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Research continues to link a father’s positive involvement in the family to outcomes that reflect children’s well-being (see, for example, Cabrera, Volling, and Barr 2018; Lamb 2004). When child welfare agencies successfully engage fathers in their children’s cases, the agencies create a connection that can also improve children’s outcomes. Relatively few studies have addressed the specific benefits of involving paternal relatives, but support from extended family is linked to children’s well-being (for example, Erola et al. 2018) and to protective factors (for example, Corwin et al. 2020). Even though involving fathers in child welfare services can have a positive impact on their children’s well-being, and there is a deepening focus on parent engagement in child welfare, fathers are not well engaged in child welfare services.
The Fathers and Continuous Learning in Child Welfare (FCL) project used a methodology known as the Breakthrough Series Collaborative (BSC) to improve placement stability and permanency outcomes for children by engaging their fathers and paternal relatives. A BSC is a continuous learning methodology developed by the Institute for Healthcare Improvement that is used to test and spread promising practices to help organizations improve in a focused topic area (IHI 2003). It has five key elements: (1) the Collaborative Change Framework (CCF); (2) inclusive multilevel Improvement Teams; (3) a Shared Learning Environment; (4) expert faculty; and (5) the Model for Improvement.
Six Improvement Teams representing five state or county child welfare agencies participated in the BSC. Throughout this BSC, each Team identified, implemented, and studied a unique group of strategies to engage fathers and paternal relatives. Teams developed processes to collect, organize, and report data to gauge whether the engagement strategies were producing improvements on specified metrics. This pilot study report describes insights into the implementation of a BSC and potential strategies for increasing father and paternal relative engagement in child welfare.
The implementation of the BSC methodology in health care settings is well known and documented. Although the BSC has been used in child welfare settings, little is known about the implementation process and resource needs. This pilot study was funded by the Office of Family Assistance and directed by the Office of Planning, Research, and Evaluation in partnership with the Children’s Bureau, all within the Administration for Children and Families in the U.S. Department of Health and Human Services. It focused on providing nuanced information about the preparation for a BSC, the components of a BSC, the early stages of implementation of a BSC, and its aims, short-term outcomes, and sustainability. FCL is conducted by Mathematica and the University of Denver (referred to as the Mathematica/DU team).
The FCL pilot study was designed to:
- Document the implementation of a BSC in order to achieve the goal of improving placement stability and permanency outcomes for children
- Document how the Teams worked with system partners to plan, test, and adjust their engagement strategies
Key Findings and Highlights
After engaging in the BSC, Improvement Team members considered themselves more knowledgeable and identified cultural shifts and changes in their own behavior and the behavior of others in engaging fathers and paternal relatives. These changes were fueled by dedicating protected time and effort toward the BSC and staying deeply committed to engaging fathers and paternal relatives.
Improvement Team members reported that the BSC could be strengthened even more by increasing protected time away from the competing demands of daily work, getting stronger guidance from the BSC team on data collection and community partner engagement, and engaging staff other than those on the Improvement Team. All Improvement Teams planned to keep using elements of the BSC after it formally concluded. Work on father and paternal relative engagement will continue by drawing on the BSC experience, building successful engagement strategies identified through the process, relying on sustained leadership, and furthering the beginnings of a cultural shift.
The pilot study methods used both qualitative and quantitative analyses. Data included interviews and focus groups, observational notes, and structured assessments collected over the course of the pilot study period.
Interviews and focus groups were conducted during site visits. The Mathematica/DU team conducted six site visits: four were conducted in person, and two were conducted virtually because of the COVID-19 public health emergency. The Mathematica/DU team took observational notes during Shared Learning Environment activities. Structured assessments included a site self-assessment that teams completed twice to report their site’s current level of engagement for fathers and paternal relatives, and an implementation assessment that all Team members completed twice to indicate each individual’s confidence level on certain aspects of engaging fathers and paternal relatives.
Fung, Nickie, Jennifer Bellamy, Eliza Abendroth, Diletta Mittone, Roseana Bess, and Matthew Stagner (2021). A Seat at the Table: Piloting continuous learning to engage fathers and parental relatives in child welfare. OPRE Report #2021-062, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
- Breakthrough Series Collaborative (BSC):
- The BSC is a continuous learning collaborative methodology used to test and spread promising practices to help organizations improve in a focused topic area. It has five key elements: (1) the Collaborative Change Framework; (2) inclusive multi-level Improvement Teams; (3) the Shared Learning Environment; (4) expert faculty; and (5) the Model for Improvement. Each plays a critical role and works with the other elements in interrelated ways. Each BSC has a topic area of focus. Improvement Teams are continuously identifying, collecting, and reviewing data on the topic to gauge their organization’s progress toward specific outcomes.
- BSC team:
- The FCL BSC team included the Mathematica/DU team plus a consultant who had expertise in the BSC. This team was responsible for identifying models of continuous learning for the Administration for Children and Families (ACF), developing the CCF, identifying and recruiting sites, identifying and preparing Faculty Coaches, and facilitating all BSC activities.
- Collaborative Change Framework (CCF):
- The CCF is used to guide the work of the Improvement Teams, and creates a common language for BSC participants. For the Fathers and Continuous Learning in Child Welfare (FCL) project, it comprised five domains that collectively depict a child welfare agency that performs optimally to engage fathers and paternal relatives. Each domain is broken down into goals, and then into strategies (also called change concepts) that Improvement Teams can test.
- Faculty Coaches:
- Faculty Coaches are expert faculty who share their expertise with Improvement Teams and facilitate shared learning across Teams. For FCL, ACF and the Mathematica/DU team selected a group of six experts to support Improvement Teams and provide practice expertise related to the five domains of the CCF. Faculty Coaches led affinity group calls and contributed to learning sessions and the content of all-team calls. Faculty Coaches were selected to ensure that diverse perspectives and identities were represented.
- Fathers and Continuous Learning in Child Welfare (FCL):
- The FCL project is designed to test the use of the Breakthrough Series Collaborative methodology. For this project, the methodology was used to improve placement stability and permanency outcomes for children by strengthening the engagement of fathers and paternal relatives with children involved in child welfare, and to add to the evidence base on engagement strategies for fathers and paternal relatives. FCL is funded by the Office of Family Assistance and directed by the Office of Planning, Research, and Evaluation in partnership with the Children’s Bureau, all within the Administration for Children and Families in the U.S. Department of Health and Human Services.
- Improvement Team:
- Improvement Teams were groups of 7 to 14 people selected by each site to lead the BSC work at each agency. For FCL, Improvement Teams included a mix of administrators, managers, supervisors, child welfare caseworkers, community partners, and fathers and paternal relatives, although the composition of the teams varied from one site to another.
- Metrics were designed to help the Improvement Teams develop insight into their current status on indicators of father and paternal relative engagement and build their capacity to track them for their own information and documentation of improvements toward outcomes over time. Improvement Teams were given a broad framework within which to develop team-specific data and metrics. Each team approached measurement of metrics with a different array of available data.
- Model for Improvement:
- The Model for Improvement is a collection of strategies Improvement Teams use to translate the CCF into testable approaches to reinforce continuous learning. In FCL, this includes both Plan-Do-Study-Act cycles and small tests of change focused on the CCF domains. Teams designed strategies, tested them, and tracked outcomes using data.
- Shared Learning Environment:
- Shared learning is emphasized throughout the BSC, as Improvement Teams test different strategies and share successes and challenges with each other. The Shared Learning Environment is a combination of learning sessions, all-team calls, affinity group calls facilitated by Faculty Coaches, and the use of an online learning community like Microsoft SharePoint that contributed to a collaborative environment that supported and enhanced learning.
- Five sites participated in FCL, representing five state or county public child welfare agencies. There were a total of six Improvement Teams.