Program Profile: HOMEBUILDERS

This is an in-home, family preservation service and reunification program for families with children returning from or at risk for out-of-home placement. The program is rated Effective. The treatment group had a statistically significant greater number of reunifications and reduced rates of out-of-home placement, compared with the control group. However, there were no significant differences between groups in successful reunification (i.e., whether the children returned to foster care).

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination .

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.

Study

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. Subgroup analyses was not conducted.

Study

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. The authors conducted subgroup analyses, to see the impact of the program on youth who did and did not experience a new high-risk substantiated report of abuse or neglect within the 1-year follow-up period.

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.

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 website: http://www.institutefamily.org/ .

Subgroup Analysis

With regard to subgroup findings, Kirk and Griffith (2003) found children in the treatment group who received intensive family preservation services (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 statistically significant 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.

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

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.

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.