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Program Profile: HOMEBUILDERS

Evidence Rating: Effective - More than one study Effective - More than one study

Date: This profile was posted on February 01, 2012

Program Summary

An in-home, intensive family preservation service and reunification program for families with children returning from or at risk of out-of-home placement. The program is rated Effective. The start of the treatment period until a child returned home was significantly shorter for the experimental group. There were successful reunifications for both the treatment and control group. The intervention was shown to significantly reduce the rate of out-of-home placement.

Program Description

Program Goals

HOMEBUILDERS is an in-home, intensive family preservation service (IFPS) and reunification program for families with children (newborn to 17 years old) returning from or at risk of placement into foster care, group or residential treatment, psychiatric hospitals, or juvenile justice facilities. The HOMEBUILDERS model is designed to eliminate barriers to service while using research-based interventions to improve parental skills, parental capabilities, family interactions, children’s behavior, and family safety. The goals are to prevent the unnecessary out-of-home placement of children through an intensive, onsite intervention and to teach families new problem-solving skills to improve family functioning.


Target Population

HOMEBUILDERS therapists work with youths and families involved in the child welfare, juvenile justice, and mental health system. For high-risk families involved with the child protective services system, the goal of the program is to remove the risk of harm to the child instead of removing the child. Therapists work with families to teach them new behaviors and help them make better choices for their children, while ensuring child safety. In addition, HOMEBUILDERS also works with youths and their families to address issues that lead to delinquency, while allowing youths to remain in the community. Program staff work with youths to ensure they attend classes regularly, adhere to curfews, comply with the courts, and learn anger management and conflict-resolution skills to avoid getting into more trouble. Finally, the program works with youths so they can avoid the trauma and stigma of psychiatric hospitalization or residential treatment for mental health–related issues by providing crisis intervention and skill building, involving the families in the youths’ treatment, and broadening the continuum of care.

 

Program Components
The primary intervention components of the HOMEBUILDERS model are engaging and motivating family members; conducting holistic, behavioral assessments of strengths and problems; developing outcome-based goals; using evidence-based cognitive–behavioral interventions; teaching skills to facilitate behavior change; and developing and enhancing ongoing supports and resources.

 

The core program strategies are:

 

  • Intervention at crisis point. HOMEBUILDERS therapists work with families when they are in crisis. Families are seen within 24 hours of referral to the program.
  • Accessibility. Services are provided in the family’s home and community (e.g., school) at times convenient to families, including evenings, weekends, and holidays. Therapists are available 24 hours a day, 7 days a week, for crisis intervention. This accessibility allows close monitoring of potentially dangerous situations.
  • Flexibility. Intervention strategies and methods are tailored to meet the needs, values, and lifestyles of each family. Services are provided when and where the families wish. Therapists also provide a wide range of services, such as helping families meet the basic needs of food, clothing, and shelter; using public transportation; budgeting; and, when necessary, dealing with the social services system.
  • Time limited and low caseload. Families receive 4 to 6 weeks of intensive intervention, with up to two “booster sessions.” Therapists typically serve two families at a time and provide 80 to 100 hours of service, with an average of 45 hours of face-to-face contact with the family.
  • Strengths based. Therapists help clients identify and prioritize goals, strengths, and values and help them use and enhance strengths and resources to achieve their goals.
  • Ecological/holistic assessment and individualized treatment planning. Assessments of family strengths, problems, and barriers to service/treatment and outcome-based goals and treatment plans are completed collaboratively with each family.
  • Research-based treatment practices. Therapists use evidence-based treatment practices, including motivational interviewing, behavioral parent training, cognitive–behavior therapy strategies, and relapse prevention. Therapists teach family members a variety of skills, including child behavior management, effective discipline, positive behavioral support, communication skills, problem-solving skills, resisting peer pressure, mood management skills, safety planning, and establishing daily routines.
  • Support and resource building. Therapists help families assess their formal and informal support systems and develop and enhance ongoing supports and resources for maintaining and facilitating changes.
  • Critical thinking framework. Therapists, supervisors, and managers use a critical thinking framework for assessing, planning, implementing, and evaluating progress and outcomes.

Evaluation Outcomes

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Study 1

Reunifications

Fraser and colleagues (1996) found that the number of days from the start of the treatment period until a child returned home was significantly shorter for families in the family reunification services (FRS) experimental group. On average, children in the FRS group were returned to their homes in 20.7 days during the 90-day service period. No FRS group children were reunified during the 12-month follow-up period. The children in the control group were reunified on average in 44.6 days during the 90-day period, while the children who were reunified during the follow-up period did so, on average, in 113 days.

 

Significantly more children in the FRS group returned home by the end of the study period, compared with children in the control group. Of the 57 children in the FRS group, 55 (96.5 percent) were reunified within the first 90 days. The remaining two children never returned home during the observation period. Only 17 of the 53 children in the control condition (32 percent) were returned home during the 90-day period, while 11 others (21 percent) were returned during the follow-up period.

 

Success of Reunifications

Of the 55 reunifications in the FRS group, 15 failed (27 percent) and these children were returned to foster care. Of the 28 reunifications in the control group, three failed (10.7 percent) and these children returned to care. Although a higher proportion of reunifications in the control group were successful (compared with the FRS group), the difference was not statistically significant. In addition, among the children who were reunified, there were no significant differences between the FRS and control groups for the amount of time at home. Children in the FRS group spent 351.3 days in their homes, while children in the control group spent 310.3 days in their homes. These findings suggest that children in the FRS group who were reunified fared just as well as children in the control group who received routine services.

 

Study 2

Placement Prevention

Kirk and Griffith (2003) found some significant impacts of intensive family preservation services (IFPS). In an initial analysis that did not control for other risk factors, IFPS and non–IFPS cases had similar placement rates at the 1-year follow-up period, with 27 percent of children in both groups experiencing a placement. However, when additional analysis controlled for prior placement, the results showed that the IFPS significantly reduced the rate of out-of-home placement. At 1 year, 19 percent of IFPS cases had experienced a placement, compared with 44 percent of non–IFPS cases. Further, when analysis controlled for prior substantiated reports of abuse or neglect, IFPS was again shown to have significantly reduced the rate of out-of-home placements—with 29 percent of IFPS cases experiencing an out-of-home placement, compared with 37 percent of non–IFPS cases.

 

In addition, the hazard rate for IFPS indicated that children in the treatment group were 21 percent less likely than non–IFPS children to experience a placement within 1 year. Children in the treatment group who received IFPS and did not experience a new high-risk substantiated report of abuse or neglect within the 1-year follow-up period (86 percent) had an average reduction in the hazard rate for placement of 32 percent (a significant, positive treatment effect). Conversely, children who received IFPS and did experience a new high-risk substantiated report within 1 year had an average increase in the hazard rate of placement of 70 percent. Similarly, children in the comparison group who did not receive IFPS and experienced a new high-risk substantiated report within 1 year had an average increase in the hazard rate for placement of 16 percent.

 

Additional analysis confirmed the positive treatment effect for the 86 percent of treatment group children who received IFPS and did not experience a new high-risk substantiated report; however, the results indicate that the treatment effect slowly diminished over time. By 270 days after referral to IFPS, a 5 percent increase in the hazard rate of placement is estimated for children in the treatment group who received services but did not experience a new high-risk substantiated report.

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Evaluation Methodology

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Study 1
The 1996 evaluation by Fraser and colleagues included 57 children whose families received experimental family reunification services (FRS), based on the HOMEBUILDERS model, compared with a group of 53 children whose families received routine reunification services as a component of an overall out-of-home care plan. Families participating in the study were randomly selected from a computer-generated list of foster care caseloads in four child welfare districts across the State of Utah. Eligibility criteria consisted of the following:

 

  • The child was in placement for more than 30 days.
  • Reunification was not imminent.
  • Reunification was part of an overarching case plan.
  • The child could be returned home to at least one parent.
  • The child was not thought to be at risk of harm if returned home.
  • The child was not in a specialized treatment program.

Overall, 120 families were randomly selected and invited to participate (however 10 families were lost during the service period). They were randomly assigned to either the experimental or control condition. Children in the intervention group were primarily white (82.7 percent) and female (57.9 percent), with an average age of 10.8 years. On average, children had been in 2.8 previous placements, with a range from 1 to 7 prior placements. The length of prior placements ranged from 1 to 85 months, with an average of 10.7 months. The most frequent reason for placement was child behavior (28.1 percent), followed by neglect (24.6 percent), parent–child conflict (14 percent), sexual abuse (10.5 percent), and physical abuse (8.8 percent). No significant differences were found on demographic variables between the groups.

 

Outcomes measured included length of time to reunification and length of stay at home before any future out-of-home placement. Proportional hazards analysis was used to investigate outcomes. The observation period started with the beginning of the 90-day FRS experimental condition (or the corresponding date for a child selected for the control condition) and ended 1 year after the termination of that 90-day service period.

 

Study 2

The evaluation by Kirk and Griffith (2003) used a retrospective, population-based design to examine the ability of intensive family preservation services (IFPS) to prevent out-of-home placements of children in abusive or neglectful families. The study sites included 51 of North Carolina’s 100 counties. The treatment group included all families from counties offering IFPS with children who received their first IFPS intervention between July 1, 1994, and March 31, 2001, and their first substantiated report after July 1, 1993, but before March 31, 2001. The comparison group, which did not receive IFPS, included all other families in the same counties with children who experienced their first substantiated report after July 1, 1993, but before March 31, 2001.

 

An operational definition of “imminent risk of placement” was imposed retrospectively, using ratings on the standardized child protective services (CPS) risk assessment instrument. A risk rating of “high” mandated removal of the child, unless an approved alternative plan was immediately implemented that ensured the child’s safety. Only families with high-risk ratings were including in the study, whether or not they received IFPS. The final study sample included 542 high-risk children who received IFPS and 25,772 high-risk children who did not receive IFPS but resided in the same counties.

 

The treatment group was 51 percent female, 59 percent white, and 41 percent nonwhite. Seventy-five percent of the treatment group were from 0 to 10 years old at the time of their referral to IFPS, and 25 percent were 11 or older. The comparison group was 50 percent female, 54 percent white, and 46 percent nonwhite. Seventy-nine percent of the comparison group was 0 to 10 at the time of the CPS report, and 21 percent were 11 or older. There were several significant differences between the groups with respect to race, age, and type of maltreatment. Children in the treatment group were more likely to be white and younger. IFPS cases were also more likely to be substantiated for injurious environment, whereas non–IFPS cases were more likely to be substantiated for general neglect. IFPS cases were also more likely to have experienced open or more prior substantiated reports of maltreatment and one or more prior high-risk substantiated reports.

 

The outcome measure of interest was placement prevention, defined as the absence of out-of-home placement 1 year from the beginning of IFPS for the IFPS treatment group or 1 year from the date of the substantiated report of abuse and neglect for children in the comparison group. Data was obtained from several sources, including the IFPS–specific Management Information System, the CPS risk assessment information from the North Carolina Child Abuse and Neglect System, and child placement data from the State information system used to track children entering out-of-home placements.

 

Event history analysis was used to assess differences in placement rates and patterns for children in the study. Event history analysis computes the relative risk of placement over time. The Cox proportional hazards regression model (the Cox model) was also used to examine associations between each independent variable and the hazard rate for placement while holding all other independent variables constant. A Cox regression model with time-dependent covariates was also used to examine time-related interactions.

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Cost

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Lee, Aos, and Miller (2008) conducted a systematic review of research evidence to identify what works to improve child welfare outcomes. After identifying and analyzing 74 methodologically rigorous evaluations of programs and policies, they performed a cost–benefit analysis to estimate the monetary value of the benefits of these programs if they were implemented. Several of the studies they examined looked at the effectiveness of intensive family preservation service programs based on the HOMEBUILDERS model. Their analysis found that, for each dollar invested in the HOMEBUILDERS program, the total benefit-to-cost ratio per participant was $2.54. The total benefits minus the costs was $4,775, a positive result indicating that money is saved by investing in the program.
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Implementation Information

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Information on training and products for the HOMEBUILDERS Intensive Family Preservation Services and Intensive Family Reunification Services are available at the Institute for Family Development Web site (please see Additional References for a link).

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Fraser, Mark W., Elaine Walton, Robert E. Lewis, Peter J. Pecora, and Wendel K. Walton. 1996. “An Experiment in Family Reunification: Correlates of Outcomes at 1-Year Follow-up.” Children and Youth Services Review 18:335–61.

Study 2
Kirk, Raymond S., and Diane P. Griffith. 2003. “Intensive Family Preservation Services: Demonstrating Placement Prevention Using Event History Analysis.” Social Work Research 28:5–18.
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Additional References

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These sources were used in the development of the program profile:

Blythe, Betty J., and Srinika Jayaratne. 1999. Michigan Families First Effectiveness Study: A Summary of Findings. State of Michigan Family Independence Agency.

Fraser, Mark W., Peter J. Pecora, and David A. Haapala. 1991. Families in Crisis: The Impact of Intensive Family Preservation Services. Hawthorne, N.Y.: Aldine de Gruyter.

Institute for Family Development. 2010. “Home.” Accessed December 20, 2011.
http://www.institutefamily.org/

Kinney, Jill, David A. Haapala, and Charlotte Booth. 1991. Keeping Families Together: The HOMEBUILDERS Model—Modern Applications of Social Work. Hawthorne, N.Y.: Aldine de Gruyter.

Lee, Stephanie, Steve Aos, and Marna Miller. 2008. Evidence-Based Programs to Prevent Children from Entering and Remaining in the Child Welfare System: Benefits and Costs for Washington. Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/rptfiles/08-07-3901.pdf

Morris, Edwin, Lourdes Suarez, and John C. Reid. 1997. “Behavioral Outcomes of Home-Based Services for Children and Adolescents With Serious Emotional Disorders.” Family Preservation Journal 3:21–32.

Pecora, Peter J., Mark W. Fraser, and David A. Haapala. 1991. “Intensive Home-Based Family Preservation Services: Client Outcomes and Issues for Program Design.” In Kathleen Wells and David E. Biegel (eds.). Family Preservation Services: Research and Evaluation. Newbury Park, Calif.: Sage, 30–32.

Rodenhiser, Roy W., Joseph Chandy, and Kazi Ahmed. 1997. “Intensive Family Preservation Services: Do They Have Any Impact on Family Functioning?” Family Preservation Journal Summer 1995:69–85.

Washington State Institute for Public Policy. 2006. Intensive Family Preservation Programs: Program Fidelity Influences Effectiveness. Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/rptfiles/06-02-3901.pdf

Wood, Sally, Keith Barton, and Carroll Schroeder. 1988. “In-Home Treatment of Abusive Families: Cost and Placement at 1 Year.” Psychology 25:409–14.
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Program Snapshot

Age: 1 - 17, 24 - 40

Gender: Both

Race/Ethnicity: Black, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): Home, Other Community Setting

Program Type: Cognitive Behavioral Treatment, Crisis Intervention/Response, Family Therapy, Parent Training, Victim Programs, Children Exposed to Violence

Targeted Population: Young Offenders, Victims of Crime, Children Exposed to Violence, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide, Model Programs Guide, National Registry of Evidence-based Programs and Practices

Program Director:
Charlotte Booth
Executive Director
Institute for Family Development
34004 16th Avenue South, Suite 200
Federal Way WA 98003
Phone: 253.874.3630
Fax: 253.838.1670
Website
Email

Researcher:
Peter Pecora
Managing Director
Casey Family Programs
2001 Eighth Avenue, Suite 2700
Seattle WA 98121
Phone: 206.270.49836
Fax: 866.322.7863
Website
Email

Researcher:
Raymond S. Kirk
Director of Research and Program Evaluations
Independent Living Resources, Inc.
411 Andrews Road, Suite 140
Durham NC 27705
Phone: 919.384.1457
Website
Email

Researcher:
Elaine Walton
Emeritus Professor
School of Social Work, Brigham Young University (Retired)
160 E. 4635 N.
Provo UT 84604
Phone: 801.228.7125
Email

Training and TA Provider:
Shelley Leavitt
Associate Director
Institute for Family Development
34004 16th Avenue South, Suite 200
Federal Way WA 98003
Phone: 253.874.3630
Fax: 253.838.1670
Website
Email