Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders

Journal of Family Strengths Volume 2 | Issue 2 Article 6 1997 Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders Edwin Morris Lourdes Suarez John C. Reid Follow this and additional works at: http://digitalcommons.library.tmc.edu/jfs Recommended Citation Morris, Edwin; Suarez, Lourdes; and Reid, John C. (1997) "Behavioral Outcomes of Home-Based Services for Children and Adolescents with Serious Emotional Disorders," Journal of Family Strengths: Vol. 2: Iss. 2, Article 6. Available at: http://digitalcommons.library.tmc.edu/jfs/vol2/iss2/6 The Journal of Family Strengths is brought to you for free and open access by CHILDREN AT RISK at DigitalCommons@The Texas Medical Center. It has a "cc by-nc-nd" Creative Commons license" (Attribution NonCommercial No Derivatives) For more information, please contact Morris et al.: Behavioral Outcomes Behavioral Outcomes of Home-Based for Children and A d o l e s c e n t s with Serious Services Emotional Disorders Edwin Morris, Lourdes Suarez and John C. Reid The current study evaluates the effectiveness of an intensive home-based treatment program, Families First, on the behaviors of children and adolescents suffering from mental disorders and being at risk for out-ofi home placement. The sample included 85 youngsters and their families from a semi-rural community. The Diagnostic Interview for Children and Adolescents-Revised (DICA-R) was administered to the children, and the Child Behavior Checklist (CBCL) was completed by a parent at pretreatment and posttreatment. The families participated in a 4-6 week, intensive home intervention where crisis intervention, social support services, and needed psychological services were offered. The results indicated that both externalizing and internalizing behavior problems in youngsters with different diagnoses of mental disorders were significantly reduced at posttreatment as indicated by their CBCL scores. Furthermore, youngsters with a diagnosis of Oppositional Defiant Disorder seemed to benefit the most, as evidenced by the improved scores on most subscales of the CBCL. Youngsters with mood disorders and conduct disorders seemed to benefit in their most deficient areas, internalizing behavior problems and delinquent behaviors, respectively. Finally, after participating in Families First, more than half of the youngsters in the sample were able to stay home with their families. The enactment of the Adoption Assistance and Child Welfare Act ( P.L. 96-272) required state child welfare agencies to make reasonable efforts to prevent out-of-home placements. The legislation endorsed the concept of attempting home-based services prior to out-of-home placement. The act inspired various family preservation programs, some targeted at families of children with emotional disorders (Petr, 1994). The passage of the Family Preservation and Support provisions of the Omnibus Reconciliation Act of 1993 ( P. L. 103-66) further challenged states to implement system-wide family preservation and family support services (Briar, Broussard, Ronnau, & Sallee, 1995). These services were conceptualized to prevent out-of-home placement by providing an array of brief, home-based services (Nelson, Landsman, & Deutelbaum, 1990; Whittaker, Kinney, Tracy, & Boothe, 1990). In addition to these legislative initiatives, family preservation programs and other family-focused services Family Preservation Journal (Volume 2, Issue 2, 1997) Family Preservation Institute, New Mexico State University Published by DigitalCommons@The Texas Medical Center, 1997 21 1 22 • Edwin Morris, Lourdes John C.Vol. Reid Journal Suarez of Familyand Strengths, 2 [1997], Iss. 2, Art. 6 have been promoted by several private organizations and foundations, such as the Edna McConnell Foundation (Clark, 1985). Family preservation has emerged as a national movement recognized for its efforts to keep families together. Family preservation has received strong support in a number of states because these programs focus on maintaining children in their natural homes and offer a less expensive alternative to out-of-home placements. Also, widespread political and financial support for family preservation has spawned a significant increase in the number of these programs. The Omnibus Budget Reconciliation Act of 1993 has provided entitlement funding encouraging states to develop or expand family preservation services (P. L. 103-66, 1993). More than thirty states currently incorporate family preservation services into their array of protective services offered by child welfare systems (Center for the Study of Social Policy, 1992). Family preservation programs have evolved from the broader categories of home-based services that served families in their homes and communities, and family-based services, which focused on the whole family, rather than the individual (Pecora, Haapla, & Fraser, 1991). Historically, the vast majority of family preservation efforts target children and families referred to protective service agencies for abuse or neglect. Family preservation is based on the notion that families are more responsive to change at times of crisis (Kinney, Madsen, Flemming, & Haapala, 1977). These family programs endorse the philosophy that out-of-home placements of children can be avoided by modifying family behaviors through the provision of home-based services. Such short-term, intensive, crisis-intervention programs are used when children are "at imminent risk" of being taken from their families (Barthel, 1992). Typically, family preservation programs include the following elements, clinical and concrete services are delivered in the home of the client families; a therapist is available to clients 24 hours a day; the duration of intervention is short ranging from four to six months; and therapists have small caseloads (Pecora et al., 1991). Because of the recent proliferation of family preservation programs, evaluation of their effectiveness seemed crucial to caseworkers and researchers. These evaluations have often relied on one single outcome measure, the child's placement after the program. Kinney et al. (1991) reported that by the end of 1990, Homebuilders had seen 5,314 cases and 73% had avoided placement twelve months after termination. Other programs designed to work specifically with adolescents and their families reported success rates of 66% (Nelson et al., 1990) and 87% (Tavantzia et al., 1985) of the cases averting placement at a twelve month follow-up. Although reports of these programs were encouraging, more recent studies and critiques are less conclusive (Rossi, 1992). An evaluation of five family preservation programs in New Jersey concluded that the participating families had fewer children placed but the effects of treatment dissipated after nine months (Feldman, 1991). Heneghan and colleagues (1996), Family Preservation Journal (Volume 2, Issue 2, 1997) Family Preservatio (...truncated)