Therapist Evaluation

A previous post focused on the qualifications of an IFPS therapist. Now it’s time for the annual evaluation of the therapist!

What is a fair and accurate measure of a therapist’s performance? If the IFPS agency has clear program standards and performance measures, then the therapist’s evaluation flows naturally from that.

Let’s look at an example of how standards produce performance measures that, in turn, produce an evaluation measure of a therapist. The Homebuilders® model of IFPS has the following standards and performance measures for therapist availability:

Standard	Performance Measure
Immediate Availability: Therapists meet with families within 24 hours of referral.	• 75% of families receive their first face-to-face visit within 24 hours of referral from DCFS; 85% of families receive their first face-to-face visit no later than the end of the day after the referral.
Twenty-Four Hour Availability: Therapists, supervisors and other team members are available and accessible to families 24 hours a day, seven days a week.	• Provider agency policies specifically allow a flexible work schedule, with work hours varying from week to week based on the needs of families.• 100% of clients have information about 24-hour availability and how to access therapist.• On the Homebuilders Client Feedback Survey, 95% of family members answer “Yes” to the question: “Was your therapist available and responsive to you?”

Now see how the therapist evaluation form addresses the availability standard and performance measure:

Notice that both the therapist and supervisor rate each measure. That allows the therapist to have input in the evaluation, compare the self-assessment with the supervisors’ assessment, and set goals for improving performance.

There are 15 performance measures in the Homebuilders evaluation form for therapists. You can view the complete form below, courtesy of the Institute for Family Development.

Homebuilders® Therapist Evaluation Form (PDF, 168 Kb)

Do you have a form for evaluation of the IFPS therapist? Please share a link to it in the comments below or e-mail it to Priscilla Martens at director@nfpn.org.

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Posted by Priscilla Martens, NFPN Executive Director

Building an Effective IFPS Program

Perhaps your agency is one of many that is on a July 1 to June 30 fiscal year. With the new fiscal year at hand, your agency may also be considering new programs.

How do you start from scratch to build an effective program?

Let’s look at how one state created an effective Intensive Family Preservation Services (IFPS) program.

Legislation

The legislative assembly of North Carolina enacted the Family Preservation Act in 1991. The legislation is only a few pages long but it sets forth the essential components of an effective IFPS model:

child is at imminent risk of placement,
families receive services for an average of four and maximum of six weeks,
family preservation workers are available by phone and for visits 24/7, and
the maximum caseload at one time is four families.

View the legislation here: http://bit.ly/10ARUBm

Request for Application/Proposal

With IFPS now firmly established in statute, the next step was to further define the program. A good source of information for establishing a program is the Request for Proposal (RFP) or Request for Application (RFA) issued by a government entity to solicit providers for a specific service.

The North Carolina Division of Social Services issued the most recent solicitation for IFPS in January of this year. We learn from this document that the state is awarding $3 million to be allocated among 11 regions of the state. The three-year contract will provide reimbursement to providers of $6,000 per family who completes services. We also learn that a master’s degree in social work is preferred for IFPS direct services workers and supervisors, and that they are required to take an initial six days of training. The bulk of the RFA describes the services that must be delivered and the expected outcomes.

View the RFA here: http://bit.ly/12XVxTu

Following submission of applications, a review committee scores each one. If there is more than a 10-point difference among reviewers, the application is pulled for further discussion and re-scored. Contracts are awarded for each region based on the highest-ranking application. Because awards are determined in this way, there is no guarantee that winning a contract in one RFA cycle will result in winning a contract in the next RFA cycle.

Tracking Results

How does North Carolina determine if the IFPS services are effective? One method is through a quarterly tracking report. Simple, yet informative, the report collects basic information on the:

number of families served,
number of families ineligible for services or opening not available,
ages of children, and
outcomes:
- percentage of families remaining together,
- improved family functioning, and
- family satisfaction with services.

At any point in time, the report provides a quick snapshot of IFPS.

Here is the most recent annual summary of their quarterly reports:

(Download the annual summary in PDF format: http://bit.ly/11B6sMA )

Special thanks to Michelle Reines, Program Consultant for Child Welfare Services, for providing information about North Carolina IFPS.

Other Resources

Here are some other resources for building and maintaining an effective IFPS program:

IFPS ToolKit

Institute for Family Development — Homebuilders® Model

National Family Preservation Network (NFPN) — Information, Training/Technical Assistance
E-mail: director@nfpn.org

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Posted by Priscilla Martens, NFPN Executive Director

Therapist Qualifications

The last post presented findings from a nationwide survey on the core elements of exemplary IFPS programs, specifically regarding therapists. This week we take a closer in-depth look at the qualifications of therapists. Let’s start with the job description.

Job Description

Two IFPS programs, one in Tennessee (new program) and one in Washington State (longest-running program in the nation), provided job descriptions for therapists. The basic job responsibilities for both programs are very similar and also reflect the core elements of exemplary IFPS programs:

Worker meets with the family within 24 hours
24/7 availability of the worker
Worker availability on evenings/weekends
Low caseload (2–4 families), brief length of service (4–6 weeks)
High number of face-to-face hours spent with families (32–40+ hours)

You can view/download the complete job descriptions below:

How do you know if someone is not a good fit for the job?

The Tennessee program lists the following red flags:

Inability to work with diverse families
Inability to connect in an interview
Highly structured world view without the ability to consider others beliefs and opinions
High desire for office-based work
Strong desire to do “only therapy” (some therapists do not enjoy the case management and hands-on aspects required by IFPS)
Inability to take constructive feedback
Judgmental attitude toward people with DCS involvement/substance abuse/poverty
Lack of adequate transportation, inability to go to a crisis “on a moment’s notice”

Interview Process

And that brings us to the interview process. The following is a list of questions that the Tennessee programs uses in the first interview:

Review résumé, ask about experience areas
Ask behaviorally specific questions, such as, “Talk about a time when you had several projects to complete. What was the situation? How did you get all those things done? And what lessons did you learn?”
Give positive feedback in interviews as this sets people at ease and we tend to get a more realistic view of who they are.
Another question: Talk about a time when you had a conflict with a supervisor. What was it and how did you handle it? What was the resolution?
Question: What is your theoretical orientation? What attracts you to that ideology? (Ask enough questions to see if the applicant knows what they are talking about.)
Question: What are your beliefs about families?
Question: How will you feel working with a diverse population of families? Some might have a religion very different than yours, might have same-gender parents, might be mixed-race couples, might have many animals, etc. Talk about your feelings on diverse families.
Question: What kinds of families or clients might be hard for you to work with?
Question: Talk about your beliefs about people and parents who abuse substances. How might you address a relapse or someone you work with?

In the second interview, the Tennessee program does a role-playing and writing exercise with candidates. You can view/download the role-play details below:

Tennessee Role-Play Details (PDF, 50 Kb)

So, how does your agency job description and interview process compare to those provided in this post?

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Special thanks to Cindy Cothran, Clinical Supervisor and Project Director of TIES, and to Charlotte Booth, Executive Director of Institute for Family Development, for contributing material for this post.

Posted by Priscilla Martens, NFPN Executive Director

What IFPS programs produce the most effective workers?

The IFPS Coast-to-Coast Blog has been examining strategies for attracting and retaining IFPS therapists. This post looks at the IFPS therapist from the perspective of the most effective IFPS programs nationwide.

A 2011 survey, conducted by the National Family Preservation Network, found 14 states with exemplary IFPS programs. Exemplary programs have written program standards, monitor compliance, and conduct program evaluation. The majority (65%) of IFPS programs use a specific clinical model and provide follow-up services (66%). In these programs an average of 91% of families remain intact at case closure.

Many of the findings in these exemplary programs relate specifically to IFPS therapists:

Most of the services are provided by one worker with team back-up
Worker has ongoing supervision that includes case consultation
Worker receives mandatory training
Key components of intensity are adhered to:
- worker meets with the family within 24 hours
- 24/7 availability of the worker
- worker availability on evenings/weekends
- low caseload (2–4 families), brief length of service (4–6 weeks)
- high number of face-to-face hours spent with families (average of 47 hours per IFPS intervention)

State by state details – click here to view (PDF, 98 Kb)

The chart also raises additional questions . . . here are some that can be answered by you!

What does a typical weekly schedule look like for an IFPS worker?
How do you maintain availability while balancing work and home life?

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Posted by Priscilla Martens, NFPN Executive Director

10 Things Supervisors Can Teach IFPS Workers to Avoid Burnout

What is burnout? It’s a state of mental, physical and emotional exhaustion that seems overwhelming and insurmountable. It decreases productivity, saps energy and reduces motivation. Workers who burn out leave the job. We’ve explored the high costs of worker turnover in a previous post and recognize the value of retaining workers.

So what can supervisors do to help their workers avoid burnout? They can teach workers to build resiliency. How? By being proactive and working together to prevent rather than trying to address burnout when it’s too late

Here are 10 strategies that supervisors can teach workers and help them implement:

1. Set reasonable expectations

Goals and plans for each intervention vary widely. Be a resource for workers for case planning. Do the goals reflect the highest priorities for the family situation? Can they be achieved in the time available? Does the worker have the resources needed to help the family achieve these goals?

2. Make a plan

Each person has their own way of dealing with long hours, hard work and stress. Talk with workers about what works for them. Make a plan with the worker for self-care that is individualized and specific. What does the worker do to restore their energy? What activities can they incorporate into their day that makes things easier? What support do they want and need? Talking about it in advance and scheduling time and activities into the worker’s routine will avoid the slow leak of energy that leads to burnout.

3. Don’t do it alone

Ensure that your workers know that they are part of a team. Encourage them to use team members for creative intervention ideas, support in hard situations and back-up. Remind them this is a team effort. Encourage them to use you as a resource as often as they need.

4. Check in often

It isn’t enough to tell the worker to call if they want. Set times that you want them to check in with you. It will vary based on the dynamics of the cases they have. Make it part of the routine, not just something for emergencies.

5. Ask for help

Set the expectation that asking for help is a good thing, not an indication that the worker can’t handle things alone.

6. Healthy thinking

Fatigue and stress can lead to “ain’t it awful” thinking and complaining. Workers need an opportunity to vent and need you to be there to listen and help them reframe. It may also be helpful to strategize with workers ways to make productive changes in their thinking and their actions that will help them feel better and less stressed.

7. Change gears

Encourage workers to take down time. Doing something completely different from their work routine can give them the physical, emotional and mental break they need to restore their energy. A 20 minute nap in the car, reading a novel during lunch, taking a walk in a local park, doing 5 minutes of yoga stretches, watching a funny YouTube video can restore energy and give fresh perspective. Workers may need support in taking time for themselves during the day.

8. Take a break

Vacation is a key element in staying emotionally, mentally and physically strong. It’s important to get away whether it’s a trip, a long weekend at home, or doing something fun with friends and family. Remind workers that taking time to restore is part of the job too.

9. Catch things early

Make sure workers know their personal early warning signs of stress and fatigue. Talk to workers in advance about the indicators that let them know it’s time to ask for help, take a break or just let you know how they are feeling.

10. Celebrate success

IFPS workers make a difference in the lives of families and contribute to strong communities. Find ways to acknowledge and celebrate accomplishments—both big and small. Remind workers to pat themselves on the back for their successes.
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Posted by Peg Marckworth

IFPS Supervisors’ Expectations from Workers

In IFPS, supervisors go above and beyond the call of duty to ensure that their workers are supported and receive adequate training to perform their duties. Supervisors want the best for their workers and care about the efficiency of the work that is delegated to the workers. They strive to empower their workers by allowing considerable responsibilities and trusting them to use critical thinking in which to carry them out.

The job of a supervisor can be very challenging when workers do not meet supervisors’ expectations when carrying out their duties. Understanding what the best workers bring to the job can increase their success. There are many things that supervisors look for in their workers. Consider the following chart:

So what are you supervisors around the nation looking for in your workers?

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Posted by Moneefah D. Jackson

To Engage or Not to Engage?

That, of course, is a rhetorical question. Nevertheless, for many professionals, the skillful process of engaging families can be a great challenge. Why do so many professionals seem to struggle with engagement? Well, the reasons can be as diverse as the professionals who enter this work and the families who receive services. In IFPS, there are several reasons that make it a challenge.

The intervention is short-term. IFPS counselors may feel pressured to get the intervention process started without really getting to know the family.

Families may be reluctant to receive services, so they say “yes” to the intervention and then become actively unavailable in one way or another. There are families who do not wish to connect with their counselors or perhaps they may be facing some unknown problem of which the counselor is not aware that cause a disconnect.

The assumption the work needs to “get going”. For many, this work would be much easier if counselors could just jump right into conducting an intervention without having to concentrate on how to effectively engage families.

But, the challenging road of engagement cannot be avoided. So this opens the door to some questions.

1) What does it really mean to engage families?

2) How do we engage families?

3) Why do we need to focus so much of our time in building a good rapport with clients?

The process of engaging families is not about just doing a job to get it done or making families feel good. The concept of engaging families has been around since the grassroots of social work. It came about as a way of building rapport with clients so that professionals will grasp a better understanding of how to work with clients on expressing themselves about the challenges they may face in their lives.

The process of engaging families requires competency, respect, creativity, insight, empathy, patience, humor, genuineness and the ability to connect with families so that one can have a better understanding of the crisis that families face. The Social Work Dictionary (5th Edition) states the following about engagement: “Rapport is the state of harmony, compatibility, and empathy that permits mutual understanding and a working relationship between the client and the social worker.” So then, the process of engaging families is about spending time to get to know the family and allowing them to know you as their partner in the process of change.

When we build a good relationship with families, the intervention process can move smoothly and the family will be able to succeed throughout the intervention. We need to spend time on building a good rapport with clients. We cannot help if we do not take the time to know. Engaging families can lead to effective goal development and adherence to the treatment plan. Then families will be able to benefit more from the services and become happy about the outcome of the intervention.

Building good rapport with families, and outlining the benefits of change, can lead to a full intervention with a successful outcome rating. To engage families, we as counselors, need to be warm (i.e., showing interest, understanding clients’ crisis, acceptance) when interacting with the different families we serve. When family members are engaged, counselors do not have to be too concerned about ongoing conflict throughout the intervention regarding the families’ compliance. Having a positive relationship will decrease the possibility of an interrupted intervention or perhaps a case being turned back.

It has been said that you can reach the heart of a person through their stomach; so why not bring an engaging snack to the family, like coffee, juice, donuts. Allow time for the family to talk about what interests them, highlight their strengths, and let them know that you look forward to working with and helping them. When that happens, families will be able to be empowered to make changes.

So what is your idea about the process of engaging families? Please feel free to share your thoughts and ideas.

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Posted by Moneefah D. Jackson

Contributing Factors to Therapist Turnover

Getting to the heart of why in-home services therapists leave their job is difficult. To better understand what motivates therapists to stay or leave, we conduct exit surveys for employees who quit as well as an annual survey of current employees.

While we find that staff leave for a wide variety of reasons, themes that arise in these surveys tend to suggest that therapists would like

higher compensation,
more training, and
more supervision time.

We also believe that a key factor in preventing turnover is understanding the millennial workforce. The book Keeping the Millennials gave us some good ideas of how to make us an appealing place to work for this generation. It suggests that having a “cool workplace” is important.

The millennial generation likes to

feel connected,
have access to technology,
have a flexible workplace and schedule, and
feel like they are making a contribution to the agency and community.

The book also suggests that it is important to “identify the keepers.” This means that we should identify those who we want to have stay, and be sure to let them know they are important and needed. They suggest giving these individuals special projects to allow them to feel like they are contributing or perhaps “groom them” to take over when current leaders retire.

What We Have Done

We have begun taking steps to address the factors we believe are contributing to our high rates of turnover.

The Board of Trustees has increased the therapist salary matrix two years in a row to be more competitive with similar agencies.
As stated above, the agency administers employee surveys annually, as well as exit surveys for employees who leave the agency, in an effort to better understand what would make us a more attractive employer.
We recently launched a social networking site responding to employees’ desire for more opportunities to get to know each other.
We also have strict hiring procedures to try to hire therapists that best fit the organization’s value system and mission.
We seek and use staff input in management decisions.
We offer supervision toward licensure to encourage therapists to stay longer.
Our agency maintains a 5 to 1 supervisor to therapist supervision ratio to support therapists.

We have tried to implement ideas from the literature on millennials.

When we identify staff members we believe have strong leadership potential, we send them to our supervisor training and have them fill in when the actual supervisor is on vacation or otherwise unavailable.
We are also trying to give therapists opportunities to contribute to our agency beyond their regular responsibilities.
We also try to celebrate employment anniversaries in a way that creates a culture of wanting to stay at the agency for a long time.

It is too soon to tell if our efforts have improved therapist turnover, but we are hopeful that as we continue to strive for a fun and fulfilling work environment, our staff members will want to stay for years to come.

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Don Fryberger Headshot Posted by Don Fryberger
Therapist/Administrative Associate
Institute for Family Development

IFPS Retention and Compensation Survey Results

The National Family Preservation Network (NFPN) recently assisted with the development of the Retention and Compensation Survey and analysis of results. The following is a summary of the 27 responses that were received.

Click here to download the survey summary (PDF file, 86 KB).

In addition to the summary of responses, NFPN conducted further analysis on three issues that required comparison across responses. Here is the summary:

Do agencies with above average compensation have higher retention rates?
YES. There was a significantly higher number of respondents reporting higher than average compensation who also reported retention rates of 50% or above for the past three years (13) in comparison to respondents who reported lower than average compensation but retention rates of 50% or higher (3).
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Do agencies that provide salary increases have higher retention rates?
NO. There was little difference between respondents reporting retention rates of 50% or higher in the past 3 years along with a salary increase since 2011 (9) in comparison to respondents who reported a retention rate of 50% or higher in the past 3 years along with no salary increase since 2011 (7).
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Do agencies that pay significantly more for a Master’s degree therapist than a Bachelor’s degree therapist have higher retention rates?
YES. All but one respondent reporting at least a $4,000 pay difference between a Master’s degree and Bachelor’s degree plus comparable experience had retention rates of 50% or higher over the past 3 years. All but two respondents reporting a $2,500 or lower pay difference between Master’s and Bachelor’s degree had retention rates of under 50% over the past 3 years.
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What can we learn from this survey?

We know from the previous post that high turnover is costly and the earlier the therapist leaves, the more cost the agency incurs. Could the field of IFPS develop a screening tool that would help to identify applicants who are more likely to stay for a longer period of time?
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Higher pay appears to be linked with higher retention while, at least in this survey, salary increases are not linked with higher retention. Perhaps IFPS therapists don’t factor in salary increases because they only occur annually, if at all? Agencies definitely do need to consider overall compensation if they want to retain therapists.
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Therapists place value on earning a Master’s degree and expect greater compensation in return. IFPS agencies need to look at the difference in pay between Master’s level and Bachelor’s level therapists and make sure that obtaining a Master’s degree is incentivized and rewarded.
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In understanding why they stay, agencies need to know that therapists value flexibility above all else. So agencies need to emphasize flexibility when hiring, ask therapists what flexibility needs they have, and fulfill them!
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Understandably, therapists leave IFPS agencies for higher pay but a very close second is “professional growth opportunity.” If IFPS agencies could meet this need, more therapists would stay.
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Sharing Ideas, Information, and Resources

What tools and resources is your agency using to recruit and retain IFPS therapists?
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If compensation is determined mainly by the funding provided through a contract, could IFPS therapists have input on how that pool of funds is allocated?
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Do any agencies use loan forgiveness programs to aid an IFPS therapist in obtaining a Master’s degree and to retain that therapist as an employee?
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Among the reasons why IFPS therapists stay at agencies are flexibility and a supportive work environment. How are flexibility and a supportive work environment defined by your agency?
.

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Posted by Priscilla Martens
Executive Director
National Family Preservation Network

The Cost of Therapist Turnover: One Agency’s Experience

At our agency, we believe that therapist turnover has both financial and intangible costs.

To understand better how therapist turnover affects us, our management team recently requested an in depth analysis of therapist turnover.

The Direct Cost of IFPS Therapist Turnover

We measured the direct costs of turnover using costs of termination, ad placement, interviewing, training, salary, lost revenue, etc. The cost to replace one IFPS therapist, including costs to the agency and lost revenue, is approximately $43,000. In 2011, 8 IFPS therapists left our agency. This means that in 2011 alone, turnover among these therapists cost us approximately $344,000.

Beyond the Dollars: Intangible Costs of IFPS Therapist Turnover

Although intangible costs cannot be measured in dollars, we believe that they are important to take into account.

When an experienced therapist leaves and is replaced by someone who has not had experience delivering IFPS, the quality of services offered to families may be impacted.
High turnover in a team of therapists may also make it difficult to develop binding relationships and may have negative impacts to employee morale or lead to a culture of leaving in an agency.

IFPS Therapist Retention

We were recently asked what percentage of our IFPS therapists from 3 years ago were still employed here. We were disappointed to find that only about 30% of the 31 therapists from April 2010 are still with us today.

On a positive note, our IFPS therapists do tend to stay longer than therapists in our other programs. When we looked at all therapists hired between 2002 and 2008 who have since quit, IFPS therapists stayed an average of 28 months while other therapists only stayed an average of 16 months. This supports current research that suggests that there is less turnover in evidence based practices (Aarons, Sommerfeld, Hecht, Silovsky, and Chaffin, 2009). Unfortunately, evidence based practices also have substantially higher training costs than other programs.

Agency-wide Therapist Turnover

In light of the identified costs of therapist turnover, we have put together some information about the specific turnover rates across all programs at our agency. The following table and pie chart show therapists hired between 2002 and 2008. The six month period category describes the amount of time a therapist stayed before leaving or if they are still currently employed with us. Fifteen percent of our therapists stayed less than six months, 48% left before 18 months, while 25.1% are still currently employed by our agency.

Chart 1

Table 1: Therapists Hired from 2002 through 2008

Six Month Period	Number	Percent	Running Percent
0-6	26	14.9	14.9
7-12	34	19.4	34.3
13-18	24	13.7	48
19-24	8	4.6	52.6
25-30	13	7.4	60
31-35	11	6.3	66.3
36+	15	8.6	74.9
Current Employees	44	25.1	100

Now what?

We know that turnover among front line workers is costly. We have identified how many people leave, how long they usually stay before leaving, and how much it costs when they leave. Now the question is: how do we keep the good therapists longer?

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Don Fryberger Headshot Posted by Don Fryberger
Therapist/Administrative Associate
Institute for Family Development