Keeping Families Together
The Keeping Families Together initiative in New York City was developed by the Corporation for Supportive Housing as a pilot to demonstrate the impact of permanent supportive housing for families who are experiencing homelessness and involved with the child welfare system. The initiative pairs permanent supportive housing with child welfare services with the goal of stabilizing families in crisis and improving family functioning. An evaluation of the program indicates that supportive housing can strengthen vulnerable families with highly complex needs while protecting their children.
Problem or Challenge:
Research demonstrates that families with a history of repeated or extended shelter use are at higher risk for child welfare involvement compared to other families with similar characteristics. Children from these families are more likely to be separated from their parents and entered into the child welfare system. Such children often go on to lead deeply troubled lives. They are at higher risk for impaired neurodevelopment, psychiatric problems, abuse, poverty, homelessness, incarceration, suicide, and early death.
Despite this connection, child welfare and homeless assistance programs usually remain uncoordinated. Families facing homelessness, mental illness, substance abuse, deeply entrenched poverty, and involvement with the child welfare system consume the time and energy of child protective service workers, shelter staff, mental health clinicians, and many others. For these workers, the temptation to give up and leave such families to the courts and bureaucracy is often great. Sometimes the families themselves, unable to navigate the system and meet the requirements of the various government agencies with which they are involved, give up.
Keeping Families Together is an approach to family preservation developed specifically to meet the challenges of the most vulnerable families. Through permanent supportive housing, it provides both the stability of a home and the missing link between the family and the service system.
Keeping Families Together was launched in 2007 as a pilot program of the Corporation for Supportive Housing (CSH) to provide permanent supportive housing to vulnerable families in order to enhance children’s safety and help prevent foster care placement. The program brings together permanent affordable housing with a range of supportive services, including intensive family preservation services. Between August 2007 and June 2009, 29 families were recruited for participation in the program. The pilot program has provided a platform for future expansion and a replicable model for other cities and states.
In 2012 the HHS Administration for Children and Families (ACF) partnered with four private foundations to jointly fund a $35 million initiative to address homelessness and keep families together building upon the Keeping Families Together pilot program. ACF is providing $25 million in grant funding over five years ($1 million a year to each grantee) to support programs in Florida, Tennessee, Iowa, Connecticut, and Washington, DC. The Robert Wood Johnson Foundation, Annie E. Casey Foundation, Casey Family Programs, and Edna McConnell Clark Foundation will provide a combined total of at least $10 million over five years to pay for technical assistance and a rigorous evaluation.
CSH has been working since 2011 to seed additional replications. One of these new sites is New Jersey, which has begun the process through the use of State Department of Children and Family Services funding and existing housing resources.
How Keeping Families Together came about
Keeping Families Together was launched by CSH at the urging of the Robert Wood Johnson Foundation, which had been closely tracking several high-profile child welfare cases in the news. The headlines told how children had died from abuse and neglect while living with families who had experienced many challenges, including recurring bouts of homelessness. The question was posed to CSH: Could permanent housing infused with family preservation services help families experiencing homelessness, behavioral health problems, and involvement in the child welfare system to remain together to avoid such tragedies, and ultimately to become thriving and stable families?
CSH called together several New York City agencies, experts, and several nonprofit organizations experienced with providing supportive housing to families, and collaboratively designed the Keeping Families Together intervention. Permanent supportive housing units were made available to families who were experiencing homelessness and at the highest risk of having a child removed from the home. CSH also worked to ensure that City agencies would help overcome the bureaucratic hurdles that can arise when serving highly vulnerable families who were known to multiple support systems. Robert Wood Johnson Foundation funds were used to cover the costs of an evaluation of the program, clinical consulting services, small pass-through grants to sites, and CSH’s management of the pilot’s implementation.
Target assistance to families who are most at-risk
The pilot was designed to serve families who were involved in both the New York City shelter and child welfare systems. To be eligible a family must have been homeless and have at least one open child welfare case. The head of the household must have a disabling health condition (documented substance use disorder, mental illness, and/or a physical disability).
Rather than using resources to assist the most stable families, Keeping Families Together sought out families with the most complicated cases and who were most at-risk. Sixty percent of the 105 children born to the original 29 participant families were not living with their families at the time of placement: 40 percent were living in foster care and 22 percent had been given up for adoption. The families had extremely high rates of mental health and substance use issues and most lacked informal support networks such as friends and family members on whom they could rely. Only 10 percent of household heads had worked in the three years prior to participation in the pilot.
The families live in two- and three-bedroom subsidized apartments located within larger supportive housing developments or scattered-site supportive housing programs. Seven community nonprofit organizations volunteered to place up to five families in their supportive housing projects, participate in monthly meetings, and attend Keeping Families Together trainings.
The supportive housing projects are primarily funded through New York/New York III (NY/NY III), which provides coordinated funding for the creation of supportive housing for people who are experiencing homelessness and have mental illness or other disabilities. Through NY/NY III, core support services are funded through the State of New York. Funding for capital and rent subsidies is provided by the City, HUD Shelter Plus Care, and other sources. CSH tapped into newly opening NY/NY III units for the pilot.
The managers who work on-site in supportive housing are the keystones of the Keeping Families Together model. They are advocates for the families and help them get the services they need, including treatment for mental health and substance use disorders, job training, parenting classes, and crisis management. Case managers work with parents to help them navigate the multiple bureaucratic systems in which they are involved, meet their obligations, keep their families functioning, and maintain their homes. They may convene parenting support groups on-site, provide referrals for services in the community, or intervene on a family’s behalf when a difficult situation involving a child arises. Case managers meet with each family at least twice a month to check in and monitor progress. Case managers are supported by clinical consultants who help them to implement family engagement strategies. A family’s participation in support services other than case management is not a requirement of the program and supportive housing providers cannot mandate services to any of their families.
The situations that case managers encounter are highly complex. They have to be extraordinarily patient, consistent, and often go above and beyond the call of duty to provide support. Many of the families have never lived independently before. They have never bought furniture, paid utility bills, or maintained an apartment. Lacking experience, guidance, and control, they struggle to set boundaries for their children, discipline them effectively, or monitor their academic progress and behavior at school.
Through Keeping Families Together, CSH found that the traditional supportive housing case management model works to an extent with families but does not go quite far enough to handle their multiple and changing needs. Parents whose children are being reunified from foster care need support and resources to help them learn to parent successfully and children in the household need clinical support to help them through the trauma and instability they have endured in their young lives growing up homeless or in foster care. Oftentimes parents may be referred (or mandated by the family court) for parenting skills or anger management classes or short-term mental health services. The quality of these programs can vary, and participation of families is often inconsistent and short-term.
In order to meet the mental health needs of vulnerable families, CSH ensured additional clinical training and support for the case management staff. CSH retained a clinical consultant team from the Mount Sinai School of Medicine to help providers strengthen their ability to engage and serve families in their projects through the delivery of evidence-based practices. The team provided a series of trainings on evidence-based engagement practices, multiple family groups, and family-focused interventions. After each training, a consultant went to each site to work directly with case management staff to help implement concepts introduced in the trainings. The curriculum was developed with very low-income, urban families and was designed to be implemented by lay people or staff who are not clinically trained.
Keeping Families Together was designed to determine whether supportive housing with child welfare preventive services can prevent family separation and child removal, increase housing stability, and improve the functioning of very vulnerable, high-risk families. To answer this question, CSH and Metis Associates, a national consulting firm, evaluated the program by tracking the outcomes of the 29 families served by the program between October 2007 and July 2009. The study found that child welfare involvement among the families declined significantly during the pilot and most families had no new abuse or neglect cases after moving to supportive housing. Six children were reunited with their families from foster care and were still with them when the pilot ended. Average school attendance improved steadily among the school-aged children. More than half (61 percent) of child welfare cases that were open at the time of move-in were favorably resolved during the families’ involvement with Keeping Families Together.
Twenty-six of the 29 families participating in the pilot remained in supportive housing and living together at the pilot’s end (May 31, 2010). By comparison, 15 control group families that met Keeping Families Together eligibility but were not placed in supportive housing typically remained in homeless shelters, with cumulative stays that averaged more than 15 months during the study period.
Based on the study, a CSH analysis examined the costs associated with the families’ use of foster care services and homeless shelters in the two years prior to and the two years following families’ placement into Keeping Families Together. The changes in public costs associated with the reduced use of these two service systems were then compared with the cost of supportive housing. They found that Keeping Families Together reduced participants’ actual and potential use of foster care services by a total of 5,415 days over two years, and their shelter use by 13,703 days over two years. These foster care and shelter reductions alone offset 97 percent of the cost of supportive housing for a net cost of the supportive housing of just three dollars per day.
The program evaluation offered several recommendations based on the evaluation findings, including these:
Training of supportive housing case managers and other provider staff on effective strategies to engage and build trusting relationships with the families is critical. Also consider adding the services of a consultant who can train case managers in addiction services and motivational interviewing strategies, as many vulnerable families struggle with substance use disorder.
Coordinate with the child welfare system to ensure close coordination and communication between child welfare workers and supportive housing staff and the participation by both in case conferences involving the family.
The CSH website provides information about Keeping Families Together, including this includes links to an overview, pilot evaluation report and cost analysis.
There is also a video describing Keeping Families Together and its impact
Evidence-Based Practice: Permanent Supportive Housing
Evidence-Based Practice: Motivational Interviewing