentz knew that there was information about best practice for visiting, but she thought it was too scattered. “The information was too overwhelming, there were too many pieces of data,” she says. Wentz set to work creating an organized format that could be used as both training guide and reference, and started with a paper matrix that added at least one column for each of four aspects of visits that she had outlined. In its beginning, it was “truly an old-fashioned cut-and-paste format,” she said, but working with the NRCFCPPP and the University of California-Davis, she has been turning it into a web-based program. No longer a matrix, it is titled Child and Parent Visit Plans: An Online Interactive Guide.

To create the program, Wentz defined four steps to developing a “purposeful and progressive” visit plan. Step One factors in the level of child development and parenting skills, Step Two recognizes the type of abuse, Step Three notes the time in care, and Step Four includes other relevant factors. Each step is broken down into detailed recommendations for the visit’s purpose, frequency and length, location, activities, supervision level, attendees, responsibilities and materials, and documentation. With the matrix, this translated into at least 32 cells, more if the case included multiple forms of abuse or several of the “other factors” Wentz listed. The online guide simplifies the process; a caseworker inputs the characteristics of a particular case, and gets only one final, comprehensive suggestion for the visiting plan.

One of Wentz’s goals is to focus attention on what children need from visits. “The first step is always about meeting the child’s needs,” she says. “When in doubt, you always go back to, what is the child’s needs? … If we truly are child-centered, what would the visit look like?” Wentz seeks to define best practice standards. She doesn’t ignore the constraints of reality, but instead starts at “what should be” in hopes that “what is” will catch up. “The matrix comes from that approach–if we were designing visits from best practice, what would that look like?”

Wentz is also developing a curriculum for training to complement the online guide. The program will highlight the range of options for all aspects of visits. Even visits themselves are part of a continuum, one type of contact between a parent and child, which also includes letters and phone calls.

Caseworkers are good at finding what’s gone wrong in a visit, but Wentz wants her training to include a “more difficult skill.” “What we haven’t taught them to do is recognize what it looks like when they’re doing it right,” she explains.

‘We’re Not Giving Children Enough Time’

Michael Key, a juvenile court judge in Troup County, Georgia, was co-chair of the Visitation Protocol Project (VPP). The group was formed after a discussion at a National Council of Juvenile and Family Court Judges conference sharpened Key’s focus on visits for the families he sees in the court system.

“I knew that we were not doing enough for our families,” Key says. He also knew the feeling stretched much farther than Troup County, and that problems in visitation practice were everywhere. “I seldom find anyone that thinks that their community does a good job,” Key says.

In collaboration with the national council and the Georgia Court Improvement Initiative, Key gathered approximately 40 representatives from a range of parties interested in improving visits. Along with other juvenile court judges, there were attorneys for children and parents, state- and national-level court appointed special advocates, psychologists, and legislators. With two two-day strategic planning meetings in 2004, the workgroup formulated a rubric for the frequency and duration of visits, determined by the child’s age. The resulting quantitative recommendations are minimums–according to Key, “the least frequent visitation we could have and still meet the needs of these families.”

Length is one of the big problems Key sees in current practice. “In the overwhelming majority of visitations, we’re not giving children enough time with their families,” he says. “It’s just resource-driven rather than needs-driven, and that’s really unacceptable.”

While the 2006 VPP report is still considered a draft, the plan calls for 30-60 minute visits three times per week for children birth-6 months; 1 hour three times per week for children 6-18 months; 90 minutes twice per week for children 18 months-3 years; and 2 or more hours once per week for children 3-5 and 5-12 years. For teens, the group found no generally applicable recommendation, but emphasized the need for frequent, meaningful family time in teens and all age groups. A list of special circumstances that may require modification to the plan is also included. “This is a beginning point for discussions and you can vary from that, that’s when we created the special circumstances,” Key says.

Listening to a presentation on child development led the workgroup to conclude age–attractive primarily because it is an objective factor–truly was an acceptable divider. Key found another practical reason: “That’s probably the only common denominator for all our kids: they all have an age.”

‘It’s Family Time, It’s a Time to Heal’

Key knows that the VPP workgroup left many questions unanswered. “Our work is nowhere near done,” he says. They ran out of time before they could get very far, but took one strong step in the direction of qualitative recommendations for visitation–by giving up the term visitation. They opted for a more basic label: family time.

“The use of the phrase family time instead of visitation, I think it was worth the time we spent on it,” Key says. The report outlines the main arguments for the switch: “The term ‘visitation’ does not adequately describe the time families need to spend together when children are placed out of their home, either from a quantitative or qualitative standpoint, before reunification is attempted. … Families need time together that is frequent, consistent, and as ‘family-like’ as possible.”

There was a consensus to move away from visitation. Krupat’s agency also avoids it: “We try not to use the word visitation,” she says. “It’s a legal term, and it doesn’t convey what we’re trying to do.” Hess related a story about a caseworker who told her the term conjured up religious images of Mary’s visitation from the angels. “It’s such an odd word, and a big word, and an official-sounding word,” Hess says. “I’ve just resorted to using visits and visiting.” She says that family time works well: “I think that is a much more family-friendly term.” Negaard says visiting doesn’t describe parent-child interactions. “Is that honoring language?” she asks. “You visit your grandma–it’s family time, it’s a time to heal and figure out family relationships.”

In the next issue of Children’s Voice, a second article will explore innovative visiting programs already serving as examples for changing practice.

Meghan Williams is a Contributing Editor to Children’s Voice.