In the studies reviewed so far, rates of placement in the groups provided family preservation services were quite low. However, we cannot conclude from these results that the services were the cause of the low rates of placement. The reason for this is that we cannot be sure what would have happened to these cases in the absence of services. To determine this, we need comparison groups that are as similar as possible to the groups provided services. While the overflow studies did incorporate comparison groups, the overflow groups were often quite small and we cannot be certain that they were similar to treatment groups at the outset. The best assurance of initially equivalent comparison groups is to randomly assign cases that are referred for services to treatment and control groups.
Below we review the results of controlled studies of family preservation programs; these studies are described in greater detail in Table 2.16 Early studies (those conducted in the late 1970s and early 1980s) involved smaller groups of clients than more recent evaluations.
The New York State Preventive Services Demonstration Project, conducted in the mid-1970s, foreshadowed later family preservation programs. It provided intensive services to families over approximately 14 months (Jones, Neuman, and Shyne 1976). During the Spring and Summer of 1974, the project served cases in which placement was thought to be imminent, families with children in placement, and those in which children had recently been returned home. The goals of the project were to prevent placement, reunify families, and prevent reentry into foster care. Here we focus on the subgroup of families in which children were living at home at the time of referral (the effort to reunify families with children in foster care is discussed below). Families of 525 children were randomly assigned to the program or a control group. At the end of treatment, placement rates were significantly lower in the experimental group than in the control group (7% versus 18%). Six months after the termination of services 8 percent of children in the program group and 23 percent of those in the control group had been placed (Jones, Neuman, and Shyne 1976). A follow-up study of a subsample of 243 children in the experiment was conducted five years after the project ended. At that time, 34 percent of the children in the experimental group and 46 percent of those in the control group had been placed in foster care, a statistically significant difference (Jones 1985). Thus, the program appears to have had beneficial effects on placement, although the differences between the experimental and control groups were not large, and determination of long term effects is quite problematic because of sample loss at the time of the five-year follow-up (less than 50% were followed).
Special Services for Children, a public agency in New York City, provided intensive services to families with children "at risk of placement." A randomized experiment involved 120 families with 282 children (Halper and Jones 1981, reviewed in Stein 1985). Four percent (6) of the 156 children in the experimental group and 17 percent (22) of 126 in the control group were placed in substitute care during the project (a statistically significant difference).
The Hudson County (New Jersey) Special Service Project in the late 1970s served families whose children were thought to be at "risk of placement within the next two years" (Magura 1981, Stein 1985). Ninety families were randomly assigned to program and control groups. At the end of the three-year demonstration project, 24 percent (11) of families in the program and 18 percent (8) of those in the control group experienced placement of a child (a non-significant difference) (Willems and DeRubeis 1981).
Nebraska Intensive Services to Families at Risk served families at risk of placement because of actual or suspected child maltreatment (Nebraska Department of Public Welfare 1981, reviewed in Stein 1985). One hundred and fifty-three families were randomly assigned to experimental or control groups. Experimental cases were more likely to be placed with relatives and friends than control cases which required more public foster care. Although the exact number of children placed is not known,17 available data indicate that 4 percent (3) of 80 families in the experimental group and 11 percent (8) of 73 families in the control group had one or more children placed in out-of-home care (Stein 1985), a non-significant difference.
The Home Based Services Demonstration Project of the Ramsey County, Minnesota (St. Paul) child protective services department (Lyle and Nelson 1983) involved random assignment of 74 families to an experimental, family-centered, home-based unit or one of three traditional child protection units (Frankel 1988). Three months after services ended, 33 percent of families in the experimental group had experienced placement of one or more children, compared with 55 percent of families in the control group. Of the children who were placed, those in the experimental group spent significantly less time in substitute care (Frankel 1988).
The Family Study Project in Hennepin County, Minnesota (Minneapolis) involved random assignment of 138 cases to experimental and control units of the county agency (Hennepin County Community Services Department 1980, reviewed in Stein 1985). The families served had children under age 15 who "were at risk of placement, but who were judged by intake workers not to be at imminent risk of abuse or neglect" (Stein 1985, p. 116). The experimental group had a higher number of children placed in foster care (123 versus 84 children in the control group); however, the total number of children in each group was not reported (Stein 1985). Of those placed, children in the experimental group spent slightly fewer days in placement (mean of 199 days) than those in the control group (mean of 208 days).
A Social Learning Treatment Program in Oregon, involved parents with children between the ages of 3 and 12 who were considered at risk of placement because of child abuse and neglect. A randomized experiment compared the experimental services with regular child protective services (Szykula and Fleischman (1985). The experiment included families of 48 children.18 Cases were identified as more or less difficult by workers, based on numbers of prior abuse reports and types of family problems.19 Cases within each difficulty group were randomly assigned to program or control services. The experimental program appeared to reduce the risk of placement among less difficult cases: 8 percent (1 of 13) of the children in the less difficult experimental group and 38 percent (5 of 13) of those in the comparable control group were placed. However, there was no significant difference between program and control groups in placement rates for more difficult cases: 64 percent (7 of 11) of children in the more difficult experiment group versus 45 percent (5 of 11) in the control group. The overall effect of the program (for both groups) was not significant.
The results of early experimental studies of family preservation programs were mixed: some found little or no effects on placement while others found that the programs achieved slight reductions in placement. However, in all studies, relatively few control group families experienced placement. This means that services were generally not delivered to the target group of families at risk of placement.
16 This table and our review of controlled studies on family preservation programs are adapted from Schuerman, Rzepnicki, and Littell (1994). Other reviews of this literature have been provided by Jones (1985); Stein (1985); Frankel (1988); Fraser, Pecora, and Haapala (1991); Rossi (1991); Wells and Biegel (1991); Nelson and Landsman (1992); and Kaye and Bell (1992).
17 Data on informal placements with relatives and friends and on placements outside the project county were not available.
18 The authors describe another study, involving an A-B-A reversal design that focused on the numbers of substitute care placements in Jackson County, Oregon before, during, and after installation of a social learning treatment program. Although the authors suggest that placements declined during the nine month period in which the program was in operation, the results are not convincing since placement was a fairly low-incident event in this county (only 58 placements were recorded during the entire 49-month study period).
19 The "less difficult" group included families with fewer than three reports of abuse, no serious housing or transportation problems, and children with conduct problems. Those in the "more difficult" group had three or more prior reports; serious problems with employment, transportation, and housing; and "major problems outside of their relationship with their child" (Szykula and Fleischman 1985, p. 281).