Supporting Attachment through Relationship-Based Visitation in Child Welfare: Results and Lessons Learned from a Randomized Clinical Trial

Background and Purpose: The Relationship-Based Visitation (“RBV”) program and its evaluation were funded by the U. S. Administration for Children and Families, Children’s Bureau, through a IV-E Waiver Demonstration Project agreement. The RBV program was designed to improve the quality of visitation between parents and their children living in out of home care, as well as to support parents to improve their parenting skills. The program used the Nurturing Parent Program curriculum (NPP; Bavolek, 2003), an identified ‘promising practice’ for enhancing parenting skills and improving the quality of parent-child relationships, provided through one-on-one parent education and coaching. Parents were paired with a parenting coach, who worked with them to develop individualized parenting plans, provided “real time” parent coaching and support during visits, and engaged in support and follow up post-reunification.

Methods: Families were eligible for services if a least one child under age 13 was placed in out of home care and remained there for at least 60 days. All new foster care entries meeting this criteria were identified and entered into a web-based client tracking system, and then screened by local child welfare branch staff to ensure that (1) families were safe for visitation; and (2) there was at least one parent available to participate in visits. Statewide, 2,027 families were randomly assigned after initial screening and either referred to the RBV program (n=1000) or to receive visitation as usual (n=1027). Implementation and outcome data were collected using a mixed-methods approach including child welfare administrative data, parent interviews and assessments, and visit observations. All randomized families were tracked for two years in administrative child welfare records; a subsample of 300 participants (n=158 program, n=142 control) completed a baseline interview; 72% received a follow up interview about 9 months later.

Results: Results from the statewide implementation and outcome study will be shared. Preliminary (one year) results suggest that RBV participants showed significantly greater improvements in several dimensions of parenting measured using the Adult Adolescent Parenting Inventory (AAPI-3), including empathy, appropriate expectations for children, self-care, and behavior management. Further, families who received more visits and remained in the program longer appeared to have greater deficits in parenting skills, but improved more over time, compared to those who participated less frequently in services. Despite these positive findings, child welfare data suggested that children in RBV families remained in foster care somewhat longer compared to controls. There were no significant differences in rates of reunification.  Final two year study results will be presented in the proposed panel.

Conclusions and Implications: Results suggest that the RBV program was associated with improvements in parenting and the quality of the parent-child relationship. However, the visitation program alone did not appear to be sufficient to increase rates of reunification or to shorten children’s time in out of home care. These results imply that even effective parenting programs may not be sufficient to change or influence key child welfare related decisions such as when to return children to parents’ care.