California's AB 1562 In-home Care Demonstration Project, in operation in eight counties from 1986 to 1989, was an intensive, in-home services program. Cases thought to involve "imminent risk of placement" due to abuse or neglect were referred by county child protective services offices.20 Families were served for an average of 7 weeks in programs conducted in eight sites by seven private agencies and one public mental health agency. Data were collected on 709 (96%) of the 741 families served by these programs over a three year period (Yuan, McDonald, Wheeler, Struckman-Johnson, and Rivest 1990).
A sub-study in five of the eight counties involved the random assignment of cases to in-home services or to regular services of the county child welfare agencies. There were 152 families in each group. Cases were followed for 8 months after random assignment. Outcome data were available for 293 (96%) of the cases in the randomized experiment. In 20 percent of the control group families and 25 percent of the experimental group families a placement occurred between two and 8 months after referral--a non-significant difference.21 (A similar proportion of the entire group of 709 families experienced placement in the study period.) There were no substantial differences in lengths of time in placement and costs of placement.22
New Jersey Family Preservation Services (FPS), modeled after Homebuilders, provided services for a median of 6 weeks. Private agencies in five counties served families referred by local child welfare offices, county family court or crisis intervention units, and regional community mental health centers. The FPS programs served "several waves" of families before a randomized experiment was instituted by the state. Data are available on 117 experimental and 97 control cases that were randomly assigned in four of New Jersey's 21 counties (Feldman 1991). Another 33 families were "turned back" after random assignment to the experimental services (because they did not meet selection criteria, the caretaker refused to participate in the program, or the children were deemed at imminent risk of harm and were removed from the home); these cases were not included in the analysis. The exclusion of 22 percent of the cases assigned to the experimental group seriously compromises comparisons of the experimental and control groups. These cases are clearly different from those that remained in the experiment and comparable cases were not excluded from the control group. Since these cases are likely to have experienced placement, the observed placement rate in the experimental group is probably understated.
During the intervention period (approximately 6 weeks) 6 percent of families in the experimental group and 17 percent of the families in the control group experienced placement of at least one target child. At 6 months post-termination, 27 percent of families in the experimental group and 50 percent of control group families had experienced at least one placement.23 At one year post-termination 43 percent of those in the experimental group and 57 percent of families in the control group had experienced placement. (Differences between groups were statistically significant at each point in time.)24 There is some evidence that the program delayed placement but the magnitude of this effect dissipated over time. For the first target child to enter placement in each family, there were no significant differences between the experimental and control groups in types of placements,25 numbers of placements, or duration of time in placement. We report below findings on measures of family functioning.
In the Family Support Project in Los Angeles families were referred by the county Department of Children's Services to two private child welfare agencies for in-home family support services. Referrals were based on "caseworker judgment about need for the services" and were not limited to cases in which children were thought to be at imminent risk of placement (Meezan and McCroskey 1993).26 An evaluation involved random assignment of 240 families to in-home services or regular child protective services. Data on placements were available for 231 families. At the beginning of the project 37 (34%) of the 108 families in the in-home services group and 30 (24%) of 123 families in the control group had one or more children in placement. During the project, 19 (6%) of the 335 children in the experimental group were placed, compared with 34 (8%) of 424 children in the comparison group. At the end of the project (12 months after services ended), families in the experimental group had more children in out-of-home placements than those in the comparison group (38% versus 24%) (McCroskey and Meezan 1993). Below we report the study's findings regarding program effects on family functioning.
The Illinois Family First Experiment is the largest randomized experiment conducted in this area to date (see Schuerman, Rzepnicki, and Littell 1994). The primary goal of the Family First program was to prevent placements among families in which a child had been abused or neglected; other goals included reducing the risk of subsequent child maltreatment, improving child and family functioning, linking families to other community services, and closing cases in the child welfare system. Initially, families referred to the project were thought to be at imminent risk of placement. Family preservation services were provided by sixty private agencies under contract with the state. Data were collected on 6,522 families referred to the program between December 1988 and December 1992. Between April 1990 and April 1992, families in six sites (containing 18 Family First programs) were randomly assigned to intensive family preservation services or regular child welfare services.27 (A seventh site was dropped from the experiment because 20% of the case assignments in that site were violated.) A total of 1,564 families participated in the experiment (995 were assigned to Family First and 569 to the control group). These cases were followed through March 1993.
Family First workers carried caseloads of 5 families on average, compared to average caseloads of 50 for workers who provided services to families in the control group. Overall, cases in the Family First program received far more intensive contact than those in the control group. Family First cases were much more likely to receive counseling, crisis intervention, advocacy, parent education, referrals for medical and specialized services, and an array of concrete services including transportation, material aid, and cash assistance. One-fifth of the cases in the control group were never opened for services in the state child welfare agency and 51 percent of those that were opened received no services of any kind during the first 90 days after random assignment. Interviews with a subsample of 278 parents in the program and control groups in three experimental sites were conducted to obtain longitudinal data on child and family functioning, parents' views of the services they received, major life events, social support, and further service utilization. These interview data support the conclusion that FPS cases received much more extensive help than cases in the control group.
Overall, the Family First program appeared to result in a slight increase in the risk of placement. At one year after random assignment, placement had occurred in approximately 27 percent of Family First cases and 21 percent of control cases. In the two experimental sites in the Chicago area, increases in the risk of placement for children in the Family First group were statistically significant (there were no sites in which the program produced a significant reduction in placement rates). Differences between experimental and control groups in placement rates were not significant once variations in case characteristics were taken into account. There were no significant differences between groups in the duration or types of placements (Schuerman, Rzepnicki, and Littell 1994).
The risk of placement among cases in this experiment was very low at the time of referral. Placement rates in the control group were approximately 7 percent at one month after random assignment, 17 percent at six months, 21 percent at one year, and 27 percent at two years. Since the program served few cases that would have experienced placement in the absence of family preservation services, we can conclude that Family First did not reach its target population of cases at "imminent risk of placement."
The Family First program had a net-widening effect in that it provided services to families that would not ordinarily have received services in the child welfare system (as noted above, 20% of the control cases were never opened for services). This effect was particularly striking in several sites. However, the program had no long-term effect on the duration of time families spent in the child welfare system.
The effects of the Family First program on subsequent maltreatment and on measures of child and family functioning are discussed below.
20 During the second year of the study, "imminent risk" was defined as the expectation (based on statements from the referral source) that action would be taken to remove the child(ren) within two weeks unless intensive services were provided. The researchers reported that many caseworkers found this definition too stringent and confusing.
21 Placements that terminated within 8 weeks of random assignment were not included in analyses of placement rates; in these cases, children were considered to be reunified with their parents during the intensive service period. A child-level analysis showed that 18 percent of children in the project group and 17 percent of children in the control group were placed between 2 and 8 months after random assignment.
22 Control group children tended to be placed more quickly than those who received intensive in-home services. Rossi (1991) has termed this the "moratorium effect" of family preservation programs in delaying, but not necessarily preventing, placement.
23 For control group cases, termination was defined as "6 weeks after referral to FPS or actual termination of community services, whichever came first" (Feldman 1991, p. 69).
24 Differences between groups were computed at termination and at 1, 2, 3, 6, 9, and 12 months post-termination.
25 Types of placements included homes of relatives, foster homes, emergency and runaway shelters, residential centers, detention, independent living, mental health in-patient facilities, and teaching family homes.
26 The project also accepted some referrals from schools, hospitals, mental health clinics, and other community agencies. Compared with families referred by DCS, cases that were referred by other sources were seen by the in-home services workers as having less severe problems at referral (Meezan 1993).
27 The probability of assignment to family preservation services was .6. Thus, about 60% of the families were assigned to these services, the remaining 40% to regular services.