Introduction

The first of the National Education Goals, "by the year 2000, all children in America will start school ready to learn," reflects the importance of early experience in the long-range development and success of children. Yet as we approach the year 2000, the American family with young children functions in a pressure cooker. These families are routinely juggling the demands of home and workplace, and burdened by financial worry. Most parents with young children experience conflict and confusion about their roles at home and at work, and feelings of guilt about neglecting children. These issues are exacerbated by the erosion of traditional family supports, divorce, and a lack of reliable and affordable child care. Although all families need support, some families are in desperate need of support. Substance abuse and violence in many communities have reached a crisis level. High risk pregnancies have increased dramatically, and more families with young children than ever before are living in poverty.

Many communities are dealing with the overwhelming issues of high unemployment, drug use, violence, racial prejudice, and family disintegration. Yet gaps in service, inadequate funding, lack of coordination among service providers, insufficient training, and crisis management seriously impede the development and implementation of critically needed services. These communities need information about appropriate intervention strategies and guidance on how to develop a collaborative family, education, and social service structure.

For the past five years Far West Laboratory (now known as WestEd), through its Bay Area Early Intervention Program, has worked with local community agencies in Oakland, San Francisco, and Marin City, California, to develop a two pronged community intervention model. This model, Augmented Family Support Systems, is now being implemented in the low-income, mostly African-American community of Marin City, California. Starting in January of 1993 Marin City Families First (hereafter referred to as MCFF) came into existence with joint funding from the Office of Educational Research and Improvement, and the Stuart Foundations. The program's goal is to develop comprehensive, community-based services for low-income children and their families starting during pregnancy and continuing until program children reach age eight.

MCFF is a research and development effort working with families, community agencies, and schools. Three documents have been created that explain the approach: Augmented Family Support Systems: A Description of An Early Intervention Model for Family Support Services In Low Income Communities, October 20, 1990; FAMILIES FIRST: An Early Intervention Program for Coordinated Family Support Services for Marin City Families, November 30, 1991; and Comprehensive Family Service Systems : A Handbook for Planning and Practice, November 30, 1992.

The following program assumptions were made based on a previous literature review and our early intervention experience:

1. An early intervention program should be designed not as an inoculation but as a first step in a continuing and comprehensive system of supports.
2. Early intervention efforts should take place with and through already existing agencies in the community served rather than stand alone; and in addition to individuals and families, service systems should be the focus of the intervention.
3. Partnerships with schools that will eventually serve program children should be established well before children reach the school door.
4. To maximize educational and social benefits, intervention should be started early with particular attention paid to the development of the fetus in a drug free and healthy womb and to the quality of child care services provided.
5. Effective early intervention calls for establishing a personal relationship between a member(s) of the early enrichment team and the families served, particularly the principal caregivers of the program children. A case manager, home-based service system is well suited for ensuring the establishment of a personal relationship.
6. A non-judgmental analysis of family strengths and practical needs (i.e., nutrition, child care, housing, finances) should form the basis of individualized intervention strategies for families. This intervention must include needed therapeutic services.
7. High quality child care services must be made available to families served.
8. Special attention has to be paid to "life cycle transitions" the family goes through as a child matures.

In this Handbook we describe the following components of the MCFF model:

1. Two Pronged Intervention Plan - Both families, and community agencies need to be the focus of the intervention.

   Young children and their families are dramatically affected by conditions and events that take place not only within the home but also within the broader contexts in which family life is embedded. Individual change must be accompanied by contextual change if the changes are to be more than temporary. This means that if an intervention approach focuses on only the home or on only the larger context in which the home is situated, the intervention will be incomplete.

   To address this possible intervention shortcoming, a two-pronged intervention strategy has been designed as illustrated in Figure 1. The model provides for direct intervention with families, support to those providers who provide the intervention and direct intervention with agencies.

   The first prong, The Augmented Family Advocacy System

   is designed to deal directly with program families, using a case management system to identify and meet individual child and family needs. This aspect of the intervention attends to the particular needs of the family: parent/child relations, other family relations, and to family relationships with the various informal neighborhood and community networks and service agencies they need to deal with to function effectively.

   A second prong, the Community Services Support System

   deals directly with those informal networks and service agencies. It is designed to develop long-term changes in the quality of family life in communities served. Agencies that serve program families are brought into collaborative working agreements with MCFF and participate in the design and implementation of a long-term service strategy for program families. Informal neighborhood and community networks are identified, enlisted, and facilitated in their support of program families. The Community Services Support System focuses on upgrading and expanding services as well as establishing and maintaining collaborative relationships among informal networks and service agencies.

   Our strategy for work in the area of family transitions can be used as an example of this two- pronged approach. It is clear that benefits gained by children and families often get lost as a child and family make a transition from one social or community system to another. When a child moves from care in their home to care in an infant center, to Head Start, and to school, the rules of appropriate action change, as do the rules for the adult family members as they relate to these and all the other social and community systems they must deal with as the child grows. The larger context influences the quality of this social experience and contributes to positive or negative experiences. For minority children, it may mean encountering children from other cultural groups for the first time or it may mean becoming more socially competent in a culturally homogeneous context. Either one of these conditions is going to require different adaptations on the part of the children. To influence adaptations in a particular cultural group, it is necessary to influence both the developmental aspect of the transition and the context for the transition. Thus, in this intervention model both individual/familial and system issues are addressed. Direct assistance is provided to the program families through case managed family advocates. At the same time direct assistance is provided to the social and community systems to help them adapt their policies and practices to deal with issues such as "developmental transitions" through the development of a special consultant pool. This is but one of many areas that could be cited as an example of simultaneous intervention into family systems, and social and community systems.

2. Individual Family Plans - Each family must participate in developing their own programmatic goals.

   Each family participates in developing a plan which outlines in a direct manner specific areas of concern which will be covered on the home visits and in other activities. Services that the family needs are outlined in this plan and serve as a guide for the families and the family advocate as to their activities. The plan also provides a concrete way in which the family can take credit for accomplishments such as successful entry into a job training program, weaning of a child, or location of a better housing situation. These plans are developed jointly by family members and the family advocate. The development of these plans and strategies for implementation are discussed at case conferences with the clinical coordinator, intervention program staff and members of the Program Facilitation Group.

3. Program Facilitation - Effective early intervention cannot be done in isolation.

   There needs to be supportive links to advice and assistance for Family Advocates and Case Managers. For that reason a Program Facilitation Group is seen as an essential component of the work. The Program Facilitation Group supports the project's intervention. Five professionals are selected each year to assist the MCFF effort. They receive a special orientation and are asked to make a 5% time commitment to the program. This group provides overall support to the family advocate, consults with coordinating agencies and provides some direct service to families. Each group member has as a primary responsibility the delivery of advice and programmatic expertise to the family advocate as well as to participating agencies. Each group member is knowledgeable and able to work with all staff in relation to the overall goals of the program as well as to be able to specialize in a particular area. The role involves regular contact with the family advocate and participation in training, linkage and coordination with community agencies.

   Each group member has a particular specialty as well as professional networks and connections to others working in their field. Areas of expertise that are included are: infant/toddler development and mental health, family development and education, community resources, career development/job training, substance abuse, medical and health service delivery, child care programming, community education, and home-based programming. Each year different members of the team are selected who best meet the needs of the program families and the family advocate.

4. Quality Child Care - Child Care must be made available to families in need.

   Based on the study of previous successful early intervention programs it has been concluded that quality child care must be a central part of any early intervention activity. Without the availability of child care many of the parent related services, for example, job training, and drug treatment, cannot be carried out successfully without putting the child in jeopardy. As a primary component of MCFF child care services for program families will be developed using already existing infant and preschool programs housed in Marin City and a Family Day Care Network that are being developed in the first year. The intention of the program is to make child care services available to all MCFF families throughout infancy, toddlerhood and preschool years. It is anticipated that this service, though not mandatory, will be a most attractive program service.

   The goal of the child care service component is to:

   1. provide quality child care with a consistent program philosophy throughout the first five years of life.
   2. allow adult family members to participate in job training, and remedial skills development, and to focus on other personal needs
   3. provide a setting for observation of children and the role modeling of appropriate interactions to give parents broader perspectives of their child(ren)
   4. provide natural support networks with other parents
   5. develop appropriate activities and supportive relationships provided by child care staff
      
      

5. Responsive Facilitation Process - Change must come about with and through the efforts of the families being served and grow from community needs and effort.

   For the past twenty years Far West Laboratory has been involved in assisting local communities plan and develop social and educational programs to better serve young children. Over the years a philosophy of assistance has been delineated which we have come to call the Responsive Facilitation Process. At the heart of our approach is the recognition of the need for children and families to experience a continuity of care across educational and social service settings and domains. There are two overarching goals of the Responsive Facilitation Process. The first is to get service providers to accurately understand the needs of families. This is done by assisting and enabling administrators, teachers, service providers, and caregivers to see the day to day life experience of community families and children from the point of view of the children and families. The second goal is to assist and enable these different groups to develop program plans based on this new "family vision," plans that address actual short term needs and plans that provide, in the long term, for the alteration, orchestration, and continuity of currently provided services.

   Three basic tenets of the Far West Laboratory facilitation philosophy are:

   1. Local norms, names, customs, and traditions should not only be respected but capitalized on to make the program meaningful for the community. The role of the facilitator using the Responsive model is to customize, adapt, and link intervention strategies.
   2. Local programs, community action groups, and other key actors should be enlisted in support of the program from its inception.
   3. Decision-makers are those who make decisions and act on them. They are found at ll levels of a community system. Therefore, it is important to enlist participation of all participants in a community - administrators, teachers, parents, and other key community members.

   Ten specific principles guide FWL facilitation efforts with local communities.

   1. Introduce new ideas. The facilitator provides information from other communities and programs that have been successful in providing services to families and children or show promise in doing so.
   2. Assist with the development of priorities. The facilitator helps the community define priorities and participates in the periodic assessment and reshaping of priorities.
   3. Provide options. The facilitator offers suggestions from which the community members (educators, other service providers, and parents) may choose.
   4. Provide training and technical assistance. The facilitators provides technical support that is requested by the community.
   5. Stimulate dialogue. The facilitator creates a non-threatening environment that allows for dialogue among the various actors on site.
   6. Be flexible. The facilitator takes a flexible approach to change while maintaining a consistent facilitation philosophy and being sensitive to the strengths and characteristics of the local community.
   7. Keep low visibility. The facilitator shares ownership for ideas and encourages key groups to assume leadership in creating the program.
   8. Provide insight about the big picture. The facilitator should be able to take a stance outside the day to day activities for the purpose of analyzing the community's efforts to attain long range goals and helping the community identify potential barriers.
   9. Give moral support. The facilitator affirms community members' efforts so they can carry out their work with the confidence that they are moving in the right direction.
   10. Share research and evaluation findings and strategies from similar efforts. The facilitator identifies models and strategies that will assist the community in its documentation of a) program implementation, and b) program outcomes.
   
   
   

6. Clinical Coordinator

   The Clinical Coordinator is designated as the primary resource person to the family advocate/s. The assignment involves periodic contact with clients of MCFF. It also includes the conduct and supervision of inservice training for the Family Advocate. A key responsibility is the linkage of MCFF work with the work of other agencies and institutions serving Marin City. In selecting the Clinical Coordinator, we thought it was important to identify someone who had a good grasp of clinical as well as social service expertise. The ideal candidate would be familiar with, and sensitive to the community served. The candidate should have a good grasp of the function of case management in a community with a large number of depressed residents and service providers. In addition, a male was sought to assist with the males (father, grandfathers, significant others, children) in the program families. It was also almost mandatory to have a Clinical Coordinator who was African American or at least familiar with the African American culture since the majority of the program participants would be African American. Also helpful was to have a Clinical Coordinator who was familiar with internal and external community resources, the politics of the county, and local funding sources. The Clinical Coordinator's responsibilities:

   Case Management

   1. Conduct initial assessment of children and each family member in the home with the Family Advocate and develop with Family Advocate an initial intervention strategy.
   2. Assignment of families to specific Family Advocate.
   3. Conduct weekly reviews of all case records and contacts.
   4. Develop with Family Advocate and family members, the Individual Family Service Plan.
   5. Weekly meetings with each family advocate in which assigned cases are reviewed and specific intervention steps are planned. A family assessment, and individual service plans will be used as guide in this process. Crisis management techniques and strategy development for presenting problems will take place.
   6. The maintenance of contact with other social service and educational agencies that are involved with the family directly or through the Family Advocate.
   7. Periodic update of individual service plans and assessment data.

   Inservice Supervision & Training

   1. Provide ongoing support to Family Advocate
   2. Organize and facilitate weekly inservice meeting for Family Advocate
   3. Assist Family Advocate in developing monthly Community Case Conference
   4. Develop inservice training content pertinent to the needs of the families, family advocates and collaborating agencies.
   5. Coordinate the work of the Program Facilitation team.

   Agency Linkage

   1. Assist in identifying and building relationships with community agencies and other resources.
   2. Facilitate community case conferences for a specific family who is involved with multiple agencies for the purpose of coordination of services. These conferences will also have as a secondary purpose the building of linkages and effective working relationships with participating agencies. These community case conferences will be seen by the Clinical Coordinator as useful in providing indirect training in supportive family and child development work in each community.




7. The Family Advocate

   After an initial assessment of the families, conducted with the Clinical Coordinator, the Family Advocate meets with families to case manage each families plan. She also assists the Clinical Coordinator to present cases to the community service agencies. The Family Advocate delivers parenting and child development information and has a specific and direct role as a broker of available family services. He/she identifies family needs and the agencies that might best provide services to meet these needs. The Family Advocate also assists families by encouraging successful approaches to obtain needed services. The Family Advocate is the key staff member in MCFF; this home visitor has a multifaceted role. During the home visits, and in other contacts, the Family Advocate assess and clarifies family needs in response to observations, parent sharing, behavioral cues and specific situations that arise. These areas are noted and the content of future visits is adjusted accordingly. Content changes are discussed with the Clinical Coordinator during their weekly case analysis meetings.

   The Family Advocates extended role consists of:

   1. Delivering parenting and child development information
   2. Helping families assess needs and providing linkage with other services
   3. Assist in identifying and building relationships with community service agencies
   4. Coordinate the work of community service agencies for the program families
   5. Design approaches and strategies for agency collaborations
   6. Work with members of the Project Facilitation Group to meet family needs
   7. Receive supervision from OGAD and FWL training and evaluation team
   8. Meet weekly with Clinical Coordinator for case conference on each case, assist in data management & participate in inservice training.
   9. Meet weekly with FF management team
   10. Participate in OGAD based weekly treatment team clinical meetings.
   11. Develop knowledge of all collaborating social service agencies staff, goals and policies.
   12. Collect information about the effective functioning of agencies in the community.
   13. Make home visits at least once per week per family for at least an hours duration.

   Her specific home visit tasks are to:

   1. Develop rapport
   2. Develop family plan, using topic areas presented in training.
   3. Collect family data.
   4. Help families identify needs, questions and concerns
   5. Conduct family interview.
   6. Assess needs of child and family which may or may not be congruent with the families own concerns
   7. Link families with obviously needed social services.
   8. Link families with child care.
   9. Share parenting and child development information.
   10. Process data collected.
   11. Work with members of the Program Facilitation Group to meet individual family needs family needs

   It is expected that the Clinical Coordinator will have skills in Clinical Case Management; have well developed time management skills and experience in handling a variety of roles; be knowledgeable about intervention programs, staff dynamics, and child and family development; have had experience supervising and training social service staff; and have worked collaboratively with a variety of agencies.

   Each week the Clinical Coordinator is to meet with the Family Advocate/s to discuss progress, analyze actions and develop intervention strategy. These supervisory meetings will also be used as the vehicle for deciding which collaborating agencies and members of the Program Facilitation Group should be linked for the purpose of serving individual families.

Back to Top