HOMEBUILDERS is an in-home, intensive family preservation service (IFPS) and reunification program for families with children (newborn to 17 years old) returning from or at risk of placement into foster care, group or residential treatment, psychiatric hospitals, or juvenile justice facilities. The HOMEBUILDERS model is designed to eliminate barriers to service while using research-based interventions to improve parental skills, parental capabilities, family interactions, children’s behavior, and family safety. The goals are to prevent the unnecessary out-of-home placement of children through an intensive, onsite intervention and to teach families new problem-solving skills to improve family functioning.
HOMEBUILDERS therapists work with youths and families involved in the child welfare, juvenile justice, and mental health system. For high-risk families involved with the child protective services system, the goal of the program is to remove the risk of harm to the child instead of removing the child. Therapists work with families to teach them new behaviors and help them make better choices for their children, while ensuring child safety. In addition, HOMEBUILDERS also works with youths and their families to address issues that lead to delinquency, while allowing youths to remain in the community. Program staff work with youths to ensure they attend classes regularly, adhere to curfews, comply with the courts, and learn anger management and conflict-resolution skills to avoid getting into more trouble. Finally, the program works with youths so they can avoid the trauma and stigma of psychiatric hospitalization or residential treatment for mental health–related issues by providing crisis intervention and skill building, involving the families in the youths’ treatment, and broadening the continuum of care.
The primary intervention components of the HOMEBUILDERS model are engaging and motivating family members; conducting holistic, behavioral assessments of strengths and problems; developing outcome-based goals; using evidence-based cognitive–behavioral interventions; teaching skills to facilitate behavior change; and developing and enhancing ongoing supports and resources.
The core program strategies are:
- Intervention at crisis point. HOMEBUILDERS therapists work with families when they are in crisis. Families are seen within 24 hours of referral to the program.
- Accessibility. Services are provided in the family’s home and community (e.g., school) at times convenient to families, including evenings, weekends, and holidays. Therapists are available 24 hours a day, 7 days a week, for crisis intervention. This accessibility allows close monitoring of potentially dangerous situations.
- Flexibility. Intervention strategies and methods are tailored to meet the needs, values, and lifestyles of each family. Services are provided when and where the families wish. Therapists also provide a wide range of services, such as helping families meet the basic needs of food, clothing, and shelter; using public transportation; budgeting; and, when necessary, dealing with the social services system.
- Time limited and low caseload. Families receive 4 to 6 weeks of intensive intervention, with up to two “booster sessions.” Therapists typically serve two families at a time and provide 80 to 100 hours of service, with an average of 45 hours of face-to-face contact with the family.
- Strengths based. Therapists help clients identify and prioritize goals, strengths, and values and help them use and enhance strengths and resources to achieve their goals.
- Ecological/holistic assessment and individualized treatment planning. Assessments of family strengths, problems, and barriers to service/treatment and outcome-based goals and treatment plans are completed collaboratively with each family.
- Research-based treatment practices. Therapists use evidence-based treatment practices, including motivational interviewing, behavioral parent training, cognitive–behavior therapy strategies, and relapse prevention. Therapists teach family members a variety of skills, including child behavior management, effective discipline, positive behavioral support, communication skills, problem-solving skills, resisting peer pressure, mood management skills, safety planning, and establishing daily routines.
- Support and resource building. Therapists help families assess their formal and informal support systems and develop and enhance ongoing supports and resources for maintaining and facilitating changes.
- Critical thinking framework. Therapists, supervisors, and managers use a critical thinking framework for assessing, planning, implementing, and evaluating progress and outcomes.
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Fraser and colleagues (1996) found that the number of days from the start of the treatment period until a child returned home was significantly shorter for families in the family reunification services (FRS) experimental group. On average, children in the FRS group were returned to their homes in 20.7 days during the 90-day service period. No FRS group children were reunified during the 12-month follow-up period. The children in the control group were reunified on average in 44.6 days during the 90-day period, while the children who were reunified during the follow-up period did so, on average, in 113 days.
Significantly more children in the FRS group returned home by the end of the study period, compared with children in the control group. Of the 57 children in the FRS group, 55 (96.5 percent) were reunified within the first 90 days. The remaining two children never returned home during the observation period. Only 17 of the 53 children in the control condition (32 percent) were returned home during the 90-day period, while 11 others (21 percent) were returned during the follow-up period.
Success of Reunifications
Of the 55 reunifications in the FRS group, 15 failed (27 percent) and these children were returned to foster care. Of the 28 reunifications in the control group, three failed (10.7 percent) and these children returned to care. Although a higher proportion of reunifications in the control group were successful (compared with the FRS group), the difference was not statistically significant. In addition, among the children who were reunified, there were no significant differences between the FRS and control groups for the amount of time at home. Children in the FRS group spent 351.3 days in their homes, while children in the control group spent 310.3 days in their homes. These findings suggest that children in the FRS group who were reunified fared just as well as children in the control group who received routine services.
Kirk and Griffith (2003) found some significant impacts of intensive family preservation services (IFPS). In an initial analysis that did not control for other risk factors, IFPS and non–IFPS cases had similar placement rates at the 1-year follow-up period, with 27 percent of children in both groups experiencing a placement. However, when additional analysis controlled for prior placement, the results showed that the IFPS significantly reduced the rate of out-of-home placement. At 1 year, 19 percent of IFPS cases had experienced a placement, compared with 44 percent of non–IFPS cases. Further, when analysis controlled for prior substantiated reports of abuse or neglect, IFPS was again shown to have significantly reduced the rate of out-of-home placements—with 29 percent of IFPS cases experiencing an out-of-home placement, compared with 37 percent of non–IFPS cases.
In addition, the hazard rate for IFPS indicated that children in the treatment group were 21 percent less likely than non–IFPS children to experience a placement within 1 year. Children in the treatment group who received IFPS and did not experience a new high-risk substantiated report of abuse or neglect within the 1-year follow-up period (86 percent) had an average reduction in the hazard rate for placement of 32 percent (a significant, positive treatment effect). Conversely, children who received IFPS and did experience a new high-risk substantiated report within 1 year had an average increase in the hazard rate of placement of 70 percent. Similarly, children in the comparison group who did not receive IFPS and experienced a new high-risk substantiated report within 1 year had an average increase in the hazard rate for placement of 16 percent.
Additional analysis confirmed the positive treatment effect for the 86 percent of treatment group children who received IFPS and did not experience a new high-risk substantiated report; however, the results indicate that the treatment effect slowly diminished over time. By 270 days after referral to IFPS, a 5 percent increase in the hazard rate of placement is estimated for children in the treatment group who received services but did not experience a new high-risk substantiated report.
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