On August 8, 2008, tragedy struck the Salt River Pima-Maricopa Indian Community. Two young siblings were playing in the trunk of a car in the middle of a hot Arizona day and accidentally locked themselves inside. Their mother, who was under the influence of alcohol, did not look for them until it was too late. The deaths galvanized Community conversations regarding child protection, resulting in an independent assessment that ushered in significant changes to the Community’s child protection approach, including implementation of a multidisciplinary team, a family advocacy center, guardians ad litem, and parent representatives, in addition to improvements in staffing, policies, and practice.¹

The deaths also caused fear and anxiety among the workforce, leading to a sharp increase in the number of removals of children from their homes. Faced with long waiting lists for services, placement often seemed like the only option available to social workers who wanted to keep children safe. Between 2010 and 2014, the number of children in out-of-home care within the Community increased by 75 percent.²

Community members knew they needed another solution, as separating children from their families was only perpetuating the historical cycle of trauma. So in 2014, the Community’s Department of Social Services (DSS) tried a new approach: Circles of Support, an intensive in-home service that incorporates evidence-informed interventions within a culturally relevant context, and which the Community developed itself. By 2018, the number of children in out-of-home care had decreased by 45 percent, a significant reduction.

Core elements

Circles of Support utilizes a wraparound model that serves each family with a triad of support: a therapist, a case manager, and a behavioral coach. Services are available to any family that, during the course of a child protection investigation, indicates a willingness to participate in services to prevent child removal. After Circles of Support is put in place, the Division of Child Protective Services (CPS) continues to monitor the family’s progress but otherwise is uninvolved so that the family and Circles of Support staff can focus on strengthening and supporting the family unit.

Circles of Support begins with an assessment of the family’s strengths and needs that includes a clinical assessment, the Adult Adolescent Parenting Inventory, and Structured Decision-Making. Together with the family, the team identifies the treatment and service needs, which go beyond the presenting CPS concerns to include: safety planning, physical abuse, substance use, mental health issues, domestic violence, trauma and trauma reactive behaviors, parenting, housing, life skills, employment, education, and financial stability.

The Circles of Support triad then draws upon evidence-informed interventions such as Cognitive-Behavioral Therapy, the Nurturing Parenting Program, Motivational Interviewing, and Solution-Focused Brief Therapy to work with the caregiver and family toward their goals. While services are intensive and frequent, based upon the family’s unique needs, each family typically meets with its therapist one or two times per week, its behavioral coach between one to three times per week, its case manager at least once per week or even daily, depending on the family’s situation.

Guiding values and principles

While safety is the utmost priority, Circles of Support is also guided by the following values and principles:

• Welcoming all families. There are no eligibility requirements, and families with children of any age can participate in services.
• Children raised by family. The program is willing to accept all cases, even those that are deemed high risk, as long as the family is willing to participate in services and do what it takes to keep its children safely at home.
• Parents as partners. The program works with parents to develop a joint plan together. One of the key goals is to help parents understand that their children’s behaviors are the result of the family environment, and help them approach their children and their own parenting in new ways.
• Culture and family tradition. Circles of Support engages with and includes extended family members and even child care providers, who are all a part of the child’s care and upbringing. The cultural traditions of the two tribes that make up the Community — the Pima and Maricopa tribes — are integral to the program’s ongoing engagement with families.
• Removal of barriers. Services are provided according to the family’s schedule and in the family home (or at another location that is more convenient for the family). Concrete needs and resource barriers are addressed so that parents can focus on other issues related to individual and family functioning and safety.
• Engagement and relationship. Staff respond quickly, typically within 24 hours, and develop relationships with families that emphasize supportive guidance rather than compliance or punishment. One reflection of successful engagement is that families often call their Circles of Support team members in a crisis, even though the Department has a specialized crisis response team available around the clock.

Impact

Circles of Support has had a significant impact on the number of children entering out-of-home care, helping to reduce the in-care population by 45 percent by safely keeping children at home with their parents, instead of placing them in foster care. Given the program’s success in preventing unnecessary child removals, the Community has begun further expanding its reach to allow families to self-refer even before they come into contact with CPS. The Community is also expanding Circles of Support to support children already in care with either relatives or foster families, in order to support their caregivers and prevent the need for placement in higher levels of care such as congregate care.

Circles of Support also is credited with fundamentally changing the Community’s perception of child protective services. While some families understandably remain wary of CPS, new champions have emerged within the Community, voicing support for DSS’ commitment to families through Circles of Support. One such advocate is a mother with an extensive family history of domestic violence and substance abuse, including an adult daughter who died of a drug overdose. Through Circles of Support, she was able to address her past trauma and ameliorate her longstanding trauma symptoms. As a result, she was able to keep her younger children safely at home with her, and she is now a vocal advocate for Circles of Support throughout the Community, encouraging other families to seek and accept the services and supports the program can provide.

Implementation considerations

The Circles of Support leadership team offered the following advice and lessons learned to other jurisdictions considering a similar in-home, family strengthening model:

• Create clear distinctions between CPS and in-home services. Even though Circles of Support was originally developed by and housed within the DSS child protection division, agency leadership was careful to message that Circles of Support was not CPS. The two programs were housed in different locations, and CPS quickly exited a case after referring it to Circles of Support in order to facilitate relationship building between Circles of Support and the family.
• Leverage all available funding streams. While Circles of Support was fortunate enough to have the support of the Tribal Council, which appropriated Community funds for the initial development and implementation of the program, leadership soon realized that Medicaid funding also could be leveraged through third-party billing. To facilitate this, Circles of Support was moved from the child protection division to behavioral health.
• Communicate the program’s purpose. When Circles of Support initially was part of the DSS child protection division, the program only accepted referrals from CPS staff. The program since has expanded to accept referrals from behavioral health and other stakeholders, such as education and legal services. As a result, it has been important to clearly message the program’s core values and principles to a wider array of community partners. Staff have had to make clear that the program does not expect perfection from families — that children can be safe at home even when their families are going through major challenges and uncertainties.
• Consider staff experience and training. Circles of Support tries to recruit and hire staff with experience in substance use intervention as well as child welfare experience, and works closely with CPS to collaborate, share information, and cross-train staff.
• Evaluate program impact. During the first four years of the program, Circles of Support primarily has gathered data related to successful completion of treatment goals and improvement in Adult Adolescent Parenting Inventory goals, while CPS has been monitoring the number of children entering out-of-home care. Moving forward, Circles of Support and CPS would like to work together to better assess the impact of the program on families’ subsequent contact with CPS, including re-referrals and entries into care post-intervention, both for those families that successfully meet their treatment goals and those that do not. This type of deeper analysis will provide the Community with a more complete picture of how Circles of Support is strengthening families, and what else might be needed to further support vulnerable children and families in the Community.

1 Unless otherwise noted, information was shared during a site visit to the Salt River Pima-Maricopa Indian Community on June 28, 2018, through interviews with Lena Jackson, assistant community manager, Erin Wilkinson, behavioral health services manager, and members of their teams: Hannah Allen, Kristina Belinte, Ashley Dailey, William Dawson, Ryan Farquharson, Stephen Hudson, Rob McClary, and Kellianne Richards.
2 Casey Family Programs. (2016). Salt River Pima-Maricopa Indian Community child welfare assessment: Final report. Internal report: unpublished.