A Synthesis of Research on Family Preservation and Family Reunification Programs. Tables

05/01/1995

TABLE 1:

SUMMARY OF NON-EXPERIMENTAL STUDIES OF FAMILY PRESERVATION PROGRAMS

 

STUDY Arizona Department of Economic Security, Division of Social Services, Administration for Children, Youth and Families, 1993
STATE Arizona
DESIGN AND SAMPLE SIZE Descriptive report on 195 families with 567 children who received Family Preservation Services covering fiscal year 1993.
TARGET POPULATION Families whose children are at risk of out-of home placement due to abuse or neglect.
PROGRAM SERVICES Services were provided by nine private agencies in contract with the state. The average length of service for families who entered the program was 56 days. One provider operated a four week program; the remaining providers offered six to eight week programs. Each agency spent an average of 45 hours providing direct services (usually in-home counseling), and 41 hours providing indirect services (these figures are based on the 182 families who exited the program in fiscal year 1993). Up to $300 was available to each family for emergency assistance (i.e., for rent, utilities, food). Service delivery models varied somewhat among the provider agencies.
OUTCOMES Investigators used three measures of success when analyzing outcome: a comparison of risk level at the beginning of family preservation services with risk level at completion of family preservation services, the number of new substantiated reports of child abuse or neglect that involved families who were receiving family preservation services (and at six months post-treatment), and number of out-of-home placements within families who were receiving family preservation services (and at six months post-treatment). Seventy-nine percent of families completed the program; risk status was reduced for 78 percent of families. In addition, almost 83 percent of families who entered and exited the program had no new substantiated reports of child abuse or neglect while receiving family preservation services. Eighty-six percent of the children who entered and exited the program during fiscal year 1993 did not experience out-of-home placement while participating in the program, and at six months following program completion.
STUDY Cunningham, et al. (1993)
STATE Tennessee
DESIGN AND SAMPLE SIZE Descriptive report on 2,558 families referred for family preservation services (Tennessee Home Ties), 2,479 were accepted for services, from October 1989 to June 1992.
TARGET POPULATION Cases in which placement was thought to be imminent. 22% referred from Department of Mental Health and Mental Retardation, 12.5% referred from Department of Youth Development, 50% referred from Department of Human Services. Nearly 41% were ordered by the court to out-of-home placements. Age 17 years or younger. 45% of the children at risk had been in prior out-of-home placement. These children had an average of 1.7 previous placements.
PROGRAM SERVICES Services provided by 28 community service agencies. Behavioral-cognitive approach. Median length of service, 4 weeks. Crisis resolution, parenting education, child development training, advocacy, communication and negotiation skills, home maintenance skills, concrete services, job readiness training, linkages to other services.
OUTCOMES At termination, of 2,795 children on whom information was available, 92% were not in state care. At a 12 month follow-up, 69% were not in state care. Cost avoidance analyses were performed. An analysis of a small overflow comparison group was to have been completed in 1993.
STUDY Hoecker (1994)
STATE Missouri
DESIGN AND SAMPLE SIZE Descriptive report on 2,178 referrals for family preservation services (1,052 accepted for services) covering fiscal year 1994.
TARGET POPULATION Cases in which placement was thought to be imminent. A child was considered at-risk of placement if they had been abused or neglected, were severely emotionally disturbed, or had been involved in delinquent behavior.
PROGRAM SERVICES Services were provided by the Department of Social Services; 35 Family Preservation Sites were involved. In-home services were provided on a daily or weekly basis and emergency housing funds were available. Preservation services were delivered for a six week period, after which cases were referred for less intensive continuing family assistance services (Loman & Siegel, 1994).
OUTCOMES Of the 1,088 families that exited the program during fiscal year 1994, 918 were intact and 144 were not intact. Reasons for a family not being intact included child ran away, child moved out of home (not placed), child living with relative or guardian (court ordered), child in foster home or group home, child in residential treatment, child with Division of Youth Services, child in juvenile justice or child in in-patient psychiatric diversion. Of the 2,054 children considered at-risk within the 1,088 exiting families, 1,799 returned home, while 222 did not return home.
STUDY North Carolina Department of Human Resources, Division of Family Development (1994)
STATE North Carolina
DESIGN AND SAMPLE SIZE Descriptive annual report on the family preservation services provided to 486 families during fiscal year 1993-1994 (756 families were referred for services, 486 families received services beyond intake). A limited number of qualitative case studies are also presented. One appendix provides instruments used in data collection.
TARGET POPULATION Families with a child or children at risk of out-of-home placement into foster care, or a mental health, developmental disabilities or substance abuse facility, or training school.
PROGRAM SERVICES In FY 1993-1994 15 Family Preservation Service Programs provided services in 32 counties. These programs were based in either county departments of social services, area mental health/developmental disabilities/substance abuse services programs or private non-profit agencies. Families received services for a six week period. Services provided included in-home family and individual counseling and parent skills training; several programs also provided transportation, food, housekeeping assistance, budgeting assistance, financial counseling, and substance abuse prevention services.
OUTCOMES At program completion, 88% of families remained intact (children had not been removed or placed). Fifty-nine children were placed out-of-home; 7 children were placed in the mental health system, 6 children were placed in the juvenile justice system, 1 child was placed in a private placement, and 1 child ran-away.
STUDY Pearson & King, 1987
STATE Maryland
DESIGN AND SAMPLE SIZE Quasi-experimental design. At intake, cases were assigned to either Intensive Family Services or traditional family services based on an assessed "risk of placement" level. Cases assigned to Intensive Family Services were assessed as more at risk of placement. 180 families were referred for traditional services while 80 families were referred for Intensive Family Services.
TARGET POPULATION Cases assessed at intake as being most at risk of foster care placement based on an assessed "risk of placement" level. Risk level was assessed through the use of a standardized risk assessment form completed by all workers at intake.
PROGRAM SERVICES Staff were assigned six cases at a time. In-home services were provided by Intensive Family Services staff (a worker or aide) between 1.1 and 2.1 times per week on average during the first month of service and less than once a month during the second and third months of service. On average, 3.55 total contacts were made per week over a 3 month period. "Flex dollars" were available to assist with payment of rent or utilities, the purchase of furniture and clothing, and transportation/vehicle needs. Intensive Family Services were provided for approximately 90 days.
OUTCOMES Of the 180 cases referred for traditional services, 33 percent experienced foster care placement within 6 months. 18 percent of the original 180 cases were immediately placed in foster care. Of the remaining 148 families who were referred for traditional services, 18 percent were placed within six months or at termination of services (six months or less). Of the 80 cases referred for Intensive Family Services, 7.5 percent were placed within 90 days or at termination of services (90 days or less). At 12 month follow-up, 8 percent of the 148 cases referred for traditional services were open in foster care, while 3 percent of the 80 cases referred for Intensive Family Services were open in foster care.
STUDY Showell, Hartley and Allen (N.D.)
STATE Oregon
DESIGN AND SAMPLE SIZE Based on data collected in 1987, this descriptive study of 999 families reports on six types of family systems: 1) neglectful, 2) sexually abusive, 3) physically abusive, 4) suicidal, 5) adoptive, and 6) delinquent. The study also discusses findings related to high and low success in family treatment. Worker surveys provided family data at time of service termination, as therapists filled out anonymous questionnaires for each family served. Families were also surveyed, and the study reports on parent satisfaction measures.
TARGET POPULATION Oregon maintains two family preservation programs. The first, Intensive Family Services, began in 1980 and is designed to serve families at risk of having a child removed from the home. The second, called High Impact, began in 1982 and is designed to serve families when they first enter the family services system; this program is designed to help prevent the threat of a child's removal from home.
PROGRAM SERVICES Treatment is short term, lasting from 90 to 120 days. On average, monthly caseworker loads were between 8.73 and 11.1 families. Of Oregon's 36 counties, 29 were served by these programs. The specific nature of service offered is not clear, although the authors write: "the focus of treatment is on healing relationships between family members rather than attempting to heal what appears to be an emotional or behavioral flaw that intrinsically resides within a 'dysfunctional' family member" (p. 4).
OUTCOMES Treatment success is discussed in relation to each of the six types of family systems outlined above; success is reported based on therapist judgement of the success of treatment and the likelihood of the family avoiding placement in the future. Therapist ratings of overall clinical success and overall likelihood of a family remaining intact in the future are also reported. Sixteen percent of families were rated as having a "poor" likelihood of remaining intact, 19% of families were rated as having a "fair" likelihood of remaining intact, 27% of families were rated as having a "good" likelihood of remaining intact, 21% of families were rated as having a "very good" likelihood of remaining intact, and 17% of families were rated as having an "excellent" likelihood of remaining intact. The authors conclude: "we are satisfied that the empirical data of actual placements...correlate with the subjective judgements of therapists about clinical success. Systemic family treatment is successful in improving family life. Families are better able to remain together" (p. 49).
STUDY Thieman and Dail (1992); Thieman and Dail (1993)
STATE Iowa
DESIGN AND SAMPLE SIZE Descriptive statistics are provided on the approximately 1,828 families served by Iowa's Family Preservation Program during fiscal year 1992 (see 1993 report; the sample size used in the analyses may be smaller as families served under 10 days and cases with substantial amounts of missing data were dropped). A qualitative report is also included, based on interviews with a subsample of 39 families.
TARGET POPULATION Exact criteria used for referral to preservation services is not clear. The authors report that 84% of families referred for services "were considered to be regular, non-emergency cases" (pp. 5-6, 1993) and "58% of the children were considered to be target children (in placement, immediate, or high risk), and 9% were actually living in an out-of-home placement" (p. 7, 1993). Case problem areas listed include child abuse or neglect, child's behavior, delinquency, chaotic environment and parental dysfunction. Cases were referred by a variety of institutions, including child abuse investigative units, schools, and the courts. Most cases were referred by a child abuse investigative unit (29%) or were self-referrals (30%).
PROGRAM SERVICES Services were provided by 13 agencies, lasting on average 44.93 days. Services provided included face-to-face contact and availability of cash assistance (for rent payments, transportation needs and food).
OUTCOMES Upon completing the preservation program, 77% of families remained intact, while 8% of children had been placed in "formal out-of-home placements" and 3% of children had been placed with a relative or friend. At 30 day follow-up, 76% of families remained intact, while 9% of children had been placed in "formal out-of-home placements" and 4% of children had been placed with a relative or friend. Placement was more likely for families who were referred on an emergency basis, who had a history of psychiatric care, who had experienced prior out-of-home placement, or who had children under court jurisdiction.

 

TABLE 2:

SUMMARY OF CONTROLLED STUDIES OF FAMILY PRESERVATION PROGRAMS

 

STUDY Jones, Neuman, and Shyne (1976); Jones (1985)
STATE New York
DESIGN AND SAMPLE SIZE Families of 525 children were randomly assigned to the program or a control group.
TARGET POPULATION Cases in which placement was thought to be imminent, families with children in placement, and those in which children had recently been returned home (here we focus only on the first group).
PROGRAM SERVICES Demonstration services were provided by seven voluntary agencies in New York City (through subcontracts with Special Services for Children), the Monroe County Department of Social Services, and the Westchester County Department of Social Services. Both the program and control groups received traditional child welfare services (including counseling, financial assistance, medical care, family-life education, and day care). Intensive services were provided to cases in the experimental group over approximately 14 months. Caseloads in the experimental group were usually 10 families per worker and the families in this group received significantly more in-person contacts with workers.
OUTCOMES:  
Placement 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% of children in the program group and 23% of those in the control group had been placed. 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% of the children in the experimental group and 46% of those in the control group had been placed in foster care, a statistically significant difference. Note that sample loss at the time of the five-year follow-up (less than 50% were followed) limits the usefulness of these data.
Child

Maltreatment

At the five-year follow-up, 21% of 98 families in the experimental group had experienced one or more indicated reports of child maltreatment, compared with 25% of 44 control group families. The difference between groups was not statistically significant.
Child and Family

Functioning

N/A
Other N/A
STUDY Hennepin County Community Services Department (1980)
STATE Minnesota
DESIGN AND SAMPLE SIZE Random assignment of 138 cases to experimental and control units of the county agency.
TARGET POPULATION 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).
PROGRAM SERVICES Staff in the experimental group carried a maximum caseload of 15 families, compared to caseloads of 22 to 40 families among workers in the control group. Experimental cases received an average of 40 hours of service, compared with 32 hours for control cases. All agency services were available to families in both groups; specific services provided to families were not described (Stein 1985).
OUTCOMES:  
Placement 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).
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Halper and Jones (1981)
STATE New York
DESIGN AND SAMPLE SIZE Randomized experiment involving 120 families with 282 children.
TARGET POPULATION Families with children "at risk of placement."
PROGRAM SERVICES Services were provided by Special Services for Children, the public child welfare agency in New York City. Families in both the experimental and control groups received counseling, homemakers, day-care, and recreational, medical, legal, financial, and family planning services. The primary difference between groups was the intensity of services provided: over a one year period, families in the experimental group had three times the number of in-person contacts with workers (an average of 39 versus 13) and almost 12 times the number of telephone contacts (39 versus 3.4). Project staff also had significantly more contact with collateral and provided emergency financial assistance, vocational counseling, and housing assistance to families. They carried caseloads of 11 to 12 families, while the average caseload size for workers in the control group was 18 families.
OUTCOMES:  
Placement During the project, 4% (6) of the 156 children in the experimental group and 17% (22) of 126 in the control group were placed in substitute care (a statistically significant difference).
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Nebraska Department of Public Welfare (1981)
STATE Nebraska
DESIGN AND SAMPLE SIZE 153 families were randomly assigned to experimental or control groups.
TARGET POPULATION Families at risk of placement because of actual or suspected child maltreatment.
PROGRAM SERVICES Services were provided by the public child welfare agency in Nebraska. Workers in the experimental unit spent about 30% of their time in direct contact with clients, while those in the control unit spent about 20% of their time in either in-person or telephone contact with clients. The main difference between these units is that staff in the experimental group were under less time pressure and had more support and direction in decision-making. Information on caseload sizes and specific services provided to experimental and control families was not available (Stein 1985).
OUTCOMES:  
Placement Control cases required more public foster care, compared with experimental cases which were more likely to be placed with relatives and friends. Although the exact number of children placed is not known, available data show that 4% (3) of 80 families in the experimental group and 11% (8) of 73 families in the control group had one or more children placed in out-of-home care, a non-significant difference. Data on informal placements with relatives and friends and on placements outside the project county were not available.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY William and DeRubeis (1981)
STATE New Jersey
DESIGN AND SAMPLE SIZE 90 families were randomly assigned to program and control groups.
TARGET POPULATION Families whose children were thought to be at "risk of placement within the next two years."
PROGRAM SERVICES Services were provided by the Hudson County (New Jersey) Special Services Project. All families received referrals to community mental health, day care, family planning, health care, and homemaker services. Those in the experimental group had access to legal advocacy, group therapy, and emergency financial services and were more likely to be referred for employment services, homemaker or teaching services, housing services, legal aid, and welfare assistance. Workers in the experimental group carried caseloads of 11 families each; caseload size for the control group was not reported (Stein 1985). Families in the experimental group received more home visits and had more contact with workers in their offices.
OUTCOMES:  
Placement At the end of the three-year demonstration project, 24% (11) of families in the program and 18% (8) of those in the control group experienced placement (a non-significant difference). Children in the control group were more likely to be placed in restrictive settings (such as residential treatment) and less likely to be placed with relatives than those who received more intensive services. While more control group children were returned to their families (7 versus 3), reunification in the control cases was described as "unplanned and unsuccessful."
Child Maltreatment N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Lyle and Nelson (1983)
STATE Minnesota
DESIGN AND SAMPLE SIZE Random assignment of 74 families to one of three traditional child protection units or an experimental, family-centered, home-based unit.
TARGET POPULATION N/A
PROGRAM SERVICES Services were provided by the Ramsey County (St. Paul, Minnesota) child protective services department. Families served in the home-based services unit received a combination of counseling and concrete services. Families in the control group received traditional case management services. Caseloads in the experimental unit were half the size of those in the traditional units. Cases in all units remained open for approximately 10 to 12 months.
OUTCOMES:  
Placement Three months after services ended, 33% of families in the experimental group had experienced placement of one or more children, compared with 55% 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).
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Szykula and Fleischman (1985)
STATE Oregon
DESIGN AND SAMPLE SIZE Randomized experiment with families of 48 children. Cases were identified as more or less difficult by workers, based on numbers of prior abuse reports and types of family problems. Cases within each difficulty group were randomly assigned to program or control services.
TARGET POPULATION Clients were parents with children between the ages of 3 and 12 who were considered at risk of placement due to child abuse and neglect.
PROGRAM SERVICES A social learning treatment program was compared with regular child protective services. The program was conducted in the child protective service unit of Cascade County Social Services in Oregon. No data were provided on the type, duration, or intensity of services received by families.
OUTCOMES:  
Placement The experimental program appeared to reduce the risk of placement among less difficult cases: 8% (1 of 13) of the children in the less difficult experimental group and 38% (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% (7 of 11) of children in the more difficult experiment group versus 45% (5 of 11) in the control group. The overall effect of the program (for both groups) was not significant.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Wood, Barton, and Schroeder (1988)
STATE California
DESIGN AND SAMPLE SIZE An overflow comparison study conducted in conjunction with researchers at the University of California at Davis. Of the 50 families referred to the project, 26 received FamiliesFirst services as well as other county services. The remaining 24 families did not receive home-based services because of insufficient space in the program; these families received regular county child protective services.
TARGET POPULATION Families were referred to the project by child protective services staff. Eligible families had children who had been abused or neglected and were thought to be at risk of having at least one child placed out of the home. Target children in the in-home services group were somewhat older than those in the comparison group (average of 8.9 years versus 5.4 years).
PROGRAM SERVICES In FamiliesFirst, Masters-level therapists provided in-home services over a 4 to 6 week period to a maximum of two families at a time. They provided family therapy, help in practical matters of living, and liaison work with schools and other community services.
OUTCOMES:  
Placement One year after intake, 25% (15) of the 59 children in the in-home services group were placed compared with 53% (26) of 49 children in the comparison group (a statistically significant difference). Children who were the focus of intervention were placed more often than their siblings.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Mitchell, Tovar, and Knitzer (1989)
STATE New York
DESIGN AND SAMPLE SIZE 21 cases were referred from the city Child Welfare Administration (CWA) and 22 from the Pius XII Court Designated Assessment Service. An overflow comparison group of 12 families was available for the Pius group; one of these 12 families was lost to follow-up.
TARGET POPULATION The average age of CWA children was 8.3, of Pius children, 13.3.
PROGRAM SERVICES This Bronx program was modeled after Homebuilders. The average length of service was 35 days.
OUTCOMES:  
Placement Families in the overflow group had relatively fewer placements than those in the service group. At three months, 19% (4 of 21) CWA, 23% (5 of 22) Pius treatment, and 9% (1 of 11) Pius comparison families had experienced a placement. At 12 months, 24% (5) of the CWA, 27% (6) of the Pius treatment, and 18% (2) of the Pius comparison families had experienced placement. Apparently, all children who were placed were still in placement at the end of the one-year follow-up period.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Schwartz and AuClaire (1989); Schwartz, AuClaire, and Harris (1991)
STATE Minnesota
DESIGN AND SAMPLE SIZE Non-random comparison group. Cases that were approved for placement were recorded on a log. When an opening in the home-based service program occurred, the log was consulted and the most recent case was referred. If there were no cases available, the next eligible case was referred. Cases not referred to the home-based service were referred for placement services. A random sample of cases, equal in number to those in the home-based service group, was selected from the placement services group as the comparison group. (It is not clear why comparisons were not done with the entire placement services group.) There were 58 cases in each group, selected during the period August through December 1985.
TARGET POPULATION The children were at risk of placement for juvenile offenses, were between 12 and 17 years of age, and had "significant behavioral, family, school, health, and substance abuse problems" (Schwartz, AuClaire, and Harris 1991, p. 39).
PROGRAM SERVICES The program, conducted by the Hennepin County Child Welfare Division, consisted of intensive home-based services delivered by eight "specially trained social workers." The service was intended to last for four weeks. Workers carried caseloads of two families.
OUTCOMES:  
Placement 3 of the experimental group cases were in placement during the entire follow-up period and were excluded from outcome analyses. Follow-up extended until December 31, 1986. Placement occurred in 56% of 55 experimental cases and 91% of the 58 comparison cases (a significant difference). 55% of cases in the family preservation group and 64% of those in the comparison group experienced multiple placements.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Feldman (1990, 1991)
STATE New Jersey
DESIGN AND SAMPLE SIZE 117 experimental and 97 control cases were randomly assigned in 4 of New Jersey's 21 counties. 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.
TARGET POPULATION Referrals came from local child welfare offices, county family court or crisis intervention units, and regional community mental health centers. Referrals were reviewed by a local screening body; screening criteria included "risk of placement." 46% of the cases involved single-parent households. The family preservation group had a higher proportion of white families (51%) than the control group (33%). About 20% of the families in both groups had experienced placement prior to referral. The mean age of "target" children was 13 years. Reasons for referral were out-of-control behavior among target children (in 60% of the cases); abuse, neglect, or risk of abuse or neglect (25%); emotional disturbance or substance abuse among target children (13%); and emotional or substance abuse problems among parents (2%).
PROGRAM SERVICES The Family Preservation Services (FPS) program was modeled after Homebuilders. Services provided by private agencies involved a median of 31 hours of face-to-face contact between families and workers over a median of 6 weeks of service. In the first week of services, families received a mean of 13 hours of direct contact with workers. The median number of total hours of contact (including telephone and collateral contacts) per family was 48 (mean of 58). There were significant differences across sites in duration of services. Concrete services were received by 68% of the families in the experimental group. No information was provided on caseload size. Referring agencies were responsible for determining the kinds of services that were provided to families in the control group. Families in the control group typically received "traditional community services," including less intensive counseling services, referrals to other community resources, youth advocacy services, monitoring by the state child welfare agency, family court interventions, and out-of-home placement. Services received by control group families were thought to be much less intensive than those in family preservation programs, but, unfortunately, there was no systematic data collection on the nature and amounts of services provided to families in the control group. It was suggested that the services provided to control cases were similar to the kinds of follow-up services received by families in the experimental group (after FPS termination).
 
OUTCOMES:  
Placement During the intervention period 17% of the families in the control group experienced placement of at least one target child, compared to 6% of families in the experimental group. At 6 months post-termination, 50% of control group families and 27% of families in the experimental group had experienced at least one placement. At one year post-termination 57% of families in the control group and 43% of those in the experimental

(continued)

 

group had experienced placement. (Differences between groups were statistically significant at each point in 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, numbers of placements, or duration of time in placement. Family preservation services appeared to result in reduced risk of placement for single-parent families (at one year after termination, 68% of the single-parent families in the control group experienced placement, compared with 49% in the experimental group).

Child

Maltreatment

N/A
Child and Family

Functioning

Both the treatment and control groups made gains on the Family Environment Scale, Interpersonal Support Evaluation List, and Child Well-Being Scales, but there were few statistically significant differences between groups in the amount of change.
Other Outcomes examined included changes in perceived social support, goal attainment, and client satisfaction. There were some differences between experimental and control groups in the amount of change in these measures (favoring the experimental group) but these were quite limited.
STUDY Yuan, McDonald, Wheeler, Struckman-Johnson and Rivest (1990)
STATE California
DESIGN AND SAMPLE SIZE 304 families were randomly assigned to family preservation or control groups (each group had 152 cases).
TARGET POPULATION Families thought to be at imminent risk of placement due to abuse or neglect were referred by county child welfare agencies. The families had an average of 2.4 children whose average age was 6.7 years. 47% of the primary caretakers were under 30 years of age. 49% of the families were headed by single parents; 59% were receiving public assistance. 34% of the adults had not completed high school; 56% were unemployed. Reasons for referral included physical abuse (43% of the cases), child neglect (33%), sexual abuse (12%), emotional abuse (6%). 64% of the families had experienced at least one placement prior to referral.
PROGRAM SERVICES Services were provided by private agencies and one public mental health agency in eight counties in California. On average, the duration between referral and the initiation of services was 7 days. Services lasted an average of 7 weeks. Families received an average of 32 hours of direct contact with workers. (In addition, workers spent an average of 17 hours per case on "collateral services" and 10 hours per case on travel.) Services consisted of assessment, case planning, individual and family counseling, crisis intervention, parenting skills training, and service coordination. Concrete services (e.g., food, clothing, assistance with housing and utilities, and chore services) were provided in less than 10% of the cases. In most cases, services were provided by licensed therapists, although some projects used co-therapists or case aides. Follow-up services were provided by the family preservation projects to 42% of the families. (No data on services provided to the control group.)
OUTCOMES:  
Placement 20% of control group families and 25% of cases in the experimental group experienced placement within 8 months after random assignment (the difference between groups was not statistically significant). There were no substantial differences in lengths of time in placement or costs of placement. Children in the control group were more likely to be placed with relatives.
Child

Maltreatment

Approximately 25% of families in both the program and control groups experienced an investigation of child abuse or neglect within 8 months after referral.
Child and Family

Functioning

(Pre- and post-tests were conducted with the experimental group only.)
Other Placement costs for in-home services and control cases were comparable ($141,375 versus $145,388) for the 152 families in each group. Average cost of providing intensive, home-based services was $4,767 per family served.
STUDY Pecora, Fraser, and Haapala (1991, 1992)
STATE Utah
DESIGN AND SAMPLE SIZE 453 Utah and Washington families in intensive home-based services based on the Homebuilders model and 26 families in an overflow comparison group in Utah. A 12 month follow-up was conducted with 263 families.
TARGET POPULATION The criteria for referral were risk of imminent placement, safety of the child with service, and willingness of at least one parent to cooperate with service. The average age of the oldest child at risk of placement was 12.5.
PROGRAM SERVICES In Utah a 60-day service model was provided in two sites by the state child welfare department while in Washington a 30-day model was provided by the Homebuilders program (under contract with the state agency) in four sites. Families in the Utah program received an average of 23 hours of in-person contact with workers; those in the Washington program received 21 hours of in-person contact. Caseloads ranged from 4 to 6 families in Utah, while therapists in Washington carried caseloads of two to three families each (Pecora, Fraser, and Haapala 1992).
OUTCOMES:  
Placement Service failure was defined as placement of a child outside the home for two weeks or more in a non-relative setting during the provision of family preservation services or within 12 months following intake. Runaways were also counted as failures (Pecora, Fraser, and Haapala 1991). At termination, 9% of the 172 Utah children and 6% of the 409 Washington children in the treatment groups had been placed. The figures for the 12 month follow-up were 41% of 97 Utah children and 30% of 245 Washington children. In the Utah comparison group of 27 children, 23 (85%) were placed during the 12 month period.
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Meezan and McCroskey (1993)
STATE California
DESIGN AND SAMPLE SIZE 240 families were randomly assigned to in-home services or regular child protective services.
TARGET POPULATION Referrals were based on "caseworker judgement about need for the services" and were not limited to cases in which children were thought to be at imminent risk of placement.
PROGRAM SERVICES In-home services were provided by two private child welfare agencies (the Children's Bureau of Southern California or Hathaway Children's Services); the control group received services from by the County Department of Children's Services. Over a three month service period, families in the in-home services group received significantly more contact with workers than comparison cases (average of 9.6 versus 4.2 contacts); in-person contacts for the program group were not only more frequent but also longer in duration (Meezan 1993).
OUTCOMES:  
Placement Data on placements were available for 231 families. At the beginning of the project 37 (34%) of the 108 families in the program 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).
Child

Maltreatment

N/A
Child and Family

Functioning

Family functioning was measured on six scales: parent-child interactions, living conditions of the family, interactions between caregivers, supports available to parents, financial conditions of the family, and developmental stimulation of children. Families in both groups reported that they did not have significant problems in family functioning at case opening and did not see significant change in these areas at case closing. However, families in the in-home services group reported more improvements in living conditions and financial conditions at one year after termination, compared to controls. Parents in the program group also reported more improvements in their children's behavior between referral and the case closing, although there were no differences between groups one year after services had ended. Workers who provided home-based services reported that the families had significant problems in all areas of family functioning at case opening and made significant improvements in four of six domains at case closing. (The four areas in which improvements were noted were: parent-child interactions, living conditions, supports available to families, and developmental stimulation given to children.)
Other N/A
STUDY Schuerman, Rzepnicki, and Littell (1994)
STATE Illinois
DESIGN AND SAMPLE SIZE Between April 1990 and April 1992, 1564 families were randomly assigned to intensive family preservation or regular child welfare services in six sites (containing 18 Family First placement prevention programs). 995 cases were assigned to Family First and 569 to the control group. The families were followed through March 1993.
TARGET POPULATION Families with children under the age of 12 who were thought to be at risk of placement. Families were referred to the program by state child protective services workers on the basis of substantiated reports of child abuse or neglect.
PROGRAM SERVICES Family preservation services were provided by private agencies under contract with the state. The average caseload for workers in the Family First placement prevention program was 5 families (compared to an average of 50 cases for public child welfare workers who provided services to families in the control group). Family preservation services generally began within 24 hours of referral and were provided in families' homes. Cases in the Family First program received more intensive services than controls (a median of 70.3 hours of face-to-face contact with workers in the first 90 days of service, compared with 2.5 for control cases). Family First cases were much more likely than controls to receive counseling (93% versus 37%) and concrete services (89% versus 31%), they also received a wider array of concrete services (median of 4 different types of concrete services versus a median of zero for the control group) and were more likely to receive cash assistance (74% versus 7%). Services provided to cases in the program included crisis intervention, parent education, transportation, advocacy, and referrals for material aid, substance abuse treatment, and medical care. Half of the Family First cases left the program within 108 days. Interviews with a subsample of 278 clients in the experiment support the conclusion that Family First cases received much more extensive help than cases in the control group. 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.
 

(continued)

OUTCOMES:  
Placement The Family First program was associated with an overall increase in the risk of placement. At one year after random assignment, placement had occurred in 27% of Family First cases and 21% of control cases. Increases in the risk of placement for children in the Family First group were statistically significant in the two experimental sites in the Chicago area (there were no sites in which the program produced a significant reduction in placement rates); however, differences between experimental and control groups disappeared once variations in case characteristics were taken into account. Family First was related to a significant increase in placements among households headed by single adults; the program had no significant effect on the risk of placement for 15 other subgroups. There were no significant differences between groups in the duration or types of placements.
Child

Maltreatment

Children in the Family First group were somewhat more likely to be identified as victims of subsequent maltreatment than children in the control group; although statistically significant, the difference between groups was small. There were no sites in which significant reductions in the recurrence of maltreatment were found, nor did the program affect the risk of subsequent maltreatment for any of the subgroups of cases examined.
Child and Family

Functioning

Measures of child and family functioning in eight domains were obtained through interviews with a subsample of parents in three of the six sites. The domains were: housing conditions, economic conditions, physical child care, discipline and emotional care of children, children's academic adjustment, children's conduct, children's symptomatic behavior, and parental coping skills. A few statistically significant differences between groups were found (most were in favor of the program group), but these gains were modest and did not last over time.
Other The Family First program had a net-widening effect in that it provided services to families that would not ordinarily have been served in the child welfare system (as noted above, 20% of the control cases were never opened for services). There were no relationships between the duration of Family First services, amounts of contact with caseworkers or parent aides in the first 90 days of services, or the number of concrete services provided and the likelihood of placement or subsequent maltreatment.

 

TABLE 3:

SUMMARY OF CONTROLLED STUDIES OF FAMILY REUNIFICATION PROGRAMS

 

STUDY Jones, Neuman, and Shyne (1976); Jones (1985)
STATE New York
DESIGN AND SAMPLE SIZE Cases were randomly assigned to program and control groups. The program group included 205 children (131 families) and there were 109 children (64 families) in the control group.
TARGET POPULATION Children under the age of 14 were either in foster care (81%) or had recently returned home (19%).
PROGRAM SERVICES Intensive services were provided to families by 7 private and 2 public agencies. Workers carried caseloads of 10. The duration of services averaged 8.5 months.
OUTCOMES:  
Reunification At the end of the demonstration, 47% of 205 children in the experimental group and 38% of 109 children in the control group had been reunified with their families. At a six month follow-up, 62% of the children in the experimental group and 43% of those in the control group had returned home. At a five-year follow-up, Jones (1985) found no significant differences between groups in the proportion who had been discharged from foster care.
Replacement N/A
Child

Maltreatment

N/A
Child and Family

Functioning

N/A
Other N/A
STUDY Walton, Fraser, Lewis, Pecora, and Walton (1993); Walton (1991)
STATE Utah
DESIGN AND SAMPLE SIZE 110 families with children in foster care were randomly assigned to an intensive, in-home reunification program or regular child welfare services in 4 social service districts in Utah.
TARGET POPULATION 76% of the children were in foster care at the time of their inclusion in the study (Walton et al. 1993); others were in shelters, group homes, residential placements or inpatient psychiatric care (Walton 1991). Children's ages ranged from one to 17 years (mean age of 10.7 years); most were Caucasian. They had a mean of 2.8 prior placements; the total time in previous placements ranged from one to 88 months (mean of 12.1 months). The mean duration of the most recent placement was 8 months. Primary caregivers were 35 years old on average and they had a mean of 12 years of education. Most families were fairly mobile (they had changed residences a mean of 4 times in the past 5 years), 61% had at least one employed adult in the household, and 54% had annual incomes under $10,000.
PROGRAM SERVICES Services were limited to 90 days and involved at least three visits per week with each family. Caseworkers carried caseloads of no more than six families at a time (mean of 5.8) and spent an average of 3.1 hours per week with each family; contacts during the first two weeks of services were somewhat more intensive (an average of 5.4 hours per week). The program provided concrete services (financial assistance, transportation, clothing, food, and household repairs) and training in communication skills, parenting skills, and anger management. Follow-up services were arranged for all of the families in the treatment group. Families in the control group received services from regular foster care workers, who had average caseloads of 22 and were expected to visit families at least once a month.
OUTCOMES:  
Reunification At the end of the 90-day treatment period 93 percent (53) of 57 children in the treatment group had been returned to their homes, compared with 28 percent (15) of 53 control children--a significant difference (Walton et al. 1993). Six months after termination 70 percent (40) of the children in the program group and 42 percent (22) of those in the control group remained at home. At the one-year follow-up, 75 percent (43) of the children in the program group and 49 percent (26) of those in the control group were living at home. Differences between the groups were statistically significant at each point in time.
Replacement Of the 56 children in the treatment group who returned home at some point during the 15 month study period, seventeen (30%) reentered out-of-home care; 5 of these 17 children were returned to their homes again before the end of the study. Of the 30 children in the control group who returned home, 5 (17%) reentered care.
 

(continued)

Child Maltreatment N/A
Child and Family

Functioning

Walton (1991) found no significant differences between groups on several measures of individual and family functioning at the end of the 90-day period.
Other Children in the treatment group spent significantly more time (days) at home during the study period than those in the control group.