What Works: Research on Family Preservation Services
Berry, M. Keeping Families Together. (In S. Bruchey (Eds.) Children of Poverty: Studies of the Effects of Single, Parenthood, the Feminization of Poverty, and Homelessness. New York: Garland Publishing, Inc. 1994.)
- Eighty-eight percent placement prevention rate found after one year (1985) of treatment from Emergency Family Care Program in Northern California to truly high-risk families.
- Success rates varied over the three years studied, from 88 percent in 1985 to 81 percent in 1986 to 89 percent in 1987. Results indicate placement likelihood does not increase with time away from the program.
Effective Program Components
- Among targeted high risk families, few individual and family characteristics were identified as predictors of treatment success or failure.
- However, several service components were recognized as making a difference in placement prevention:
- An average of two and a half months of service were found to be effective in helping families stay together.
- The proportion of time workers spent in the home, not the overall length of service, was highly related to success. Families that received larger proportions of services in the home were more likely to remain intact.
- The type of service provided made a difference in outcome. Families were more likely to stay together when receiving concrete services, which involved teaching family care, supplemental parenting, securing medical care and food, and providing training on financial management.
Program Effects on Types of Problems
- When the family's problem was an environmental or economic condition or related to a physical disability the program was fairly effective in preventing out-of-home placement.
- When families made substantial improvements in safety, cleanliness, condition of living, they were more likely to stay together.
- When the family's problem was related to child abuse/neglect or parent substance abuse, the program was less successful.
- Child placement is more likely when family members are developmentally or mentally impaired, despite equivalent service provision and skill attainment during program treatment.
- Availability of friends/relatives was found to contribute to the likelihood of child placement. Although relatives are usually associated with social and economic support to at-risk families, the interaction with relatives was a particularly strong predictor of subsequent child placement. The relatives/friends may be a stressor rather than a resource.
Ciliberti, P. An Innovative Family Preservation Program in an African American Community: Longitudinal Analysis. Family Preservation Journal. 1998, 3(2), 45-72.
The Family Enhancement Program (FEP) was developed by an African American community-based service agency as intensive family preservation services for African American families. Caseworkers assume three roles to functioning in the African American community: parental, instructional, and mentoring. The study compared the outcomes of families served by FEP intervention with families served only by the Oregon State Office of Services to Children and Families (SOSCF).
- The differences between the FEP and SOSCF families at 6 months and 12 months posttest periods were not statistically significant. However, FEP families had fewer placements, fewer days in placement, and fewer founded maltreatment reports than comparison families.
- By the 12 month period, more FEP families with children in placement were using kinship than nonkinship care, with children in kinship care showing significantly more placements and days in placements.
- A decrease in placement days was evident for children in kinship care and nonkinship care when their biological mothers received drug and alcohol services.
- Neglecting families showed a relatively high engagement in service utilization, possibly because of the family-based approach.
- This study could not account for maltreating families who had not been identified by state caseworkers.
- The generalizations of results to other family preservation programs should be approached carefully because of the unique characteristics of the community in which the FEP program was implemented.
Feldman, L.H. Evaluating the Impact of Intensive Family Preservation Services in New Jersey, 47-71. (In D.E. Biegel & K. Wells (Eds.) Family Preservation Services: Research and Evaluation, Newbury Park, CA: Sage Press, 1991.
- The New Jersey Family Preservation Services Program, a Homebuilders model of family-based services, was effective in preventing and delaying placement of children at-risk of placement, when compared to a group of families receiving traditional community services.
- At the end of the FPS service, seven of 96 (7.3%) families had been placed in care while 13 of 87 (14.9%) of the control group had been placed outside the home.
Ford, C.A. & Okojie, F.A. A Multi-Dimensional Approach to Evaluating Family Preservation Programs. Family Preservation Journal. 1999, 4(1), 31-62.
This study evaluated the Mississippi Family Preservation/Family Support Services which was both a family preservation program and a family support program. Its services were client driven, built on client strengths, provided both family preservation and family support types of services, stressed flexibility and creativity, and were designed from a culturally competent delivery system. The primary objective of the MFP/FSS was to prevent out-of-home placements.
- There was little evidence indicating that MFP/FSS resulted in lower placement rates.
- There was no evidence that MFP/FSS resulted in lower teen pregnancy or abuse.
- Clients perceived an increase in tangible support, availability of people to talk to, and an increase in self-esteem support after participating in the program.
- There were significant changes in family functioning. Families changed from being disinclined to talking to being amenable to talking to resolve problems. The change was found to be higher in White than in African-American families.
- The majority of clients felt positively about the services they received, the program's impact on helping them with their problems, and the manner in which the program protected their dignity and pride.
- The MFP/FSS program was conducted in 18 sites throughout Mississippi with variations in how the intervention was implemented.
- The study utilized a quasi-experimental design because random assignment to a treatment and control group was not possible.
- The program had only been in progress for 8 months before the study's evaluation began. The total duration of the program is one year and eight months.
Kovacevic, M. It's Nice to Know Someone Cares: What Parents Think About Family Preservation. Family Preservation Evaluation Project. Center for Juvenile Justice Training and Research, Child Welfare Division, December 1994.
- Parents who received Family Preservation Services were very satisfied with the services they received and the skills they learned.
- Additionally, FPS was being delivered by the workers in ways that were consistent with the philosophy and guidelines of the intervention, such as empowering families, working collaboratively with parents in their own environment, focusing on their strengths, and being available when needed.
Littell, J.H. Effects of the Duration, Intensity, and Breadth of Family Preservation Services: A New Analysis of Data from the Illinois Family First Experiment. Children and Youth Services Review. 1997, 19 (1/2),17-39.
- No evidence that overall length of FPS was related to reductions in subsequent child maltreatment or placement.
- Intensive FPS was related to an increase in substantiated reports of maltreatment and out-of-home placements. This may be due to "case-finding" effects or that more intensive contact was provided to "high-risk" cases.
- Cases provided with many concrete services were more likely to remain open one year after FPS.
- The duration, intensity, and breadth of family preservation services had little effect on subsequent child maltreatment, out-of-home placement, or the closing of cases.
- A substantial proportion of variance could not be explained by the case and service characteristics that were examined.
- The duration, intensity, and breadth of family preservation services do not have the same effects among families with different attributes and needs.
- Other features of FPS programs may be more important such as the client-worker relationship, content of their discussions/activities, and extent/type of workers' advocacy efforts on behalf of clients.
Meezan, W., & McCroskey, J. Improving Family Functioning through Family Preservation Services: Results of the Los Angeles Experiment. Family Preservation Journal. Winter 1996, 9-29.
- The data showed small, but significant improvements in family functioning reported by families and workers.
- This study found no significant difference in placement rates or types for children in the service and comparison groups.
- The service characteristics did not predict outcome. Instead, the relationship between the worker and the caregiver, backed by the philosophy of family-based services resulted in success with families.
- Research supports the notion that if families' basic needs are not met, the positive changes in interpersonal relationships are unlikely to occur.
Recommended Guidelines to Further Enhance Development of Both Practice and Research on Family-Based Services
- Desired program outcomes should be defined to include both effectiveness for clients as well as cost efficiency for the service system. Does it work and at what cost?
- Meaningful practice-relevant instruments should be used to assess family functioning. Need a community functioning measure.
- The field should incorporate multiple perspectives on the progress and outcomes of the service into both research and practice. Include client and worker's views in evaluation.
- We need to pay greater attention to the relationship between the worker and the family.
- The multiple systems, such as school, child care, health etc., serving families and children must work more closely together to meet the needs of families and children.
- Programs need to incorporate information on outcomes, not just on process, into their regular data collection.
- Researchers, administrators, practitioners, service recipients, and funders must be partners in the challenging search for accurate and meaningful cost-effective outcomes.
Morris, E., Suarez, L., & Reid, J.C. Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders. Family Preservation Journal. 1997, 2(2), 21-32.
This study evaluated the impact of the Families First Project, a family preservation program, on the behavioral functioning of children with a serious emotional disturbance.
- Internalizing and externalizing behaviors in children and adolescents significantly decreased, as reported by their parents.
- Children/adolescents diagnosed with Oppositional Defiant Disorder showed a significant decrease in problem behaviors.
- Children/adolescents diagnosed with mood disorder showed a decrease in internalizing scores from pretest to posttest.
- Children/adolescents diagnosed with Conduct Disorder decreased their externalizing scores, specifically in aggressive and delinquent behavior.
- Both female and male children seemed to benefit from Families First.
- Nearly two-thirds of the children and adolescents remained home with their families at the time of follow-up.
- The results were based on parents' report of their children's behavior.
- Other treatments were provided to most of the children while they participated in the Families First Project.
- Comparisons with a group that did not receive treatment could not be made because the study did not include a control group.
Nelson, K.E. Populations and Outcomes in Five Family Preservation Programs, 72-91. (In D.E. Biegel & K. Wells (Eds.). Family Preservation Services: Research and Evaluation, Newbury Park, CA: Sage Press, 1991.)
- The study did not support the hypothesis that the success of family-based services is due to excluding the most difficult cases in the child welfare system.
- Researchers concluded that the family-based services' client population is not less difficult than the general child welfare population.
- Involving children in the treatment process makes a positive contribution toward preventing placement.
Nelson, K., Landsman, M., Tyler, M., & Richardson, B. Examining the Length of Service and Cost-Effectiveness of Intensive Family Service. Research Exchange. Fall 1996, 2, 13-17.
- In the Portland site, six months (as opposed to three months or no limit) of in-home family treatment was most effective in preventing placements among families with older children and significant histories of prior services. This was especially evident in families involving substance abuse and child behavior problems.
- Also in the Portland site, low income families and particularly those with child behavior problems, achieved better outcomes with time-limited services.
- In the Baltimore site, researchers concluded that longer services might be more effective with families experiencing adult depression/emotional problems or child behavior problems.
- These findings suggest that specific service models are more effective with some populations than with others. Also, costs differ considerably according to service models and population.
- The findings suggest that programs should consider both the importance of time-limited services and the need to match length of service to their service model and population.
- Researchers recommended that cases involving reunification, substance abuse, child abuse/neglect, and cases with a great need for concrete services require a more comprehensive treatment model, which may include teamed services, flexible funds, smaller caseloads, and in-home services.
- Family preservation services need to be integrated with other child welfare and community resources to provide appropriate concurrent and follow-up services.
Pecora, P.J., Fraser, M.W., & Haapala, D.A. Client Outcomes and Issues for Program Design, 3-32. (published in D.E. Biegel & K. Wells (Eds.). Family Preservation Services: Research and Evaluation, Newbury Park, CA: Sage Press, 1991.
- Although a number of placements were not prevented by the IFPS therapists, the success rates were significantly higher for families that received family preservation services than for those families that did not.
- Other outcome measures in the study supported the observed findings as positive changes in child, parent, and family functioning and were highly correlated with treatment success.
- Despite the more successful family preservation rates demonstrated by the private agency (Washington state program), the data indicates that public child welfare IFPS programs can provide an effective service. There are, however, additional challenges, such as staff recruitment, organizational environment, workload management, program stability, and worker turnover, associated with delivering IFPS through a public agency.
- The data from the entire FIT study indicate that parents are empowered with both the skills and the resources necessary to create a safer and more enriching environment for their children when services combine the Homebuilders philosophy, emphasizing client respect and advocacy, with in-home intervention, clinical services, concrete services, and the teaching of skills.
Potocky, M. & McDonald, T.P. Evaluating the Effectiveness of Family Preservation Services for the Families of Drug-Exposed Infants: A Pilot Study. Research on Social Work Practice, 1996, 6(4), 524-535.
- A significant difference was found for number of children in the family, which was higher in the group whose children were placed in foster care (average of 4.8 children) than in the group whose families remained together (average of 2.6 children).
- The child well-being intake scores were not predictive of child placement outcomes.
- Participation in the parent education/support group and the parent/child interaction group were the only two service variables that had a significant impact on the service outcome. Families who remained together attended these services more often than the families whose children were placed out-of-home.
- The participants were generally very positive about the staff and described this program as good. More specifically, they identified the following positives about the program:
- "it kept me focused;"
- "the program gave me the additional support I needed;"
- "I enjoyed the coming together of women with common problems;
- "I liked having someone to talk to whenever I needed it;"
- "the staff didn't judge me or tell me that I was bad;"
- "I liked the availability of transportation."
Raschick, M. A Multi-Faceted, Intensive Family Preservation Program Evaluation. Family Preservation Journal. 1997, 2 (2), 33-52.
This study evaluated Intensive Family Based Services (IFSB), an intensive family preservation program which targeted families who seek help voluntarily and are not involved in the child protection system. IFSB also has a more structured educational approach with a curriculum that includes videos, readings, and workbooks.
- The trend of the data suggested that IFBS services reduced average duration and restrictiveness of out-of-home placements.
- There were no significant differences between the treatment and comparison groups on standardized measures of family health and stability but this may be due to the small sample size.
- Participants' feedback about the program suggests that the program was providing highly accessible services, forming close helping relationships with clients, and teaching parenting skills effectively.
Rodenhiser, R.W., Chandy, J., & Ahmed, K. Intensive Family Preservation Services: Do They Have Any Impact on Family Functioning? Family Preservation Journal. Summer 1995, 69-85.
Using a one group pretest-posttest design, the study evaluated the extent to which intensive family based services in five North Dakota agencies affected family functioning and preservation.
- Parents' mental health, knowledge of child care, motivation to solve problems, supervision of teenage children, constructive verbal discipline, affection, child's mental health, school adjustment, and home-related behavior appeared to have significantly improved as a result of IFPS.
- Physical punishment, sexual abuse, and delinquency significantly decreased.
- The overall child well-being status increased significantly after IFPS.
- No changes were found in economic risk and household adequacy (basic needs).
Schwartz, I.M., AuClaire, P., & Harris, L.J. Family Preservation Services as an Alternative to the Out-Of-Home Placement of Adolescents: The Hennepin County Experience. (In D.E. Biegel & K. Wells (Eds.) Family Preservation Services: Research and Evaluation, Newbury Park, CA: Sage Press, 1991, 33-46.)
- The willingness of family members and the ability of a treatment team to cooperatively establish a program-relevant set of treatment goals are central to the home-based service model implemented. Families with a greater willingness to participate in goal-setting and actively working toward goal achievement, are more likely to have a positive outcome than are families less willing or able to actively involve themselves in the treatment process.
- Thirty-one of the 55 intensive home-based service clients had to be removed from their homes. Many were removed several times and for long periods of time. Since a high rate (56.4%) of this group were removed from the home, the study raises the question that perhaps some seriously emotionally disturbed adolescents are not amenable to home-based interventions and must be placed out-of-home.
- Additionally, researchers and practitioners should not apply "a one size fits all approach" when developing and applying family preservation and intensive home-based services. Various models should be considered and tested to determine which models are effective with particular kinds of cases.
- Of all the clients placed out-of-home, the results indicate that the comparison group clients experienced almost twice as many placements as did clients in the home-based service group.
- Also, the comparison group clients experienced 7,260 more days in placement than did the home-based service group clients.
- Although, both client groups utilized approximately the same number and percentage of placement days of shelter care, there was a large difference between the groups with respect to the number and percentage of days utilized in other placements, such as foster homes, treatment foster homes, group homes, and residential treatment facilities, etc. Excluding shelter care, the home-based group utilized 3,313 placement days versus 10,584 by the comparison group.
Smith, M.K. Utilization-Focused Evaluation of a Family Preservation Program. Families in Society: The Journal of Contemporary Human Services, 1995, 76(l), 11-19.
The two major components of this family preservation program included intensive interaction with the same social worker and an ongoing and structured educational plan. The workers tailored intervention to families' cognitive capacity to learn the stages of child development and effective principles of family communication and child rearing. They focused on how to change family child rearing behaviors and communication patterns on the basis of their cognitive learning. Also, the workers demonstrated how to maintain a safe and clean household.
- Marital relationships improved. A reduction in frequency of marital fights in general and physical aggression in particular.
- Family communication improved. An increase in communication frequency and topics occurred among family members.
- The community support network strengthened. Families increasingly participated in social groups such as parent-teacher organizations and churches.
- Intrafamily relationships improved. Closer physical contact, more frequent communication, and sharing of household chores occurred among family members.
- Home-management skills improved. Homes were cleaner, better meals prepared, and shopping skills improved.
- Child-care methods greatly improved. Parents showed more appropriate expectations and discipline techniques and a greater attentiveness to the needs of their children.
Three Factors Researchers Attributed to Program Success
- The agency applied purposeful criteria for admitting families to this intensive family preservation program.
- In most of the 26 families studied, child abuse and neglect had come to the attention of the agency for the first time.
- Only families that recognized their problems and a willingness to receive services from a social worker were admitted into the study.
- This program involved intensive intervention by social workers with proven skills in work with families.
- Social workers must have a wide range of skills, including case management, and skills to facilitate cognitive and behavioral learning.
- Undergraduate and graduate social work programs teach such skills.
- The Program included follow-up on families by the same social workers who worked with the families.
- The program provided a supportive social network available to the families after leaving the program.
- Families contacted their social workers when they realized their tolerance was about to reach its threshold or to invite them to important family events such as a child's graduation or birthday party.
Unrau, Y.A. Predicting Use of Child Welfare Services After Intensive Family Preservation Services. Research on Social Work Practice, 1997, 7(2), 202-215.
- The follow-up studies reveal that the effectiveness of Intensive Family Preservation Services in preventing placement diminishes over time.
- Cases involving individual problems of either parent or child, such as child behavior problems or parental domestic violence, were less likely to have positive outcomes. In contrast, cases involving problems with parent-child interactions, such as child abuse, were more likely to result in positive outcomes.
- Previous placement experience was significantly related to service outcome at the 3- and 6-month follow-ups. Children's placement history, not their placement situation at referral, was related to subsequent services.
- The program's outcome rates suggest that the combination of the Homebuilders and the Teaching-Family model is an effective service delivery approach.
Walton, E. Enhancing Investigative Decision in Child Welfare: An Exploratory Use of Intensive Family Preservation Services. Child Welfare, 1997, 76(3), 447-461.
At the end of the 6-month follow-up period, differences were observed between the experimental group, which received brief, intensive family services and the control group, which did not receive any additional services beyond the routine child protective services investigation:
- Fewer cases were opened for the families in the experimental group (29%) than the control group (38.5%);
- Of the cases opened, children from the experimental group were more frequently maintained in their own homes (85%) than children from the control group (60%);
- Custody was taken less often in the experimental group (25%) than in the control group (32%);
- Cases from the experimental group remained open, on average, for 114.85 days, compared to 170.00 days for the control group.
Walton, E. & Dodini, A.C. Intensive In-Home Family-Based Services: Reactions from Consumers and Providers. Family Preservation Journal. 1999, 4(2), 39-51.
Clients receiving IFPS and the caseworkers providing the services were interviewed regarding their experiences, opinions, and recommendations. The services were based on the Homebuilders model and were designed to prevent out-of-home placement.
- The relationship between the family and the worker was the single most important factor of the service effectiveness and the family's willingness to participate in the intervention.
- Most families considered the treatment goals to be important and worth pursuing.
- Workers felt that helping families with concrete services, as well as clinical help, was an essential part of the program.
- Workers felt that families targeted to receive IFPS should be appropriately screened and that parents may be the best judges as to whether these services would be helpful.
- The consumers who participated in the study were a small, biased sample because they were relatively stable families who wanted help with their problems.
- Only four caseworkers were available for the interviews.
Wells, K., & Whittington, D. Child and Family Functioning After Intensive Family Preservation Services. Social-Service-Review, 1993, 67(l), 55-83.
- Study data show that many of the problems that families had at admission were either eliminated or improved by follow-up. However, the results also reveal that at follow-up families were functioning at a lower level than nonclinical families. Although this difference may be due, in part, to socio-demographic differences between the study sample and the nonclinical samples, the pattern of differences suggest that families treated in intensive family preservation services are still vulnerable at follow-up.
- Although 80 percent of the children in the study were not placed out-of-home, 41 percent moved from the homes of their parents (to the streets and homes of friends and relatives) at least once. As a result, placement and stability of a child's living situation should be treated as separate concepts in subsequent research, as well as, the stability of a child's living situation and its effect on the child's well being.
- These findings do not necessarily mean that intensive family preservation services are failing, but that practitioners and researchers must recognize that the goal of services is to help families achieve basic skills and goals necessary to keep a child at home, not to try to produce major changes in family functioning.
- This study concluded that out-of-home placement is an inadequate indicator of how well children and their families are functioning after discharge, because child placement may be a result of a large number of factors, such as the child or family's psychological health. Instead, the researchers focused on the stability of a child's living arrangement. If a child moves from home to home, but avoids placement, the researchers argue that this does not constitute family preservation.
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