In 1980, the Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) required states to make “reasonable efforts” to prevent children from entering foster care and to reunify children who were placed out of the home with their families. A major focus of policy and planning in state child welfare systems was the development of family preservation programs. The emphasis on family preservation culminated in 1993 in the Family Preservation and Family Support provision of the Omnibus Budget Reconciliation Act (OBRA) (Title IV, subpart 2 of the Social Security Act), which encouraged states to institute or further develop family preservation and family support.
As part of the legislation, the Department of Health and Human Services (HHS) was authorized to set aside funds to evaluate State family preservation and family support programs. In support of this, HHS funded three separate studies in September 1994:
- Family Preservation and Family Support Services Implementation Study. This study was awarded to James Bell Associates and is a process analysis of the implementation of the legislation, focusing on the types of programs developed and the barriers encountered. The interim report, “Family Preservation and Family Support (FP/FS) Services Implementation Study,” was released March 1999.
- National Evaluation of Family Support Programs. This study was awarded to Abt Associates, Inc. and is an outcome evaluation of family support programs.
- The Evaluation of Family Preservation and Reunification Services. This study was awarded to Westat, Chapin Hall Center for Children, and James Bell Associates and is the subject of this report. It is an outcome evaluation of family preservation and reunification programs.
The three projects are designed to be complementary. Although each focuses on a different aspect of the 1993 legislation, taken together they represent a comprehensive examination of the programs authorized.
More recently, the enactment of the Adoption and Safe Families Act of 1997 changed and clarified a number of policies established in the 1980 Act with a renewed emphasis on safety, permanency, and adoption. This legislation placed Federal family preservation initiatives under the rubric of “Promoting Safe and Stable Families” and extended the funding for three years, through FY 2001. The law made safety of children the paramount concern in service delivery. The law increased the need to understand how family preservation services strengthen families and prevent foster care placement and subsequent abuse and neglect allegations.
Concurrent with the development of legislation have been program initiatives in family preservation at the state and local levels. Since the 1970s, a number of programs have been developed to provide services to children and families who are experiencing serious problems that may eventually lead to the placement of children in foster care or otherwise result in the dissolution of the family unit. Although these programs share a common philosophy of family- centered services, they differ in their treatment theory, level of intensity of services, and length of service provision. Three models have emerged (Nelson, et al. 1990):
- Crisis intervention model. This model, based on crisis theory and intervention stresses the situation of everyday people confronted with unstable and unsecure circumstances from precipitating events, and the belief that symptoms can be worked through in a brief amount of time (Barth, 1990). Crisis theory also holds that those experiencing a crisis — that is, families about to have a child placed in foster care — will be more amenable to receiving services and learning new behaviors (Nelson et al, 1990, citing Kinney et al, 1988). Homebuilders, a foster care placement prevention program developed in 1974 in Tacoma, Washington, is the prototype program for the crisis intervention model. The program calls for short-term, time-limited services provided to the entire family in the home. Services are provided to families with children who are at risk of an imminent placement into foster care. Social learning theory also plays a part in defining the Homebuilders program, providing the theoretical base for interventions employed (Nelson et al, 1990). Social learning theory stresses that behavior, beliefs, and expectations influence each other in a reciprocal manner, and rejects the belief that changes in thinking and feeling must precede changes in behavior (Barth, 1990). Concrete and supportive services are an important element of the Homebuilders program. Key program characteristics include: contact with the family within 24 hours of the crisis, caseload sizes of one or two families per worker, service duration of four to six weeks, provision of both concrete services and counseling, and up to 20 hours of service per family per week (Nelson et al, 1990).
- Home-based model. This model focuses on the behavior of the family overall, how members interact with one another, and attempts to change the way in which the family functions as a whole and within the community. Programs using the home-base model stress longer term interventions based on family systems theory. The FAMILIES program which began in Iowa in 1974 is the original program using the home-base model. Under the original program in Iowa, teams of workers carried a caseload of 10 to 12 families whom they saw in the families’ homes for an average of four and one-half months. Both concrete and therapeutic services are provided (Nelson et al, 1990).
- Family treatment model. This model focuses less on the provision of concrete and supportive services and more on family therapy (Nelson et al, 1990, citing Tavantzis et al, 1986). Services are provided in an office as well as in the home and are less intensive than those using the crisis intervention model. The Intensive Family Services (IFS) Program, which began in Oregon in 1980, is based on the family treatment model. The IFS program also uses family systems theory, which views individual behavioral problems as a reflection of other family problems. Therefore, treatment focuses on the family as a whole. Workers carry a caseload of approximately 11 families. Services are provided for 90 days with weekly follow-up services provided for three to five and one-half months (Nelson et al, 1990).
Over the years, various states have adopted these family preservation models, sometimes with variations. The growth in family preservation can be partly attributed to early evaluations that were “unequivocally positive and reported high placement prevention successes” (Bath, Howard, and Haapala, 1993). Primarily, these studies only measure family outcomes such as placement prevention for families who receive the treatment. No comparison was made to families who did not receive the services. It was assumed that nearly all children would be taken into foster care placement. However, it cannot be assumed that a high proportion of children receiving family preservation services were at imminent risk without observing the experiences of a comparison group that did not receive the intervention. More recent studies using experimental designs have shown that most of the cases referred were not at imminent risk of placement, as many children in the control groups did not become part of the foster care population.
Although many nonexperimental studies have suggested that high percentages of families remain intact after intensive family preservation services, the results of randomized experiments are mixed. Seven of eleven studies reviewed in A Synthesis of Research on Family Preservation and Family Reunification (Littell and Schuerman, 1995) found that the programs did not produce significant overall reductions in placement. In less than half of the control or comparison cases, placements did not occur within a short period of time after group assignment, which suggests that these programs were generally not delivered to families with children at risk of placement. When the risk of placement among family preservation clients is low, it is unlikely that a program will demonstrate significant reductions in placement.
Despite these findings, placement prevention remains a primary goal of family preservation programs. A review of family preservation programs was conducted in 1995 as part of the Evaluation of Family Preservation and Reunification Services. Information from that study was updated in 1997. As part of the update, 32 family preservation state coordinators were asked if placement prevention was the primary purpose of their program. The majority (78 percent) indicated that it was still the primary purpose, with the remaining coordinators identifying child safety (18 percent) and family functioning (4 percent) as the primary purpose. These goals broaden when county public agency and family preservation administrators were asked about the objectives of local family preservation progress. From the 32 states, 58 county public agency administrators and family preservation program administrators were asked to describe their family preservation objectives. Of the 58 administrators contacted, most offered multiple service objectives. The most frequently reported objective was placement prevention, followed by strengthening families and child and family safety. The purpose of the Evaluation of Family Preservation and Reunification is to test whether these service delivery objectives are attained.