What do we know about crisis nurseries?

The need

With the passage of the Family First Prevention Services Act of 2018, states and tribes now have a tool to advance a 21st century child welfare system that:

  • Redefines safety, so that children are free from abuse and neglect and don’t have to be harmed for the system to intervene. The current system is a reactive rather than a proactive one. It defines children’s safety as prevention of repeat maltreatment, but brain science and research suggest that intervening after a serious trauma has occurred is much less effective than avoiding the initial trauma altogether.
  • Reflects population-based prevention strategies, so that interventions address indicators and social determinants of health in children, families and communities that are most at risk of harm, rather than the devastating impact of trauma on children after it occurs.
  • Reorients responsibility for child well-being, so that the child protection agency is only one agency within a broader child well-being system that includes public health, mental health, early childhood, substance abuse, education and others.
  • Raises the level of technical excellence, so that decision-making is enhanced through the use of integrated datasets and predictive analytic tools, and by strengthened services and supports that are tailored to meet the real needs of children, families, and communities.

Crisis nurseries are part of such an approach. All parents feel overwhelmed at one time or another. Ideally, a family member or friend is willing and able to provide necessary support during these stressful periods. However, many vulnerable and high-risk families don’t have an available support network. Emergency support services such as crisis nurseries can assist parents experiencing challenges and prevent harm to children, as well as the need for children’s entry into foster care.

The model

Sometimes called “crisis respite,” “respite services,” or “relief nurseries,” crisis nurseries provide emergency shelter for children when parents are overwhelmed with complex situations and are unable to care for their children. Crisis nurseries are considered effective approaches to child abuse and neglect prevention, serving families with children who are at high risk of involvement with the child welfare system (including some with current or previous involvement with this system).1 Most programs accept children at any time, day or night, to protect them from a potential or existing crisis in the family. They provide short-term care (lengths of stay typically vary from 24 hours to 90 days). Beyond the immediate goal of emergency care for children, acknowledged goals of most crisis nurseries include strengthening and preserving families, reducing the chance of child welfare placement, and promoting child well-being.

The history

The crisis nursery model began in the 1960s as a grassroots effort to prevent child abuse and neglect by supporting parents under stress. Based on an understanding of the vulnerability of infants and young children and the pressures their needs can place on parents, especially those already dealing with challenges related to poverty and other circumstances, the nurseries focused on children newborn to 5 years old.2 Financed by private donors, they often were located in communities with low-income families to provide easy access to respite for parents and stable, caring environments for children. Crisis nursery workers also understood the need for crisis intervention services beyond respite for parents and temporary care for children, and most offered a range of emergency and follow-up services.2

Legislation in the mid-1980s and early 1990s3 provided funding for temporary care to help preserve and support families and strengthen the parental bond. Between 1988 and 1994, 47 states obtained funding to establish a total of 175 crisis nurseries. As a growing body of research on early brain development emphasized the critical role that early attachment relationships play in children’s development, and pointed to the need for support services that promote engaged and nurturing parenting, many crisis nurseries began including enhanced family functioning and parenting education as part of the service array to improve positive outcomes for children and boost family preservation.4

I don’t know where I would be without a place like this. … Words can’t describe how much hope they’ve given me.

– Mother who used crisis nursery services, Maryville Crisis Nursery, Chicago, Illinois

The defining characteristics

The guiding philosophy of crisis nurseries5 emphasizes the importance of services that meet families’ underlying needs to achieve long-term well-being of children. Toward this goal, many crisis nurseries:

  • Provide shelter for children without judgment, welcoming children with compassion toward their caregiver(s)
  • Are voluntary, confidential, and free
  • Provide care 24 hours a day, 365 days a year
  • Are staffed by professional social workers or specialists who understand the developmental needs of young children and how to provide safe and nurturing environments
  • Provide shoes, clothing, diapers, and other tangible items, including comfort items such as toys and blankets
  • Employ administrators and staff that are trained in childhood development and know how to ameliorate the effects of traumatic experiences
  • Crisis nurseries provide an array of services for children and for their parents. Services vary among nurseries, but they usually involve some or all of the following:

Services for the children

  • Nutritious meals and snacks
  • Scheduled age-appropriate learning activities
  • Early learning programing
  • Supervised playtime, mealtimes, and bedtime
  • Transportation to school and regular appointments in the child’s community
  • Therapy
  • Art and literacy activities
  • Medical care

Services for the parents

  • Initial crisis assessment and intervention services
  • Referral to community services in the parent’s community, or co-located at the nursery, including parenting classes, mental health counseling, or substance abuse treatment
  • Assistance with resolving the immediate crisis
  • Referrals and transportation to another agency, if capacity prevents intake
  • Case management and action planning
  • Home visiting
  • After-crisis interventions and follow-up care
  • Community outreach and awareness

At the Maryville Crisis Nursery, staff understand that parents who bring their children to their front door are experiencing a multitude of circumstances that led them to seek respite and care for their children, including:

  • Sudden illness or accident
  • Desperation or helplessness
  • Emotional distress or frustration
  • Domestic violence
  • Homelessness
  • Drug or alcohol treatment
  • A medical or mental health situation
  • Employment or housing situation
  • Risk of abuse and neglect (i.e., stressed single parent with no support)

The impact

By eliminating stress and other known risk factors of child abuse and neglect, crisis nurseries appear to promote safety for children and strengthen family functioning.6 By providing comprehensive services to families with young children, they strengthen parenting skills, improve family stability and family functioning, and support parents’ ability to successfully parent their children. Available evaluation results indicate that crisis nurseries help reduce child maltreatment and entry into foster care, as well as support the timely reunification of children in out-of-home care with their parents.

Feedback from parents reflects caregiver satisfaction with services provided to their children and to their family, as well as caregiver perception that crisis nurseries effectively decreased stress, lowered the risk of child maltreatment, and enhanced parenting skills.7 For example, in a study of five crisis nurseries in Illinois, 67 percent of parents surveyed suggested that without crisis respite, their children may have been at risk of maltreatment or endangerment. Nearly half of parents acknowledged risk of voluntary or involuntary placement of their children in foster care if crisis respite had not been available.6

The list below summarizes what is known about the impact and effectiveness of crisis nurseries in reducing the incidence of child maltreatment, out-of-home placement, and time to permanency:

A selection of crisis nurseries and their impact on foster care placement

The Sacramento Children’s Home Crisis Nursery

Children in the test group were less likely to have experienced abuse or neglect than the children in the comparison group, and were far less likely to ever have a substantiated report of maltreatment than the families without crisis nursery services.6

Oregon Association of Relief Nurseries

Relief nurseries strengthen family functioning and reduce the number of risk factors associated with abuse and neglect in the families served. They also reduce foster care placements and help children exit the foster care system twice as quickly as those not receiving services.9 Relief nurseries:5

  • Increase parent employment, frequency of reading to children, and child immunization rates
  • Improve quality of parent-child interactions, family functioning, and stability
  • Reduce number of family risk factors and the use of emergency room services
  • Decrease the number of families living in poverty and the number of families likely to use the emergency room

The Providence House

Crisis nursery services delivered with case management and parenting education may be an effective intervention to reduce foster care placement, given that:10

  • Children whose parents participated in the recommended case management had 65 percent lower odds of subsequent foster care placement compared with children whose parents declined the recommended service
  • Similar results were found for children whose parents participated in the recommended parenting education

Illinois’ Six Crisis Nurseries

Crisis nurseries demonstrate that they can be instrumental in reducing parental stress, enhancing parenting skills, and reducing the risk of abuse.11 Families who access crisis nurseries before coming to the attention of the child welfare system are twice as likely to be reunited compared to families that do not access such services,12 and families who access case management and parenting education provided through a crisis nursery are less likely to have a subsequent entry into foster care.11

Yolo Crisis Nursery

Of the families that received crisis nursery services13:

  • 97% of families completed referral to wrap-around services
  • 97% of parents did not become clients of Child Protective Services
  • 97% of parents reported stress reduction after using nursery services

1 NPC Research. (2009). Evaluation of Oregon’s Relief Nursery Program, July 1, 2007 – June 30, 2008: Executive Summary. Retrieved from https://npcresearch.com/wp-content/uploads/Oregon_Relief_Nursery_Executive_Summary_02091.pdf
2 DeLapp, J., Denniston, J., Kelly, J., & Vivian, P. (1998). Respite, crisis care, and family resource services: Partners in family support (ARCH Factsheet Number 51). Chapel Hill, NC: National Center for Respite and Crisis Care Service.
Cole, S.A & Hernandez, P.M. (2011). Crisis nursery effects on child placement after foster care. Children and Youth Services Review, 33(8), 1445-1453. Retrieved from http://cap.law.harvard.edu/wp-content/uploads/2015/07/12_crisis-nursery-effects-on-child-placement.pdf
3 The Temporary Child Care for Children with Disabilities and Crisis Nursery Act of 1986, reauthorized in 1992 as the Child Abuse, Domestic Violence, Adoption and Family Services Act, and Temporary Child Care for Children with Disabilities and Crisis Nurseries Act Amendments
4 Green, B. (2012). Evaluation of the Oregon Relief Nurseries July 1, 2010 – June 30, 2012. Retrieved from https://docs.wixstatic.com/ugd/e1269c_65edac990f464fbeab049769c2c06ac0.pdf
5 Arch National Respite Network. (2007). Crisis respite: Evaluating outcomes for children and families receiving crisis nursery services. Retrieved from https://archrespite.org/images/docs/CN_Final_Revised.pdf
6 More research is needed to evaluate the long-term impact of crisis nurseries.
7 Cole, S.A. (2012). Summary of research on crisis nurseries in the United States. Retrieved from http://cap.law.harvard.edu/wp-content/uploads/2015/07/11_summaryf-research-on-crisis-nurseries-in-the-united-states.pdf
8 Children’s Institute. (2010). Oregon’s starting five: Five early childhood programs making a difference for Oregon’s at-risk children. Retrieved from https://docs.wixstatic.com/ugd/e1269c_96def82bba174901be57531a33612653.pdf
9 Green, B. (2011). Child welfare outcomes report: Oregon Relief Nurseries 2008-2010. Retrieved from https://www.voaor.org/pdf_files/oarn-2008-2010-outcomes-full-report
10 Crampton, D. & Yoon, S. (2016). Crisis nursery services and foster care prevention: An exploratory study. Children and Youth Services Review, 61, 311-316. http://dx.doi.org/10.1016/j.childyouth.2016.01.001
11 Cole, S. A., & Hernandez, P. M. (2008). Crisis nursery outcomes for caregivers served at multiple sites in Illinois. Children and Youth Services Review, 30(4), 452-465.
12 Cole, S. A., & Hernandez, P. M. (2011). Crisis nursery effects on child placement after foster care. Children and Youth Services Review, 33(8), 1445-1453.
13 Yolo Crisis Nursey 2017-18 Impact Report. Retrieved from: https://yolocrisisnursery.org/