Achieving Timely Reunification through Interprofessional Collaboration: A Mixed Methods Study

Background: The child welfare system strives to reunify foster children in a timely manner (i.e., within 12 months). Various professionals play a role in achieving timely reunification, including caseworkers, guardians ad litem (GALs), and treatment providers (e.g., mental health therapists and substance abuse counselors). This mixed methods study explored how communication and joint decision-making—two key components of interprofessional collaboration—between these professionals affects the likelihood of a foster child being reunified in a timely manner. The research question for the quantitative phase was is communication and joint decision-making between caseworkers and GALs or treatment providers associated with timely reunification? The research question for the qualitative phase was why does communication and joint decision-making between these professionals affect timely reunification?

Methods: The quantitative phase involved analysis of administrative data from an urban county in a mountain region state. The sample consisted of children placed in foster or kinship care (N = 271). Children were 6.72 years old on average (SD = 4.91), 52.2% were male, and 43.9% were white/non-latinx (26.2% were African American and 28.4% were latinx). More than half were placed in foster care (58.5%) and almost two-thirds were removed from a family with a high risk for maltreatment (62.2%).

A multilevel logistic regression was conducted to test if the frequency of communication and joint decision-making between the professionals of interest was related to the likelihood of a child being reunified within 12 months (0 = No, 1 = Yes). Communication was measured as the average number of contacts per month between the caseworker and GAL, and the caseworker and treatment providers. Joint decision-making was measured as the percent of team decision-making meetings attended by GALs and treatment providers.

In the qualitative phase, semi-structured interviews were held with a sample of caseworkers, GALs, and treatment providers (N = 21) working in the county examined in the quantitative phase. Interviews were audio recorded, and the transcripts were coded in dedoose by two researchers using consensus coding. The constant comparative method was used to identify themes that reflected the process by which communication and joint decision-making affect timely reunification.  

Results: Children were more likely to achieve timely reunification when the caseworker and GAL communicated more frequently (OR = 3.56, p = .016). Caseworker communication with treatment providers and joint decision-making with GALS or treatment providers was not linked to timely reunification. The qualitative findings indicate communication facilitates timely reunification by ensuring that the family’s needs are addressed, improving case monitoring, and keeping professionals are on the same page. They also suggest communication between caseworkers and treatment providers may be more directly related to treatment outcomes than child welfare case outcomes (e.g., timely reunification).

Implications: The results indicate communication between caseworkers and GALs promotes timely reunification by improving the quality of case services. Caseworkers and GALs should therefore make a concerted effort to communicate regularly. Administrators should address factors that inhibit caseworker-GAL communication and implement strategies that facilitate it. Further research with a larger, more geographically diverse sample is needed.