An intensive intervention and counselling program for families who have children at imminent risk of placement in state-funded care.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
- Continuing care
Australian Study
Risk of Bias
Cost
Target Age Group
About
Homebuilders® is a short-term, intensive home and community family preservation services program for families in crisis. Families are considered to be in crisis if they have a child at imminent risk of out-of-home placement. The goal of the program is to remove the risk of harm to the child instead of removing the child from their family, through intensive, on-site intervention and teaching families new problem-solving skills to prevent future crises. Child safety is ensured through small caseloads, program intensity and 24-hour a day service availability. It is the oldest and best-documented Intensive Family Preservation Services (IFPS) program in the United States. Homebuilders is also used for families whose children are being returned from out-of-home care and for difficult post-adoption situations.
Aims
- Reduce or eliminate child abuse and neglect
- Improve family functioning
- Improve parenting skills
- Prevent out-of-home placement
- Prevent contact with child protection services
- Improve family preservation.
Impact
Evidence suggests that Homebuilders® was effective in reducing rates of children in out-of-home care. More children under the Homebuilders® program were able to stay at home compared to children in the comparison group after a period of intensive in-home treatment over 4 to 6 weeks. The rates of children removed at a later stage at the end of the year was also reduced. The program was cost-effective with lower placement costs at one-year follow up.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Family preservation | Yes | Not found | Not found |
| System | Out-of-home care | Yes | Not found | Not found |
| Cost | Cost effectiveness | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
Homebuilders® has an evidence rating of Supported+.
This means that Homebuilders® has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on one research output of QE design. Another 6 RCTs and one QE were identified but did not count towards the evidence due to concerns with study quality. Homebuilders® has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | Not identified or included |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
The quality of the evidence of the QE is low and results should be interpreted with caution.
The study was conducted in the United States and does not include Aboriginal children and families. Homebuilders® is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The QE was conducted in State of Washington, United States.
Sample
- A total of 50 families or 108 children (59 intervention, 49 control) enrolled in this study.
- The families were in placement for more than 30 days and were eligible for reunification. About half of the families had received some form of financial aid from the county during the year prior to referral, and the others ranged in income from working poor to affluent.
- Participants identified as White (72%), Black (15%), Asian (9%) and Hispanic (4%). This is relatively representative of the county’s population.
Implementation
Delivery model, mode and setting
- Homebuilders® is delivered in-person and over the phone, to the parent only, child only and/or parent and child together.
- Services take place in the client's home or the community.
Target cohort
- Families at imminent risk of placement or needing intensive services to return from foster care or other treatment facilities
- Families referred by the state or involved in the Family Preservation Service and Intensive Family Reunification Service
- Families with children up to age 17.
Program delivery
- Professional therapists reach families within 24 hours of referral.
- The services are designed to resolve the immediate crisis and teach the skills necessary for the family to remain together.
- Therapists are on call to their clients 24 hours a day, 7 days a week. Families are given as much time as they need when they need it. This accessibility also allows close monitoring of potentially dangerous situations.
- Therapists carry only 2 to 3 cases at a time. Low caseloads enable them to be accessible and provide intensive services. The services support families experiencing the most pain and have the most motivation to change.
- Therapists provide a wide range of services, from helping clients meet the basic needs of food, clothing and shelter, to sophisticated therapeutic techniques.
- Therapists utilise a range of research-based interventions, including crisis intervention, motivational interviewing, parent education, skill building and cognitive/behavioural therapy. They also educate families in areas more commonly associated with counselling, such as child development, parenting skills, anger management, other mood management skills, communications and assertiveness.
Duration and intensity
- Each family receives an average of 40 to 50 hours of direct service. Services are time-limited and concentrated in a period of 4 weeks.
Manuals and guides
- The Institute for Family Development website has a Standards manual that describes how to deliver Homebuilders®.
- Formal support is available for implementation and there are fidelity measures and Standards to ensure quality enhancement and training.
Additional information
- The Institute for Family Development website has more information about Homebuilders®.
Staffing
- Therapist are required to have a master's degree in psychology, social work, counselling or a related field; or bachelor's degree in the same fields plus 2 years of experience working with families.
- Supervisors are required to have a master's degree in psychology, social work, counselling or a related field; or bachelor's degree in the same fields plus 2 years of experience providing the program and one year of supervisory/management experience.
Training
- Clinical staff receive 5 days of initial training and 8 days of intermediate/advanced training.
- Supervisors receive 7 additional days of training.
- Program implementation and quality assurance process involves quarterly 2-to-3-day site visits, 12 hours of records reviews and 6 to 8 hours per month of phone consultations.
- The Institute for Family Development website has a checklist for individuals to assess their skill readiness to be a therapist.
To our knowledge, Homebuilders® is available in Victoria and New South Wales.
In Victoria, Homebuilders® is delivered by Anglicare.
Cost
We were unable to locate any information on the cost of Homebuilders®.
References
Studies identified and included in the review
- Wood S, et al. (1988). In-home treatment of abusive families: Cost and placement at one year. Psychotherapy: Theory, Research, Practice, Training 25(3): 409-414.
Studies identified but not counted towards the evidence rating due to study quality
- Department of Health and Human Services (United States), 2002. Evaluation of family preservation and reunification programs: Final Report. Vols 1 & 2. (Retrieved from https://aspe.hhs.gov/report/evaluation-family-preservation-and-reunification-programs-final-report-volume-one and https://aspe.hhs.gov/report/evaluation-family-preservation-and-reunification-programs-final-report-volume-two, 21/01/2020)
- Fraser MW, et al. (1996). An experiment in family reunification: Correlates of outcomes at one-year follow-up. Children and Youth Services Review 18(4): 335-361.
- Kirk RS & Griffith DP (2004), Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research, Vol. 28, No. 1, pp. 5-15.
- Walton E (2001). Combining abuse and neglect investigations with intensive family preservation services: An innovative approach to protecting children. Research on Social Work Practice, 11(6), 627-644.
- Walton E (1998). In-home family-focused reunification: A six-year follow-up of a successful experiment. Social Work Research 22(4): 205-214.
- Walton E, et al. (1993) In-home family-focused reunification: an experimental study. Child Welfare 72(5): 473-487.
- Walton E (1991). The reunification of children with their families: A test of intensive family treatment following out-of-home placement (Order No. 9133658). Available from ProQuest Dissertations & Theses Global. (303955539). (Retrieved from http://proxy.library.adelaide.edu.au/login?url=https://search-proquest-com.proxy.library.adelaide.edu.au/docview/303955539?accountid=8203, 14/01/2020)