Evaluation of Family Preservation and Reunification Programs:

Chapter 9:
Conclusions

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Contents

In the late 1980s and early 1990s, family preservation programs became a popular response of states to rising rates of foster care placement of children. It was commonly assumed that many children were unnecessarily removed from their parents and that intensive services could prevent those placements while protecting children from harm. Early evaluations suggested these programs had considerable promise but these studies were criticized for flaws in research design. Later, more rigorously designed studies began to cast doubt on the extensive claims of success. The largest of these studies were in California, New Jersey, and Illinois. No placement prevention effects were found in California and Illinois, while the study in New Jersey found short term effects that dissipated with time.(1) However, these studies were also criticized, most notably for not having examined those programs thought to be most likely to be effective.

This evaluation of family preservation programs was designed to overcome shortcomings of previous studies. It assessed the extent to which key goals of the programs are being met: the goals of reduction of foster care placement, maintaining the safety of children, and improving family functioning.(2) It studied the Homebuilders model of service, thought by many to be the most promising.

The design for this evaluation was an experiment in which families were randomly assigned to either a family preservation program (the experimental group) or to other, "regular" services of the child welfare system (the control group). Families were followed for over a year after random assignment. Data collection involved multiple interviews with caretakers and caseworkers and examination of administrative data on placements, reports of maltreatment, and case openings and closings. This report concerns programs in three states, Kentucky (Louisville and Lexington), New Jersey (seven counties), and Tennessee (Memphis). The programs in these states followed the Homebuilders model of family preservation (sometimes labeled "intensive family preservation").

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9.1 Outcomes

9.1.1 Placement

We are unable to conclude that the family preservation programs in these three states achieve the objective of reducing placement of children in foster care.(3) A summary of various analyses of placement rates at various points in time following random assignment is shown in Table 9-1. In none of the three states were there significant differences in placement rates over time for the samples as they were originally randomly assigned (the "primary" analysis). Since some of the families in the control group were actually provided family preservation services ("violations") and some of the families in the experimental group did not receive services or received only minimal services ("minimal service" cases), we also conducted analyses in which we dropped those cases ("secondary" analyses). Results of the secondary analyses were quite similar to the primary analyses, also showing no significant differences between the groups.

Since it was thought that the samples included families that did not fit the conception of cases best suited for the program model, we attempted to identify subgroups that might better fit criteria for referral. This selection was based on the idea that the service is most useful for families in crisis. Hence, we focused on cases referred in the course of an investigation of abuse or neglect and cases with recent substantiated allegations of maltreatment, on the grounds that these groups of cases might reflect families in crisis. These "refined groups" analyses also failed to show differences between the experimental and control groups on placement rates over time.

In Kentucky and Tennessee, we obtained data from case records and caseworkers on placements with relatives that were not recorded in the administrative data. Adding those data to our analyses, there were again no differences between experimental groups. Although not statistically significant, some of the differences between groups appear to be fairly substantial, particularly at the one-year point. However, there is no consistent pattern to these differences, sometimes the experimental group percentage is higher, sometimes it is the other way around.

Table 9-1.
Summary of Placement Data, Survival Analyses
Percents of families experiencing placement
of at least one child within specified periods of time
Kentucky
   One month 6 months One year
E C E C E C
Primary analysis 6 5 18 18 23 24
Secondary analysis 4 4 13 17 20 24
Refined Analyses:
  • Investigative cases, primary
8 5 16 14 26 15
  • Recent substantiated, primary
6 3 17 12 29 16
Petition cases, primary 7 10 14 26 18 33
Including relatives, primary 8 9 21 25 27 32
Including relatives, secondary 5 9 14 25 22 32
New Jersey
Primary analysis 4 6 19 16 28 22
Secondary analysis 3 6 18 16 26 22
Refined Analyses:
  • Investigative cases, primary
3 5 18 13 25 16
  • Recent substantiated, primary
8 5 20 12 27 15
Tennessee
Administrative data, primary analysis 11 11 22 19 23 19
Administrative data, secondary analysis 7 12 18 19 19 19
Including relatives, primary 11 11 26 21 28 23
Including relatives, secondary 7 12 20 19 23 21
Refined Analyses:
  • Recent investigation, CORS
7 12 15 15 17 15
  • Recent investigation, includes Relative
7 12 18 18 22 21

Since these programs were intended to prevent the placement of children, the target group for the services was families in which at least one child was "in imminent risk of placement." We found that, by and large, the families served were not in that target group. This is shown by the placement rate within a short period of time in the control group, indicating the placement experience in the absence of family preservation services. In all three states, the placement rate in the control group within one month (a liberal definition of "imminent") was quite low. It would, therefore, have been virtually impossible for the programs to be effective in preventing imminent placement, since very few families would have experienced placement within a month without family preservation services.(4) It should be noted, however, that the rates of eventual placement in the control group were higher, about one-fifth to one-fourth within one year. Hence, it would have been possible for family preservation to have shown effects on placement over time, but those effects were not observed.

There was one group that it seemed might represent better targeting, the "petition" cases in Kentucky. Prior to random assignment, workers submitted petitions to the court for placement or some other court ordered intervention on 67 families. It might be supposed that this group would be more likely to have children placed. Although more of the control group families in this group experienced the placement of a child within one month than other subgroups in Kentucky, that proportion was still quite low (10%), suggesting that focusing on groups such as this (cases with court involvement) would not resolve the targeting problem.(5)

9.1.2 Child Safety

In general, the rates of substantiated allegations of abuse or neglect were quite low. In most of our analyses, there was little difference between the family preservation and control groups in the incidence of reports of maltreatment subsequent to random assignment. An exception was the group of cases in Tennessee with prior allegations of harm within 30 days before random assignment. For this set of families, the control group had a significantly higher rate of subsequent substantiated allegations.

The findings of little difference between the experimental and control group can be read in two ways. It indicates that families served by family preservation were no more likely than families not receiving the service to be subjects of allegations of harm. In this sense, children were, by and large, kept safely at home while receiving family preservation services. However, children in both groups were primarily in their homes, and family preservation did not result in lower incidence of maltreatment compared with children in the control group.

9.1.3 Subgroups

In Kentucky and New Jersey, we examined a number of subgroups of families to determine whether we could detect differences between experimental and control groups on placement and substantiated allegations subsequent to random assignment within each subgroup. Most of the subgroups were defined in terms of problems of the family, for example, substance abuse, financial difficulties, and depression. The number of cases in Tennessee was not sufficient to support subgroup analysis. In only one subgroup was a significant difference found between experimental and control cases: among single mothers in New Jersey, those in the experimental group were less likely to have a subsequent substantiated allegation than those in the control group. No subgroups were found in which there were effects on placement. Hence, the effort to find subgroups for which family preservation service was successful in reducing placement was not successful.

9.1.4 Case Closing and Subsequent Reopening

Family preservation services are sometimes thought to lead to quicker case closings in the public agency and less frequent subsequent involvement with the child welfare agency. Administrative data on case closings and subsequent case openings were examined to determine the effects of these services on case closings and subsequent reopenings. There were no significant differences between experimental groups in rates of case closing over time in the three states. In Kentucky, only three of the cases that were closed had reopened at the time we collected administrative data, two in the experimental group and one in the control group. In New Jersey, the difference between groups in proportion of cases reopened was not significant (21% in the experimental group, 23% in the control group). In Tennessee, significantly more of the closed control group cases reopened (9 of 30, 30%, compared to 8 of 66, 12% of the experimental group).

9.1.5 Family and Child Functioning

We interviewed caretakers at three points in time, shortly after the beginning of service (the "initial" interview), four to six weeks later (at the end of service for families receiving family preservation services, called the "post-treatment interview"), and again a year after services began (the "follow-up interview"). Caseworkers for both experimental and control group families were interviewed at the first two of these points in time. In these interviews, we examined a number of areas of family and child functioning that might have been affected by family preservation services. We looked at both levels of functioning at post treatment and follow up and changes over time in levels of functioning. We examined responses to some of the individual items in the interviews, and we combined responses into various scales measuring dimensions of functioning. The following are the areas examined.

Caretaker interview:

Caseworker interview:

The results of the measures of functioning are summarized in Tables 9-2 and 9-3. In a few of these areas of functioning, in one or the other of the states, families in the experimental group appeared to be doing better post-treatment. There were very few differences at the year follow-up and in changes over time. Those differences that did appear (primarily at post-treatment) were not consistent across states and were not maintained. At best, it can be said that family preservation services may have small, apparently short-term, effects on some areas of functioning. There was one item with some consistency, the overall assessment of improvement by caretakers. At post treatment, in Kentucky and New Jersey, a significantly larger proportion of experimental group caretakers generally thought there was "great improvement" in their lives. This difference was significant in both the primary and secondary analyses. In the Tennessee secondary analysis, results tended in the same direction, though not significantly (p = .09). At follow up, differences between the groups in Kentucky and New Jersey had nearly disappeared. In Tennessee at follow up, control group respondents more often thought there was "great improvement" (p = .055).

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9.2 Targeting

The findings of no effects of family preservation programs on placement rates and of problems in targeting these programs are not new, they have been observed in a number of rigorously designed experiments.(6) Partially as a result of these previous findings, efforts were made in this project to improve targeting. In New Jersey and Kentucky (but not in Tennessee) a screening instrument developed by the evaluators was employed to encourage referral of cases with a risk of imminent placement and to discourage referral of cases not at risk of placement. It is evident that this effort did not work; evidently, the screening instrument was a weak "intervention" in the problem of targeting.

Clearly, referring agents sent families to the programs that did not fit the criterion of imminent risk of placement. Our interviews with referring workers, discussed in earlier chapters, reveal some of the reasons. Workers acknowledged that they often did not refer cases that were at risk of placement, rather they used the programs for families that they thought could benefit from them. Evidently, they believed that in cases where placement was needed, family preservation services were not appropriate, contrary to the assumptions of the designers of these programs. But the programs were valued, and they were used to help families in the context of a generally service-poor child welfare system.

Table 9-2.
Summary of family and child functioning outcomes, data from caretaker interviews
Differences between experimental and control groups at post treatment, follow up, and change over time
Area Post treatment Follow up Change over time
Life events
Positive life events scale (6 items) No significant differences between experimental and control groups in any state No significant differences between experimental and control groups in any state No significant differences between experimental and control groups in any state
Negative life events scale (8 items) No significant differences No significant differences No significant differences
Depression scale (4 items) No significant differences No significant differences No significant differences
Family problems, 9 individual items KY: no significant differences NJ: fewer experimentals did not have enough money for food, rent, or clothing TN: fewer experimentals had few or no friends No significant differences NA
Economic functioning (4 items)
Individual items KY: no significant differences NJ: experimental group had less difficulty paying rent and buying clothes TN: no significant differences KY: no significant differences NJ: no significant differences TN: fewer experimentals had difficulty paying rent NA
Scale KY: no significant difference NJ: experimental average lower (better) TN: no significant difference No significant differences No significant differences
Household condition (10 items)
Individual items KY: experimentals had fewer broken windows or doors NJ: no significant differences TN: more experimentals in unsafe building because of illegal acts No significant differences NA
Scale No significant differences No significant differences No significant differences
Child care practices (15 items)
Individual items KY: fewer experimentals used punishment for not finishing food NJ: experimentals less often got out of control when punishing child and more often encouraged child to read a book TN: more experimentals went to amusement park, pool, or picnic No significant differences NA
Positive scale (5 items) No significant differences No significant differences No significant differences
Negative scale (10 items) KY: no significant difference NJ: experimentals lower (better) TN: no significant difference No significant differences No significant differences
Punishment (5 items) KY: no significant difference NJ: experimentals lower (better) TN: no significant difference No significant differences No significant differences
Caretaker depression scale (13 items) No significant differences No significant differences No significant differences
Child behavior
Aggression scale (3 items) No significant differences No significant differences No significant differences
School problems (5 items) No significant differences No significant differences No significant differences
Positive child behaviors (10 items) No significant differences No significant differences No significant differences
Negative child behaviors (21 items) KY: no significant differences NJ: experimental group lower (better) TN: no significant differences No significant differences No significant differences
Overall assessment of improvement KY: experimentals, greater improvement NJ: experimentals, greater improvement TN: no significant difference No significant differences NA
Note: Changes over time were not determined for individual items so entries for those cells are designated "NA."

Table 9-3.
Summary of family and child functioning outcomes, data from caseworker interviews
Differences between experimental and control groups at post treatment and change over time
Area Post treatment Change over time
Caseworker report of caretaker functioning (9 items)
Individual items KY: no significant difference NJ: control group higher (better) in ability in giving affection and providing learning opportunities TN: experimental group higher (better) on five items KY: respecting child's opinions: experimental group declined, control group increased NJ: control group had more positive change in respecting child's opinions TN: experimental group more positive change on setting firm and consistent limits
Scale KY: no significant difference NJ: no significant difference TN: experimental group higher (better) No significant differences
Caseworker report of household condition Scale (13 items) KY: control group better NJ: control group better TN: no significant difference No significant differences
Caseworker report of caretaker problems Scale (21 items) KY: experimentals more problems NJ: no significant difference TN: no significant difference KY: no significant difference NJ: no significant difference TN: experimentals declined more
Caseworker report of child problems Scale (12 items) No significant differences No significant differences

There are other possible explanations for the low placement rate in the control group. It is possible that in cases assigned to the control group, workers on those cases exerted efforts to prevent placement of the child. Placement prevention as a central value may pervade the system (perhaps more during the time we were collecting these data than now, it is possible that the Adoption and Safe Families Act has shifted emphasis away from this value). Of course, in this regard the philosophy of family preservation seems to have been widely adopted, even though rigorous evaluations have not shown placement prevention effects of its services.

But there are still other aspects of the targeting problem. Homebuilders has developed into a quite generalist program, used in a wide variety of cases. In Kentucky and New Jersey there is considerable heterogeneity in the cases referred to these services, in both characteristics and problems of families and in where the case is in the child welfare system. Families come from both the investigative and on-going phases of cases.(7) It seems likely that many of those referred from on-going caseloads are not referred because of likelihood of placement but because the case is not going well and everything else has been tried.(8) Families do not always appear to be in crisis, another important criterion for referral. Furthermore, a number of cases do not involve abuse or neglect, but rather are cases of child dependency or of parent-adolescent conflict. And the cases involve a wide range of ages of children at risk. It could be argued that this variation is detrimental to the development of programs. No one program can expect to be successful in all cases. Having such variation inevitably results in a lack of focus and prevents the development of specialized expertise in handling particular cases. The lack of focus and expertise is likely to affect the outcomes that can be expected. Furthermore, the variation in the character of cases must contribute to variations in outcomes.

A natural response to this state of affairs is that we must tighten up the targeting, demanding strict adherence to referral criteria. Our attempts to assist states to do this were clearly unsuccessful. We suggest that it will be extremely difficult to achieve the goal of better targeting. There are a number of reasons for this skepticism. Referring workers acknowledged that they often referred families that were not at risk of placement, at least not those at imminent risk of placement. We cannot fully explain why workers did not follow the rules for referrals, but we can propose some conjectures. Workers believe that they remove children from the home only when that is absolutely necessary, when no service can prevent placement. In this sense, one might conclude that family preservation values have come to pervade the system, there are few unnecessary placements, leaving few placements to be prevented with intensive services.(9) However, these services are valued by referring workers, they are responses to the needs of families (families other than those with children about to be placed), and services to meet those needs are scarce. Hence, family preservation programs are used for very real needs of families in the child welfare system.

Beyond this dynamic, there is the general tendency to expand the benefits of a good program. If a program is believed to be beneficial, it is often assumed that it will be useful for an ever-expanding range of cases. Evidently, this occurred in the states we studied. Expansion of the target group is aided by the fact that target group definitions usually have one or more vague terms that allow for the expression of discretion (e.g., most people’s problems can be conceptualized as "crises").

Finally, our efforts to identify particular groups of families for which the programs are successful at preventing placement were mostly unfruitful. Hence we are unable to satisfy the demands of policy makers and practitioners for guidance on specific groups that might be targeted.

These circumstances, together with the fact that referrals to family preservation programs involve judgments that cannot be completely systematized or circumscribed, lead to our skepticism about the likelihood of improving targeting of these programs. Furthermore, it is possible that the programs are, by and large, being used in those circumstances for which they are best suited.(10)

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9.3 Possible Alternative Explanations of the Findings

Positive findings of experimental evaluations provide evidence for the validity of a theory of intervention and confirm the effectiveness of a particular implementation of that theory. Null findings are more ambiguous, they do not necessarily disprove an intervention theory and may not even be evidence of ineffectiveness of implementation. One cannot be sure whether the results are due to problematic program conceptions, inadequate program implementation, unique contextual problems, or flawed evaluation procedures. The findings of this study will be questioned, as have those of the previous studies, for various supposed methodological and implementation shortcomings. We consider here some of the factors that might have affected the findings, beginning with problems in the implementation of the evaluation.

Violations of experimental assignment. In all three states, there were violations of experimental group assignment, that is, families assigned to the control group that were given family preservation services. This was particularly a problem in New Jersey, where 14% of the control group families received family preservation. The dictates of rigorous analysis required that we retain these cases in the control group (we also conducted "secondary" analyses in which we dropped these cases from analysis and there were few differences between our primary and secondary analyses). Violation cases could significantly affect the findings. For example, they could represent cases that would have experienced placement in the absence of the service. To the extent this was the case, the placement rate in the control group would be underestimated. This could affect the conclusions about both the effective targeting rate and experimental-control group differences in placement.

We attempted to examine the extent to which violations might have affected the results in New Jersey (there were too few violations in Kentucky and Tennessee to have significant effects). Even if all of the violations had been placed early on, the proportion of families in the control group experiencing placement would not have reached levels that one would consider close to adequate targeting. Sensitivity analysis in which all violations are assumed to be placed early suggests that under this extreme assumption there would have been differences in placement rates favoring the family preservation group early on but these differences dissipate over time.(11) Hence, at the very least, violations could not affect a conclusion that family preservation does not appear to prevent long placements of a year or more.

Inclusion of minimal service cases in the analysis. Some families in the experimental group did not receive family preservation services or received only small amounts of service. These cases were included in the primary analysis and it might be argued that this reduced the apparent effects of the service and that we should have eliminated these cases from analysis to produce a fair estimate of effects. We did drop these cases from our "secondary" analysis, and found few differences compared to the primary analysis. In addition, it should be observed that programs will always have minimal service cases, cases in which the family cannot be found, declines service, or otherwise refuses to cooperate. Retaining them in the analysis is appropriate in determining the average effects of the service over a group of cases thought to need the service. Theoretically, one might be able to reduce the size of the minimal service group through better targeting, but in practice, it is likely to be difficult to identify a substantial proportion of these cases prior to referral.

The "John Henry" effect. The John Henry effect is reputed to be present in some experimental evaluations. This is the situation in which workers in control group cases exert special efforts on behalf of families, providing them far more service than would have been provided in normal circumstances (so the control group is not a "regular service" group). There are a couple of possible reasons this might occur. A worker might be unhappy with the experiment in general and with the assignment of this particular case to the control group in particular, and exert special effort in response. Alternatively, workers might feel the families assigned to the control group really need the experimental service, the prevention of placement is very important, so efforts are made to emulate Homebuilders. (This may be a special case of experimental leakage.)

In Kentucky and New Jersey, there is no evidence in the data on services to suggest this happened. Families in the experimental group did receive much more service than the control group. It is possible that the control group received more than "regular services." We cannot determine that. So it is possible that there is a threshold of services that has placement prevention effects and that was reached by the control group. If this were the case, it would indicate that the desired results can be obtained without intensive family preservation services.

In Tennessee, there is some evidence that families in the control group may have received as much, or perhaps more, service than the experimental group. This is seen in a specific set of questions asked of the caretakers about services received, and is not confirmed in other evidence regarding services provided to the two groups. Nonetheless, we cannot be as confident in Tennessee that experimental group families received much more service than the control group. Since the outcomes of the two groups were similar, this could again be taken as an indication that the results could be obtained without the family preservation services we studied.

Effects of the experiment on the nature of the referred group. It is possible that instituting the experiment caused a change in the character of cases referred to the program. In particular, agencies and workers were required to refer more cases in order to fill the control group as well as the experimental group. This resulted in dipping further into the pool of cases, perhaps taking "less severe" cases, those with less risk of placement. Anticipating this problem, we endeavored to select sites for the experiment in which demand considerably exceeded supply, however, we cannot be sure that we succeeded in this regard. It is also possible that workers referred different cases because of the chance that they would be assigned to the control group and not receive family preservation services. Or they may have changed referral practices to sabotage the research.

We cannot be sure that these factors were not present in referrals of families to the experiment, but we have no strong evidence that they were a strong influence. Operating against such dynamics were the desires of workers to provide significant services to families.

The program implementation was flawed. The family preservation programs in Kentucky, New Jersey, and Tennessee claimed adherence to the Homebuilders model of service. However, it is possible that the implementation did not adequately follow that model, with the result that this evaluation was not a fair test of the model. We attempted to measure certain aspects of model adherence and found some variation from the prescribed ideal. One cannot expect any implementation of a model to adhere totally to it, adaptations must be made to local conditions, the character of individual cases, and to the styles of individual workers. Models of social service do not provide for the same response in all cases nor can they be used to prescribe exactly what should be done in each case. Even for the best specified model, judgment abounds in its application, such that there might be legitimate disagreements as to whether it was applied in a particular case. In fact, one might hope that a model would be "robust" for at least small violations of it, having benefit even when it is not applied in an ideal way.

In the end, it is a matter of judgment as to whether the model was adequately adhered to in these three states. The fact that we have three states with similar findings, that is, similar degrees of adherence to the model, is again relevant. Was the model violated in all three states? Possibly, but that would then suggest the difficulty, perhaps the unlikelihood, of adequately implementing it elsewhere.

Contextual factors caused the model to fail. It is possible that a variety of contextual factors caused the outcomes that we observed. There are a multitude of possible such factors: the political and economic climate, the climate in the agencies, administrative barriers, approaches of judges, competence of workers, availability of other services, etc. These influences would weigh on both the experimental and control groups, presumably in equivalent ways, but they could prevent any new approach from having effects different from usual treatment. While we cannot exclude such factors as explanations for our results, again the fact that we have three states with similar results is relevant. Multiple sites make it less likely that the same contextual factors are explanations of the findings. Furthermore, social programs must operate in less than ideal contexts, to be effective, their conceptualizations must take into account these circumstances.

One set of contextual factors may have prevented positive effects of family preservation services: broad social problems of poverty, racism, inadequate housing, inadequate education, and substance abuse. Perhaps it is unrealistic to expect a short term program to solve such serious problems.

The program conceptualization is flawed. It is always possible that findings such as ours are the result of program design that is flawed. Obviously, this is the interpretation that is most difficult for program advocates to contemplate. But it is possible that the intervention activities of family preservation programs, even if carried out in an ideal way, are inadequate to achieve their goals. We note here one specific aspect of these programs that is often criticized and blamed for perceived failures: their brevity. It is often suggested that a program only four weeks in length, even if it is very intense, cannot expect to have significant effects on very serious individual and family problems which are often of long duration, therefore requiring much longer interventions. Going even further, it is possible that the available intervention technology is simply inadequate in the face of the problems it is expected to solve.

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9.4 What to Make of These Findings

The findings of this study are not new. As in this investigation, a number of previous evaluations with relatively rigorous designs have failed to produce evidence that family preservation programs have placement prevention effects or have more than minimal benefits in improved family or child functioning. The work reported here may be thought of as three independent evaluations, in three states, adding to the set of previous studies with similar results. While the findings of this study can be questioned (as have those of the previous studies), the accumulation of like findings from a number of studies in several states, with varying measures of outcome, is compelling.

The results do not indicate that family preservation services are detrimental to families. Generally, families in these programs did not do worse than those in the control groups. Nor should the findings be taken as showing that these programs serve no useful purpose in the child welfare system. The findings can be seen as a challenge to keep trying, to find new ways to deal with the problems of families in the child welfare system. The findings indicate the grave difficulties facing those who devise approaches to those problems, failure in such undertakings should not be surprising, and those who risk trying to find solutions should not be punished when evaluations such as this indicate they may have come up short.

The accumulation of findings suggests that the functions, target group, and characteristics of services in programs such as this need to be rethought. Obviously, function, target group, and services are closely intertwined. We discuss below some of the issues that should be considered in rethinking these programs.

The foremost of these issues concerns the objectives of the programs. A number of observers have suggested that placement prevention be abandoned as the central objective in intensive family preservation services in favor of other objectives, notably the improvement of family and child functioning. We have suggested above that targeting these services on families at risk of placement is unlikely to be successful, so if these services are to continue, they will continue to serve "in-home" cases, families in which there has been a substantiated allegation of abuse or neglect or serious conflicts between parents and children but in which children remain in the home. Although the focus of concern in child welfare policy has long been on foster care, in most jurisdictions there are more cases opened for in-home services than for foster care (a relatively small proportion of indicated reports of maltreatment eventuate in removal of the child from the home and even fewer result in long term placement). Many, if not most, of these "intact" families need help. Relatively intensive and relatively short-term services such as those provided by family preservation programs are one source of such help. In this respect, family preservation programs can be thought of as an important part of the continuum of child welfare services.

Another question that program designers must address is that of specialization. We did not find subgroups for which the programs were successful, but as indicated above, these programs are quite generalist in character, and thus may sacrifice some of the benefits of specialization. Among those benefits are a clearer focus of services, tighter target group definition, specification of service characteristics such as length and intensity based on needs of the target group, and the development of more specific competencies on the part of workers. Specialization could be in terms of problems (e.g., substance abuse) or characteristics of clients (young, isolated mothers). There are clear drawbacks to specialization, including the tendency to define problems in terms of the service one offers. Furthermore, limiting target groups inherently limits the impact of programs. Nonetheless, it may be better to mount a series of small programs rather than putting all of one’s resources into large, undifferentiated efforts.

Another issue that program planners must address is that of length and intensity. These aspects of services are generally considered to be inversely related. Because of cost, long-term services cannot be as intensive as short-term efforts. The Homebuilders model pushes the combination of intensity and short term to what seems to be the limit: no more than two cases per worker at a time, 10 to 20 hours of work on a case per week for one month, a period of time much shorter than the planned service period in traditional social services. This is a bold departure from the usual way of doing things. It is based on ideas of crisis intervention. At the time of crisis, people are ready to change and ready to make use of intensive help to change. While crises can happen at any time, child welfare clients are thought to be most likely to be "in crisis" at the time of, or shortly after, an investigation of child maltreatment. Hence, the prototypical family preservation case is a family referred by an investigative worker.

The extent to which the intensive-short-term-crisis approach fits the needs of child welfare clients needs to be reexamined. Families encountering the child welfare system have often been there before and have usually been involved with other public or private service programs, so that being investigated and threatened with removal of a child is more an element of on-going experiences than a crisis. Furthermore, the lives of these families are often full of difficulties — externally imposed and internally generated — such that their problems are better characterized as chronic, rather than crises.

Families with chronic difficulties can no doubt benefit from short-term, intensive services, but those services are unlikely to solve, or make much of a dent in the underlying problems. As an example, substance addiction is a chronic problem in many child welfare families, one that cannot usually be successfully treated in a month’s time, however intensive the treatment. Of course, the hope is that family preservation programs will be able to connect families with on-going services to treat more chronic problems, but that appears to happen far less than needed. The central point here is that we need a range of service lengths and service intensities to meet the needs of child welfare clients.

Perhaps the best summary of the status of family preservation programs was provided by McGowan in 1990:

Family preservation services must not be viewed as a panacea. These are categorical programs able to help only one segment of the total range of families and children in need of support and are organized to provide limited types of case services. They cannot address the socioeconomic forces that contribute to tensions and inadequacies in family functioning nor can they provide the long-term assistance and/or specialized treatment required by some parents and children. Thus it is essential to maintain realistic expectations of what these programs can and cannot do.(12)

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Endnotes

(1) J. Littell and J. Schuerman. (1995). A Synthesis of Research on Family Preservation and Family Reunification. http://aspe.hhs.gov/hsp/cyp/fplitrev.htm. [Back To Text]

(2) We did not assess the extent to which reducing placement was an appropriate goal in particular cases; preventing placement and preserving families whenever possible is a well accepted value of the child welfare system. [Back To Text]

(3) The language we use here is carefully chosen. Technically, we cannot conclude that the programs had no effect. [Back To Text]

(4) It would be unreasonable to expect that targeting would be perfect, that is, that all cases referred for services were at imminent risk of placement. But how high should the targeting rate be? The answer to that question depends on the impact of the program, its costs, and the cost of placement. If the impact of the program is large (that is, it substantially reduces the rate of placement in those cases in which placement would have occurred) or if it is relatively inexpensive relative to the cost of placement, the targeting rate can be lower. Some algebra indicates that the ratio of cost of FPS to placement cost averted (per case served) must be less than the proportion of cases in which placement was averted. For example, if the targeting rate was .5 and the success rate was .4, then the proportion of cases served that result in placement avoidance will be .2 (the product of .5 and .4). The ratio of the cost of FPS to the cost of placement must then be less than .2 for FPS to be cost effective. [Back To Text]

(5) This group also showed the largest difference between the experimental and control groups in percentages of families experiencing placement at one year, a difference of 15% favoring the experimental group. However, the difference is not significant. Furthermore, there are other differences in the table almost as large, some favoring the control group. [Back To Text]

(6) J. Littell and J. Schuerman. (1995). A Synthesis of Research on Family Preservation and Family Reunification. http://aspe.hhs.gov/hsp/cyp/fplitrev.htm. [Back To Text]

(7) A number of cases in Kentucky and New Jersey were referred to family preservation to assist in the return home of children from foster care. These reunification cases were excluded from the experiment, but they may have contributed to the diffusion of the program. [Back To Text]

(8) The fact that the case is not going well and that everything else has been tried may or may not mean that placement is likely. Note that "everything else has been tried" is sometimes specified as a criterion for Homebuilders referral. As we noted earlier, this criterion conflicts with the objective of immediate response to crisis. [Back To Text]

(9) However, it is clear that there is great variation among jurisdictions, workers, judges, and other decision makers in the circumstances in which children are removed from their homes (J. Schuerman, P. Rossi, and S. Budde. (1999). Decisions on Placement and Family Preservation. Evaluation Review 23:599-618). [Back To Text]

(10) We note one effort to solve the targeting problem in the family preservation program in Detroit. As part of an experimental evaluation of the Families First program, judges were asked to identify cases in which they intended to remove a child from the family, but which they deemed could be diverted to family preservation. After screening by project personnel, a group of such cases was randomly assigned to family preservation or to other services, presumably placement. Results of the study have not been published to date. Our understanding is that the group selected for random assignment was a relatively small portion of all families designated for placement. Furthermore, although the procedure was very promising from the standpoint of tightening up the evaluation, it is unlikely that it could be implemented widely or consistently to solve the targeting problem. [Back To Text]

(11) Under the assumption that all violations would have been placed in the first month, 27% of the control group would have been placed in the first six months, compared to 19% of the experimental group. At one year, the proportions would have been 29% in the control group and 28% in the experimental group. [Back To Text]

(12) Brenda McGowan. (1990). Family-based services and public policy: Context and implications. In J. Whittaker, J. Kinney, E. Tracy, and C. Booth (eds.). Reaching high risk families: Intensive family preservation in human services. (pp. 81-82) New York: Aldine de Gruyter. [Back To Text]


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