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 four independent evaluations, in four 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 far 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. (123)
111. J. Littell and J. Schuerman. (1995). A Synthesis of Research on Family Preservation and Family Reunification. http: //aspe.hhs.gov/hsp/cyp/fplitrev.htm .
112. 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.
113. The language we use here is carefully chosen. Technically, we cannot conclude that the programs had no effect.
114. This concern was less present in Philadelphia, since that site did not expressly target cases at imminent risk of placement.
115. 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.
116. 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 percent 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.
117. J. Littell and J. Schuerman. (1995). A Synthesis of Research on Family Preservation and Family Reunification.
http: //aspe.hhs.gov/hsp/cyp/fplitrev.htm .
118. 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.
119. 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.
120. 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).
121. 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.
122. Under the assumption that all violations would have been placed in the first month, 27 percent of the control group would have been placed in the first six months, compared to 19 percent of the experimental group. At one year, the proportions would have been 29 percent in the control group and 28 percent in the experimental group.
123. 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.