Professional Documents
Culture Documents
138 Full
138 Full
preservation services
Mark W. Fraser, Kristine E. Nelson, and Jeanne C. Rivard
138
CCC
Code:1070-5309/97
1997,
Association
of Social Workers,
Inc.
Social
Work Research$3.00
/ Volume
21,National
Number
3 / September
1997
139
140
Services are tailored to the needs of family members. Building on ecological, systems, social-learning, psychoeducational, and crisis theories, they
often include a mix of crisis intervention, concrete assistance, supportive counseling, skills
building, and advocacy.
Services are provided in the context of a familys
values, beliefs, and culture.
Services in many programs are available 24 hours
a day, seven days a week.
Workers have small caseloads of between two and
six families and may visit families many times
during a week. In many programs, families are
seen between two and 15 hours per week. Hence
the term intensive is sometimes used to describe FPS (Angelou, 1985; Nelson & Landsman,
1992; Yuan & Rivest, 1990).
METHOD
Sample
The authors reviewed published and unpublished
studies of FPS since 1985. Family preservation services was defined broadly as family-centered services
designed to prevent the removal of children from
their homes or to reunify with their families children who are in out-of-home care, including foster
and group home, residential treatment, and correctional placements. Emphasis was placed on studies
of intensive, in-home services for which caseloads
were small and the intervention period lasted no
more than 20 weeks. Studies of family-centered casework, family therapy, and other family services for
which contact with families averaged one hour or
less per week and children were not viewed as at risk
of placement, incarceration, or hospitalization were
excluded from the analysis. Because increasing numbers of oppositional, defiant children are referred to
child welfare agencies and because important tests
of family preservation have taken place in the juvenile justice system, studies involving both maltreated
and delinquent children were included in the sample.
In addition to placement prevention services in
child welfare and juvenile justice, studies of familybased services in reunification and family-centered
psychoeducation in mental health were included.
From the beginning, FPS programs have been used
to help reunify children in out-of-home care with
their families. But few studies have focused exclusively on this aspect of family preservation. In mental health, a small number of family-based services
studies have focused on strengthening families with
adults and, to a lesser degree, children who have
141
142
Not reportedc
No. of
Successes Total
Comparison Groupa
No. of
Successes Total
16
12
4
72
16
276
24
67
15
701
172
24
13
11
87
22
338
55
117
27
974
225
66.6
92.3
36.4
82.8
72.7
81.7
43.6
57.3
55.6
72.0
76.4
14
8
6
64
9
291
5
42
4
451
146
24
13
11
85
12
352
58
97
27
564
225
57
57
96.5
70.2
17
25
53
53
110
731
143
974
76.9
75.0
113
440
150
564
75.3
78.0
+.05
.07
12 months
59 weeks
120 weeks
48 months
12 months
48
25
17
68
32
58
43
43
92
40
82.8
58.1
39.5
73.9
80.0
24
16
8
24
23
40
41
41
84
40
60.0f
39.0
19.5
28.6i
57.5
+.52
+.40
+.42
+.93
+.48
59 weeks
12 months
34
33
43
40
79.0
82.5
13
24
41
40
31.7 +1.01
60.0 +.49
Not reported
At 12 months
Eight months
At 12 months
At 12 months
12 to 16 months
At 12 months
At 12 months
Eight months
12 months
58.3
61.5
54.5
75.3
75.0
82.7
8.6d
43.3
14.8
80.0
64.9e
Effect
Size
+.19
+.76
.38
+.20
.05
.03
+.88
+.28
+.90
.19
+.24
32.1 +1.54
47.2 +.47
Except where indicated, treatment in the comparison group consisted of usual or routine services.
Although all families were referred for child maltreatment, 13 of 24 families in the experimental group were rated as less difficult
because parenting problems were viewed as related to serious conduct problems in children. In more difficult cases, parent problems
were viewed as related to serious parental and environmental deficiencies that were not directly associated with child behavior.
The differences between the experimental and control conditions were significant in the less difficult group (p < .01) and not
significant in the more difficult groups.
c
Most success rates are reported using total number of children as the denominator. However, if child-specific rates were not
available, total number of families was used. Reports here are based on the family as unit of analysis.
d
Placement list.
e
Child leaving substitute care.
f
Alternative treatment.
g
Withdrawals are included in analysis; otherwise, withdrawals are excluded from analysis.
h
Same sample as Henggeler et al. (1992), but reports on different follow-up period.
i
Individual therapy.
b
143
144
Referral
Reason (%)
Effect
Size
Child Age
(years)a
Parentb
+.90
+.88
12.5
14.3
50
0
Childc
Programs Sites
No. of
Familiesd
Control
Placement (%)
50
100
1
1
2
1
54
113
85
91
more
26
38
62
38
110
47
+.28
13.0
27
+.24
5.0g
81
+.20 not reported 100
73
9
0
1
1
1
4
7
1
214
450
172
57
35
25
100h
100
0
100
0
0
100g
0
1
8
1
18
1
8
1
6
48
690
34
1,538
42
17
25
20
less
22
45
+.19
.03
.05
.19
10.7
312
6.7
13.3
8.0
145
At 24 months
At 12 months
Prevention of hospitalization
Falloon et al., 1985a
At 12 months
13
14
18
16
At 24 months
21
At 9 months
60
15
At 24 months
At 24 months
10
At 24 months
15
At 24 months
15
At 24 months
At 24 months
No. of
Successes
Data
Collection
Period
21
18
21
24
24
83
20
20
21
10
18
Total
61.9
77.7
85.7
66.6
87.5
72.3
75.0
50.0
71.4
60.0
83.3
Experimental Group
Family treatment
and customary care
Family therapy
and medications
Family intervention
and medications
Family intervention
and medications
Family treatment
and customary care
Psychoeducation
and medications
Family therapy
and medications
Social skills training
and medications
Family therapy,
social-skills training,
and medications
Multifamily therapy
and medications
Family therapy
and medications
Type of
Service
TABLE 3Effect Sizes of Exemplary Studies in Family-Based Psychoeducation in Mental Health Cases
10
12
15
52
11
11
11
No. of
Successes
20
18
20
29
29
89
29
29
29
18
Total
50.0
44.4
45.0
41.4
51.7
58.4
37.9
37.9
37.9
22.2
16.7
Comparison Group
Individual case
management
and medications
Customary care
Single-family
therapy and
medications
Education and
routine care
Education and
routine care
Customary care
Individual case
management
and medications
Medication
only
Support and
medications
Support and
medications
Support and
medications
Type of
Service
+.24
+.71
+.90
+.53
+.82
+.30
+.77
+.24
+.68
+.80
+1.44
Effect
Size
lies with young children (average age 6.3 years) referred to child protective services, Lyle and Nelson
(1983) found that an extended service model of
approximately 315 days produced positive effects.
Comparable to studies in reunification and prevention of rearrest in juveniles, the difference in placement outcomes between the experimental and control groups in this unpublished study produce an
effect size of +.45. Unfortunately, posttreatment
placement prevention outcomes were not reported.
But during the course of the service provision period, the placement prevention rate in the experimental group (76 percent, 26 of 34) was significantly different from the placement prevention rate
in the control group (55 percent, 22 of 40). These
figures suggest that the brief model of FPS that is
currently used in many states and that was used in
the California and Illinois studies may be of insufficient duration to affect the complex parental and
environmental factors that place children at risk of
neglect (see also Guterman, 1997; Kolko, 1996).
Relatedly, Schuerman et al. (1994) have pointed
out that the difference in outcomes across studies in
child welfare may be explained by a system effect.
Courts and workers may be far more likely to use a
family preservation strategy with an older child who
may be viewed as less vulnerable to the effects of abuse
and neglect. Conversely, they may be less willing to
deploy and persist in a family preservation effort for
a younger child who is at risk of serious injury.
Family Preservation and Child Protection
The data might be construed as suggesting that
FPS does not offer a sufficient response to child abuse
and neglect; however, this conclusion must be conditioned on serious limitations in the research on
family preservation in child welfare. Counterintuitively, in many of the smaller studies in which power
should be low, positive findings were observed, and
in larger studies in which power should be high, null
findings were observed. These results imply that
design problems exist not so much in the use of control or comparison conditions (or even in data analyses) as in the sampling of families and the implementation of the independent variable. As with any
research, negative findings may signify failure to
achieve a desired outcomein this case failure to
avert placement or protect children from abuse and
neglector they may represent a failure of the research to detect the successes of the program
(Bickman, 1990).
Two problems have been encountered by researchers conducting large experimental evaluations
147
in which younger children at risk of abuse or neglect constituted the majority of referrals. First, children in the samples do not appear to have been at
high risk of placement (Table 2). Thus, the variation in the placement outcome has been constrained
by referral and subject selection (that is, sampling)
problems. In the California and Illinois studies, fewer
than 25 percent of the children in control groups
were placed at the conclusion of the 12-month follow-up (Schuerman et al., 1993; Yuan et al., 1990),
indicating that routine services were sufficient to
avert the need for placement, that a needed placement did not occur (perhaps because of foster care
shortages), or that placement was not imminent. A
placement prevention service is not likely to show
an effect on placement rates if the large majority of
clients are not at risk of some form of substitute care.
Second, larger studies do not seem to have been
successful in consistently implementing services that
contain the core elements of family preservation
(Table 4). Making comparison of outcomes difficult, experimental services differ markedly across
studies and even across sites within studies. The research on FPS cannot be interpreted without a careful analysis of these differences. In some studies, it
is scarcely clear how family preservation may have
differed from traditional family casework, which has
a tepid history (for example, Meyer, Borgatta, &
Jones, 1965; Powers & Witmer, 1951). In other
studies, it appears that family preservation provided
a method for delivering relatively intensive services
to families who might not otherwise come into a
clinic, office, or school. These include services that
have strong empirical support, such as parenting,
problem-solving, and other skills-building interven-
Length
(Days)
Direct Contact
(Hours)
Individual
Counseling
Family
Counseling
Parent Skills
Crisis
Concrete
Training
Intervention Services
32
1745
NA
4290
NA
4491
NA
461
NA
1754
<10
NA
91
35131
62
NA
43
NA
49
NA
48
3957
89
7896
148
149
CONCLUSION
Studies of the effectiveness of FPS are both promising and disturbing. A program of rigorous intervention research is needed. The effect sizes estimated
in this study suggest that family preservation may
be an effective tool in the fight against youth violence. Findings are consistent with the pioneering
family-centered work of other researchers (for example, Alexander & Parsons, 1973, 1982; Gordon,
Graves, & Arbuthnot, 1995; Klein, Alexander, &
Parsons, 1977; Patterson, Reid, & Dishion, 1992).
To improve FPS for families and children who are
referred to juvenile justice and child welfare agencies for delinquency, services must be tested in conjunction with other promising interventions that
more directly affect peer relations, academic achievement, the after-school environment, and other risk
factors for antisocial and aggressive behavior (for reviews, see Fraser, 1996a, 1996b; Williams, Ayers, &
Arthur, 1997). Henggeler et al. (1995) and Stern
and Smith (1990) have adopted this strategy.
In mental health studies, effect sizes suggest that
family-centered intervention both reduces symptoms
and lowers the risk of hospitalization. A program of
research to further tease out the effects of medications management, family involvement, skills training, and advocacy is needed. It is not clear whether
these programs contribute a measure of support over
what might be available in a community with a fully
articulated continuum of care that includes psychosocial clubhouses and assertive treatment teams.
Testing in different community care environments
is needed. In addition, it is not clear in these programs whether service delivery in the home is necessar y and, when home-based programs are
mounted, whether they succeed in involving families who might not otherwise participate in a
psychoeducation program.
In child welfare, most of the studies fielded so far
have not been able to establish a margin of benefit in
child protection and placement prevention. Future
research must address vexing questions: Are different kinds of services needed for families and children
who are referred for abuse and for neglect? Can overburdened and underfunded child welfare systems
provide a sufficient response to child maltreatment?
Should, as Wells and Tracy (1996) recently suggested,
prevention of placement be abandoned as a rationale
of FPS? That is, should we conceptualize FPS not as
a last resort to placement but as an initial response
to all maltreating families in which children do not
require immediate placement (Wells & Tracy, 1996,
p. 682)? Can a brief intervention be expected to offer
150
protection against complex problems like child maltreatment? As has been done in juvenile justice, should
the duration of service be extended? And through
the development of family reunification programs,
can FPS strategies be used to shorten lengths of stay
for children who are already in foster care? The success of future research in answering these questions
will depend in part on the development of intervention models that address more fully the risk factors
associated with various types of maltreatment (for
review, see Thomlison, 1997).
Finally, we know almost nothing about a next
generation of important questions: Across all fields
of practice, what is the relation between treatment
outcome and a childs gender, race or ethnicity, and
socioeconomic status? Do workers with professional
training produce better outcomes than paraprofessionals or students in field placements? Other than
placement prevention, do services affect family functioning or child development? And what is the differential contribution of elements of servicesskills
training, concrete problem-solving, and empowermentto outcomes? To date, the findings are mixed,
complex, and given to misinterpretation. To sort
promise from compromise, a program of rigorous
intervention research is urgently needed.
In the meantime, practitioners, program managers, and policymakers can take heart that FPS has
been shown to be effective in some settings and with
some populations. A set of core or common service
elements has begun to emerge. The challenge of further testing and elaborating these elements to elucidate what combinations of service are effective with
specific types of problems and families should not
be underestimated. However, neither should the
benefits of these services be discounted through the
mistaken conclusion that they have been proven
ineffective.
REFERENCES
References marked with an asterisk indicate studies
included in the analysis.
Abbott, G. (1938). The child and the state (Vol. 2). New York:
Greenwood Press.
Adams, J. (1910). Twenty years at Hull House. New York:
Macmillan.
Adoption Assistance and Child Welfare Act of 1980, P.L. 96272, 94 Stat. 500.
Alexander, J. F., & Parsons, B. V. (1973). Short-term
behavioral intervention with delinquent families:
Impact on family process and recidivism. Journal of
Abnormal Psychology, 81, 219225.
Alexander, J. F., & Parsons, B. V. (1982). Functional family
therapy. Monterey, CA: Brooks/Cole.
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152
153