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IFPS and Mental Health

IFPS Started with Mental Health

The first IFPS model, HOMEBUILDERS®, was developed in 1974 to prevent the psychiatric hospitalization of severely behaviorally disturbed children. As early as 1986, HOMEBUILDERS was cited by the National Institute of Mental Health’s Child and Adolescent Service System Program as an important part of a system of care for emotionally disturbed children and youth (Stroul & Friedman, 1986). The Substance Abuse and Mental Health Services Administration has accepted HOMEBUILDERS® for inclusion on their National Registry of Evidence-Based Programs and Practices.

Efficacy of IFPS for Children with Mental Health Challenges

Many children in the child welfare system experience mental health challenges. A study in Los Angeles found that 44% of children in the child welfare system who receive in home services display elevated levels of problem behaviors that need to be addressed in order to avoid placement (Mennen, Meezan, Aisenberg & McCroskey, 1999).

Demographic data from the HOMEBUILDERS® program in Washington show that approximately 13% of youth are identified at referral as having serious mental health issues and/or suicide ideation or attempts. From January 2009 through April 2013 the program served 3014 children at risk of placement, 383 of whom were reported to have serious mental health symptoms. In the entire population, 97.5% of children successfully avoided placement at termination of services. Ninety-six percent of the 383 youth with serious mental health issues avoided out of home placement at termination of services. These data suggest that Homebuilders® IFPS is equally effective at preventing out of home placement for children with serious mental health challenges as those without.

Also notable is that most of the youth in this evaluation were minorities. There were 58.8% Hispanic youth, 33.6 Black, and 5.5% White youth (Evans et al. 2003 & Evans et al. 1997).

An evaluation of the HOMEBUILDERS® program serving families referred by the Regional Support Network in Spokane County, WA, supports the usefulness of the model as a hospital diversion program. Three years of data show 94.7% of children avoiding psychiatric placements at termination of services. Follow-up data reveal that 77.4% continue to remain a home one year after service closure. A statistically significant relationship between race and avoiding hospitalization was found, showing Black and Native American youth having higher rates of success than White youth.

In 1997 a study was conducted by the Missouri Department of Mental Health on the impact of the HOMEBUILDERS® model on child behavior change. The research tracked 85 children, all of whom had at least one psychiatric diagnosis and were also at imminent risk of out of home placement. Mental health issues included Mood Disorder, Conduct Disorder, Oppositional Defiant Disorder and others. The Child Behavior Checklist was used to measure the behavior change at pre and post services. The results indicated significant decrease in mental health symptoms. The greatest changes occurred in children with Oppositional Defiant Disorder although children with Mood Disorder and Conduct Disorder also displayed significant decreases in their most deficient behavior areas. Improvements were seen in both internalizing and externalizing behaviors. A follow-up visit conducted 6-12 months after services revealed that 64% of the children treated with HOMEBUILDERS® were able to continue living at home and avoid placement in foster care or court custody (Morris, Suarez, and Reid, 1997).

Cost Effectiveness

Using figures from the Washington State Department of Social and Health Services, Tracey et al. (1991) shed light on the issue of dollars saved by investing in the HOMEBUILDERS® program. One of the highlighted studies included 123 child mental health cases with an 83% success rate 3 months after termination of the case. If HOMEBUILDERS® services were not received by these children, it is estimated that 13% would have gone into foster care services and 87% to residential treatment facilities. The estimated cost of such placements, taking into account average lengths of stay and average cost per month, would be approximately $3,203,586. The entire cost of the HOMEBUILDERS® services for the 123 children was $319,800. This represents an estimated cost savings of $2,883,786.

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Posted by Charlotte Booth, Executive Director, Institute for Family Development      

IFPS with Juvenile Justice

When originally developed in 1974, the HOMEBUILDERS® model of IFPS was used primarily to serve adolescents and their families. From 1974 until 1986 adolescents comprised approximately 58% of referrals. The proportion of families served who have younger children has steadily grown. Adolescents now comprise approximately 22% of referrals.

While most of these youth have been referred from the child welfare system, concurrent or past juvenile court involvement is common in this population. Following is a brief history and outcomes of the services to families of youth involved in the juvenile justice system that have been provided by Institute for Family Development (IFD).

  • 1976 — Pierce County, WA, Juvenile Court. HOMEBUILDERS® was funded by the U.S. Department of Health, Education and Welfare, Administration for Children, Youth and Families to provide services to youth and families referred from the Pierce County Juvenile Court.

    Twelve months after intake, 73% of youth served were not placed in out-of home care. Data from the overflow comparison group showed that only 28% of the comparison youth avoided placement.

  • 1987–1994 — Family Ties, Bronx, NY. The Family Ties program was developed to test the HOMEBUILDERS® model with a juvenile justice population. The program was designed to avert juvenile placements and reduce recidivism. Institute for Family Development trained the New York staff and assisted them in the replication of the HOMEBUILDERS® model.

    Outcome data from the program showed that Family Ties averted from incarceration 65% of the youth referred by Juvenile Court; 82% of juveniles who participated in the program remained crime-free and out of placement twelve months later; and the program was cost beneficial, saving the state and city governments an estimated 2.7 million dollars a year.

  • 1992–1993 — Division of Juvenile Rehabilitation. IFD entered into a contract with the Washington State Department of Social and Health Services and the Division of Juvenile Rehabilitation to offer the HOMEBUILDERS® model to families of youth committed into Option B Probation (an alternative program to commitment for middle and serious offenders).

    Outcome data for the treatment group: 50% of youth had detentions, 17% had new charges, and 8% had new commitments. Outcome data for the control group: 100% of youth had detentions, 80% had new charges, and 20% had new commitments.

  • 2003–2006 — Parents and Children Together (PACT), Snohomish County Juvenile Court. IFD received funding from the Washington State Governor’s Juvenile Justice Advisory Committee (GJJAC) and the City of Everett, WA to provide services modeled on the HOMEBUILDERS® program to court involved youth. Referrals included youth on probation and status offenders; youth were assessed as being at moderate risk to re-offend.

    An independent evaluation of IFD’s PACT program in Snohomish County compared pre- and post-project court records (JUVIS), and “determined that youths had 58% fewer offense convictions during a 12-month follow-up period than in a comparable period before they entered the project” (September 2005).

Based on these studies and others, HOMEBUILDERS® has been designated as an evidence based practice for juvenile justice:

  • The HOMEBUILDERS® program is designated a Model Program for preventing juvenile delinquency by the U.S. Office of Juvenile Justice Delinquency Prevention (OJJDP) and the Center for Substance Abuse Prevention (CSAP).
  • HOMEBUILDERS® is designated as an effective program by Crime Solutions. Crime Solutions is an effort undertaken by the U.S. Department of Justice’s Office of Justice Programs (OJP) to identify effective, quality programs and practices in the fields of criminal justice, juvenile justice, and crime victimization to serve as evidence-based models for the field. This evidence-based repository will serve as a valuable clearinghouse of information about what works and what is promising in justice programs and practices. www.crimesolutions.gov

 

To learn more about the Homebuilders® program, visit www.institutefamily.org

 

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Posted by Charlotte Booth, Executive Director, Institute for Family Development

 

Featured IFPS Program: Louisiana

Louisiana is the second in our series of featured IFPS programs. (See more at Mississippi.) Louisiana began offering intensive family preservation services in the 1990s. It was discontinued due to budget restraints and reinstated in 2007.

We asked the provider, Volunteers of America Greater Baton Rouge, LA, and the Louisiana State Administrator to talk about key elements of their program.

1.How long has your state offered IFPS? Share about the history of IFPS in your state.

IFPS State Administrator:
Louisiana DCFS has offered IFPS since 2007. It was available in the mid-90s; however, it became a casualty of significant budget restraints and was discontinued. It was resurrected post-Katrina in 2007, when funds became available, and has maintained funding each year now that we have data to support its success. Also, in March 2013, the Homebuilders® model of intensive family preservation became a Medicaid covered service, thereby opening it up to more families.		 IFPS Provider:
We started in 1990 with a federal grant. In 1991, we started contracting with the State through OCS, later renamed to DCFS, to provide intensive home-based prevention and reunification services, based on the Homebuilders® model.

2. Why does your state/agency offer IFPS?

IFPS State Administrator:
  • It’s ultimately about safety! If we can prevent a child from coming into custody and safely maintaining them in their own home (now and in the future without repeat maltreatment), the savings to the state is significant and the “emotional savings” to the child and family are immeasurable.
  • Removal of a child from the home can be very traumatizing, even if placed in the best of foster homes. By intervening quickly, we can diffuse a crisis situation and teach the family new skills in order to keep the child safe in the home.
  • The State is also focusing on reducing the number of children in foster care and making sure they have safe and permanent homes. Homebuilders® allows a child to return to their home environment by placing extra supports to smooth the transition, increasing stability in the placement. Referrals to Homebuilders® are also encouraged to stabilize a foster home placement, thereby reducing the number of placement changes and disruptions for the child.
 IFPS Provider:
  • We believe that families are more interested and more capable of change during times of crisis and that families can, with help, learn healthier, more nurturing ways of responding to family members, including their children.
  • The Homebuilders® model emphasizes community networking, family advocacy and skills building to increase family self-sufficiency and improve family living.

3. What qualities do you want to see in providers of IFPS, both at the agency and at the therapist level?

IFPS State Administrator:
The Provider/Therapist would have to have:
  • a clear understanding of safety,
  • an ability to teach skills in a motivating and encouraging manner,
  • apply a collaborative approach with the agency and community providers,
  • have a belief in families and their ability to make changes,
  • flexibility to work with all ages and “issues”,
  • availability (24/7 including evenings and weekends),
  • appreciation and respect for diversity and
  • an ability to be engaging with families, seeing them as partners in the process.

All levels of the organization need to be “on board” when it comes to adhering to the Homebuilders® model. From the Therapist to the Program Supervisor and the Program Manager, all need to understand and implement the model with fidelity.

 IFPS Provider:
The Provider/Therapist is someone:
  • with good therapeutic skills,
  • who understands the philosophy that families are best served in their homes where intervention happens in real-life situations,
  • who is very flexible and available to see clients when it is convenient for them, rather than the therapist,
  • who is non-judgmental about working with parents who have abused their children,
  • who is a “people” person.

4. What qualities do you look for in an IFPS therapist?

IFPS State Administrator:
  • Life changing transformation in behavior, thoughts, and actions from even the most challenging of family circumstances has occurred.
  • It’s amazing what families can accomplish when they are guided, given the skills and encouragement, and are linked with supports in the community.
  • The feedback surveys are overwhelmingly positive and “glowing” with praise for the program and thanks for giving them this chance to make improvements.
 IFPS Provider:
See #3.

5. How do you measure success of IFPS services? How successful are IFPS services in your state?

IFPS State Administrator:
Success is measured by:
  • improved NCFAS ratings,
  • family satisfaction surveys,
  • child safety (whether the child comes into care or is reunified—as long as they are not re-victimized),
  • success at closure (for example, did the family complete the full intervention without dropping out or having a removal), and
  • avoidance of repeat maltreatment within 6 months of the closure date of IFPS.

Homebuilders® is an integral part of our family services menu and is regarded as highly successful in maintaining families safely.

 IFPS Provider:
In baby steps often. Indicators we look for:
  • Parents are receptive to suggestions
  • Parents put the new skills into practice
  • Decreased yelling
  • Less fear in the children
  • Parents are not using physical punishment
  • No additional CPS reports for a period of 6 months to at least a year

6. What advice and resources can you share with other states that want to establish a strong IFPS program?

IFPS State Administrator:
  • We recommended that states use a research based model, such as Homebuilders®, and provide oversight to ensure it is followed with integrity and fidelity.
  • Having a State “coordinator” is helpful as this contact person can coordinate trainings for all providers (date, location) as well as conduct Provider meetings to collaborate, problem solve and share successes.
  • For Louisiana, we have access to the Online Data Management (ODM) system where all Homebuilders® data is stored for our families so we can run current statewide data (from a therapist level to a program level to a statewide level) as well as link that system data with our agency system data to check for repeat maltreatment.
 IFPS Provider:
  • We use the Homebuilders® model and use the assistance and training provided by the Institute for Family Development (IFD).
  • Coordinate at the state level to evaluate the level of need for this service in your area.
  • Develop a clear agency financial model for providing this service.
  • If you have more questions, you can reach me at 225-928-9398.

Contacts:
IFPS State Administrator
Nell Aucoin
DCFS Child Welfare
Prevention and Family Services
Baton Rouge, LA

IFPS Provider
Raylene McKinnon
Director of Child and Family Services
Volunteers of America Greater Baton Rouge, LA

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Posted by Peg Marckworth

IFPS is Effective with Older Youth

Several years ago, the National Family Preservation Network, in association with Dr. Ray Kirk and the National Alliance to End Homelessness, conducted research on the use of IFPS with older youth.

Two agencies provided data on IFPS services to older youth with one of the agencies providing comparative data for younger children. Older youth were defined as ages 12–17 while younger children were defined as ages 0–11.

The major findings of the study:

  • IFPS services were highly effective with older youth for both placement prevention services and reunification. The difference in outcomes for older youth vs. younger children was very small:
    Younger Children Older Youth
    Placement Prevention Success Rate 88% 92%
    Reunification Rate 97% 92%
  • Older youth were more likely to be female and had significantly higher rates of physical and sexual abuse than younger children, as well as family conflict. Other issues much more prevalent in older youth than younger children included adoption disruption, behavior problems, delinquency, child-centered violence, school problems, mental health problems, and substance abuse. All of these issues were effectively addressed in terms of preserving the placement or reunifying the older youth with their families.
  • The NCFAS and the NCFAS-R assessment tools were found to be reliable for use with both the older youth and younger children. This is critical because the tools measure over 40 factors of family functioning that affect youth and their families and are used in a wide variety of youth- and family-serving systems.
  • Despite having many more presenting problems than younger children, older youth and their families made just as much progress as younger children and their families on all measures of family functioning with one exception. That exception was the area of child well-being which includes the factors of mental health, child’s behavior, school performance, relationship with caregivers, relationship with siblings, and relationship with peers. Since these factors are child-focused, rather than parent-focused, and tend to reflect the older youth’s desire for independence and ability to make choices, including bad choices, less progress in this area is perhaps understandable. In any event, somewhat less progress in the area of child well-being did not adversely affect the overall positive outcomes for older youth.
  • Early IFPS programs served primarily older youth and we are now coming full circle to realizing that IFPS is still an excellent resource for adolescents.

To view the Older Youth Research Report, visit:
http://nfpn.org/preservation/186-older-youth.html

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Posted by Priscilla Martens, NFPN Executive Director

IFPS with Adoptive Families

The National Family Preservation Network, in association with Dr. Marianne Berry, conducted research on the use of IFPS with post-adoptive families in a project funded by a grant from the Annie E. Casey Foundation. Data on IFPS were provided by the state of Missouri.

The published research included these key findings:

• Services focused primarily on parent/child conflict, communication problems, the child’s emotional problems, and school problems.

Variable (N = 99)

n

%
Primary Problem Addressed in Adoption IFPS Intervention
Parent/child conflict

62

62.6
Communication skills

47

47.5
Parenting skills problems

47

47.5
Emotional problems

22

22.2
Physical abuse

19

19.1
Mental health problems

19

19.1
Pregnancy

13

13.1
School problems

13

13.1
Medical illness/disability

8

8.0
Physical violence

8

8.1
Delinquent behavior

7

7.1
Child neglect

4

4.0
Severe financial problems

3

3.0
Criminal behavior

2

2.0
Sexual abuse

2

2.0
Marital conflict

2

2.0
Runaway

2

2.0
Drug abuse

1

1.0
Developmental disability

1

1.0
Shelter

1

1.0
Other

10

10.1

• 83% of the adoptive families studied were preserved by the end of IFPS. At a 6-month follow-up point, 76% remained intact. No families contacted at the 6- or 12-month follow-up checks had legally disrupted.

Table 9: Case Outcomes

Variable (N = 99)

n

%
Type of Placement Originally Anticipated
Foster Home

42

42.4
Residential

39

39.4
Relative Care

7

7.1
Psychiatric Hospital

5

5.1
Detention

5

5.1
Emergency Shelter

1

1.0
Placement
No placements

82

82.8
Prior to IFPS services

9

9.1
During IFPS services

2

2.0
After IFPS services cease

6

6.1

• The adopted children who were most likely to experience placement during or after IFPS were those who were significantly older and IFPS was being used to reunify the family, rather than avert placement. Placement rates were highest for children served for delinquent or criminal behavior, running away, or where the family was experiencing physical violence, severe financial problems or medical illness or disability.

• The content of training for preservation workers who work with adoptive families is significantly enhanced with information of special importance to adoptive families. These content areas include grief and loss, attachment, parental expectations, and ways to enhance the parental characteristics of patience, flexibility, humor and acceptance.

• Findings from this study indicate the need for greater availability of IFPS services to adoptive families, given placement prevention rates in the 80% + range, and high parental satisfaction.

Click here to get the full report on IFPS with Post-Adoptive Families:
http://nfpn.org/articles/ifps-with-post-adoptive-families

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Posted by Priscilla Martens, NFPN Executive Director

An Interview with Rep. Roger Freeman

Rep. Roger Freeman

Rep. Roger Freeman

The IFPS Blog seeks to present a variety of perspectives on Intensive Family Preservation Services. In October, 2013 we conducted this interview with Washington State legislator, Roger Freeman.

Representative Roger Freeman passed away on October 29, 2014. He was a first-term legislator in Washington State and Vice Chair of the Early Learning and Human Services Committee. Rep. Freeman was an attorney and manager of the dependency unit of the King County Department of Public Defender.

http://housedemocrats.wa.gov/news/rep-roger-freeman-1965-2014/
http://housedemocrats.wa.gov/tag/rep-roger-freeman/

IFPS Blog: Rep. Freeman, you are a public defender. Could you share some of your experiences? Do you represent families facing removal of their children?

Rep. Freeman: We’re part of a model court system in which attorneys have specialized training and experience in working with dependency cases. I have been involved with child welfare dependency cases for nine years. I represent parents from the investigative stage all the way through to termination of parental rights. Over 80% of the cases are drug related. But the biggest shock to me is that so many of the children are removed due to the family’s poverty. These families may resist intervention, so my job is to mediate between the families and the child welfare workers to connect the families with the help that they need to keep their children.

What I see as the key to helping families is to get them engaged with services within the first 30 days. The families that engage early on have better outcomes, with their children returned to them within 6-12 months. When families do not engage, it can lead to termination of parental rights.

Click here to see how adequate legal representation provided in Washington State affects children (PDF file, 881Kb).

IFPS Blog: How did you learn about Intensive Family Preservation Services and what are your thoughts about these services?

Rep. Freeman: I knew about FPS (a less intensive service), but I realized that some families need more contact, teaching, and hands-on services. That’s when I learned about IFPS and what a vital service it is. The earlier that families are referred to IFPS, the less likely it is that they will go further into the child welfare system. I’m a huge fan of IFPS and would like to obtain more funding for it, especially for use with drug-affected parents before the child is born.

IFPS Blog: As a legislator, what do you look for to determine if a program is effective?

Rep. Freeman: The legislature supports early intervention. We want to fund services that create better outcomes for families such as pre-K programs, substance abuse treatment, and day care in order for parents to maintain employment.

I am especially concerned about parents with disabilities. If parents with disabilities are unable to care for their children on their own, then they should be assisted through kinship care or other arrangements that allow the parents to remain involved in their children’s lives.

IFPS Blog: What do you think are the best ways to help families stay together?

Rep. Freeman: I think the best way is “aggressive engagement.” We need rapid response teams that provide immediate assistance rather than waiting for multiple complaints before providing services. IFPS is an example of a rapid response. We need more services like that in which parents receive fast, competent, and skill-building services in order that they can move to more effective parenting.

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Posted by
Mary Fischer, Associate Director
Institute for Family Development

Updated after Rep. Freeman’s death.

Featured IFPS Program: Mississippi

Mississippi has offered intensive family preservation services since 1992.

We asked the provider, Mississippi Children’s Home Services and the State Administrator to talk about key elements of their program.

Why does your state offer IFPS?

IFPS State Administrator:
It offers IFPS services to prevent the removal of children from their home setting due to abuse, neglect, etc.		 IFPS Provider:
Mississippi Children’s Home Services (MCHS) recognizes the importance of family preservation services as a part of a service continuum to help families remain together and to prevent children from entering foster care, when they can be safely maintained at home.

How long has your state offered IFPS?—share about the history of IFPS in your state.

IFPS State Administrator:

  • Mississippi’s intensive family preservation services began in 1992 as a pilot project in one county with two contract employees.
  • It expanded to all counties in 1996.
  • Between 1999 and 2007 the positions were state service.
  • In 2007 the services were once again outsourced.
  • Currently, we have one Provider that provides the service to all 82 counties.
 IFPS Provider:

  • The Mississippi Department of Human Services (MDHS) provided family preservation services in-house from 1995–2006.
  • Mississippi Children’s Home Services (MCHS), applied and was awarded the contract for Family Preservation in 2006, when MDHS first outsourced the service.
  • MCHS has continued to provide family preservation services and in 2010, was awarded the contract for Comprehensive Family Support Services Program (CFSSP), which included family preservation and reunification services.
  • MCHS is the sole provider of CFSSP for the state.

What qualities do you want to see in providers of IFPS both at the agency and at the therapist level?

IFPS State Administrator:
We would look for competence, stability, values, a commitment to the families served, and a provider who has similar views on child abuse prevention, etc.		 IFPS Provider:Question not applicable

What qualities do you look for in an IFPS therapist?

IFPS State Administrator:Question not applicable IFPS Provider:
We look for therapists who are:

  • committed to preserving the family unit
  • understand that this is a time-limited intensive program and can stay focused on the family goals and treatment needs
  • build on the family’s strengths and recognize that the family is a key resource for change.
  • MCHS also seeks therapists who are able to learn and apply evidenced based models and interventions in practice.

What changes do you see in families that receive IFPS?

IFPS State Administrator:

  • Most of the families learn to maintain on their own without future assistance from the agency.
  • They are driven to keep their children safe, and use the skills taught to them so that further issues concerning abuse/neglect do not arise.
  • They are confident, have more positive interactions within their families; and are more positive in their outlook on life.
 IFPS Provider:
Families who by the end of the intervention:

  • communicate effectively with each other
  • know who their support systems are in the community
  • parents have realistic expectations of their children
  • improved marital relationships
  • improved and appropriate disciplinary techniques
  • better income management skills
  • better home management skills
  • more respect among all family members

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Posted by Peg Marckworth

Information provided by:
Carolyn Cotton Bland, Mississippi Division of Family and Children’s Services
Elizabeth Frizsell, Mississippi Children’s Home Services

IFPS and Evidence-Based Practice, Part 2

Last week we introduced the topic of evidence-based practice.  This week we look at how the state of Washington is implementing evidence-based practice that includes IFPS.

In 2012 the Legislature passed E2SHB 2536 with the intent that “prevention and intervention services delivered to children and juveniles in the areas of mental health, child welfare, and juvenile justice be primarily evidence-based and research-based, and it is anticipated that such services will be provided in a manner that is culturally competent.”  Washington is one of the few states to have enacted a law for implementation of evidence-based practice. You can view the legislation here:
(PDF, 29Kb) http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/House%20Passed%20Legislature/2536-S2.PL.pdf

Two independent research groups were designated to create an inventory of  evidence-based, research-based, and promising practices and services.

One of these research groups, the Washington State Institute for Public Policy (WSIPP), had previously conducted an extensive review of IFPS.  WSIPP reviewed all rigorous evaluations of IFPS programs that included a comparison group and then sorted the evaluations based on fidelity to the Homebuilders® model. IFPS programs with high model fidelity had a significant reduction in out-of-home placements of children and produced $2.59 of benefits for each dollar of cost. IFPS programs that did not adhere to the Homebuilders® model produced no significant effects.  You can view the full study here:
(PDF, 45Kb) http://www.wsipp.wa.gov/rptfiles/06-02-3901.pdf

Because fidelity of IFPS programs to the Homebuilders® model is key to their effectiveness, it’s important for the IFPS field to be informed of the fidelity measures.  The more familiar measures include

  • 24/7 availability,
  • caseload of 2 families at a time,
  • meetings with family 3–5 times a week, and
  • services provided for 4 weeks.

Other measures include

  • standards for supervisors,
  • comprehensive assessment,
  • goal setting and service planning,
  • engagement and motivation enhancement, and
  • cognitive and behavioral approach.

For a complete list of the Homebuilders® fidelity measurs and accompanying performance measures, see:
(PDF file, 82Kb) http://www.institutefamily.org/pdf/HOMEBUILDERS-FidelityMeasures-Abridged-2-6.pdf

If your agency is considering implementing or strengthening an IFPS program, you can easily incorporate these standards and performance measures into the design.

Washington State is the birthplace of the Homebuilders® program and thus state policy makers had access to a good example of evidence-based practice. Homebuilders® IFPS is included in two places in the current state inventory of evidence-based programs. You will note in the inventory chart (see link below) that Intensive Family Preservation Services (Homebuilders) is the fourth item in the child welfare category and is ranked as an evidence-based program (top ranking). It is also listed in the mental health category under “serious emotional disturbance” as a research-based practice, based on a single evaluation. You will find the rankings for many other familiar programs in the chart.

WSIPP Inventory Chart:
(PDF file, 66Kb) http://www.wsipp.wa.gov/rptfiles/E2SHB2536-3i.pdf

We have seen in this series of posts how evidence-based practice has developed and where IFPS fits in. The field of IFPS is heavily dependent on the Homebuilders® model of IFPS for its inclusion in evidence-based practice. Charlotte Booth and Shelley Leavitt at the Institute for Family Development (parent agency of Homebuilders®) have spent decades building, maintaining, and training on model fidelity, and contributing data on their program. You can join me in publicly thanking them by posting a comment below.

Thank you, Charlotte and Shelley and all IFD staff, for your dedication and commitment to make IFPS one of the most effective programs for families!

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Posted by Priscilla Martens, NFPN Executive Director

IFPS and Evidence-Based Practice

There is perhaps no more frequently used term in the child welfare field today than “evidence-based practice.” In this series of posts, we look at the definition and evolution of evidence-based practice, why it is important, where IFPS fits in, and how one state is implementing evidence-based practice.

In 2005 the National Association of Public Child Welfare Administrators (NAPCWA) published guidelines for evidence-based practice. NAPCWA noted the following issues surrounding evidence-based practice:

  1. The base of solid empirical research on child welfare practice is still developing.
  2. Child welfare practices cannot simply be divided into “evidence-based” and “non-evidence based.” There is a continuum from highly research supported practice at one end to very questionable and concerning practices at the other end.
  3. There is no universally accepted definition or classification of evidence-based practice.

NAPCWA adapted a definition of evidence-based practice from the Institute of Medicine that combines three factors:

  1. Best research evidence
  2. Best clinical experience
  3. Consistent with family/client values

In order to operationalize these factors and provide objective measures, the California Evidence-Based Clearinghouse for Child Welfare (CEBC) was established. A practice is rated based on the following criteria:

 1. Well-Supported by Research Evidence

2. Supported by Research Evidence

3. Promising Research Evidence

4. Evidence Fails to Demonstrate Effect

5. Concerning Practice

NR. Not able to be Rated

The CEBC relies on published, peer-reviewed research to determine the rating.

Why is using an Evidence-Based Practice important?

A CEBC advisory committee member’s response to that question follows.

Evidence-based practice:

  • Ensures that families are referred to the most effective and efficacious programs that the community provides.
  • Helps child welfare workers and supervisors empower families in crisis to resolve their own conflicts, using well-tested programs.
  • Allows child welfare workers to refer families to services that have been scientifically researched and proven effective, which in turn may cause the families to make a greater commitment to participation.
  • Provides child welfare workers with a better understanding of the range of programs available so they can make informed choices when referring families to services.

How does IFPS fare in the CEBC rating system?

Homebuilders® IFPS has been rated by the CEBC in the areas of:

  • Interventions for Neglect,
  • Post-Permanency Services,
  • Reunification,
  • and Family Stabilization.

The rating assigned to each of these areas is a “2” with a detailed report available. (Click here to view one of these detailed reports.)

The CEBC website ( http://www.cebc4cw.org/ ) is user-friendly and contains a wealth of information about evidence-based practice and programs. Because IFPS is an evidence-based practice, the IFPS field should be aware of and support other evidence-based practices. Be sure to check out the CEBC website!

Next time we’ll look at how one state has implemented evidence-based practice that includes IFPS.

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Posted by Priscilla Martens, NFPN Executive Director

Ethical Dilemmas

When I was very young and starting my social work career as a probation officer, I was surprised to find myself facing ethical dilemmas.

For example, my probationers often had the television on while I visited and frequently at top volume, especially if they didn’t like me. What to do? I would start talking in long sentences but say certain words above the volume of the television. These words included “curfew,” “good behavior,” and “early release.” Whereupon the probationer would leap to his feet, turn off the television, and take the chair next to me, listening with rapt attention. I would then explain in a normal tone of voice that the curfew would remain the same until the behavior improved and then we might consider early release from probation.

A more awkward situation occurred when I left the bar with my friends at 1:00 a.m. and encountered a probationer on the street, out after her curfew. What to say? The probationer broke the silence by asking, “You have friends?” That focused my attention on the immediate need and I responded, “You know that you’re out after curfew. Get home right now and be in my office at 9:00 in the morning—ummm, make that 10:00.”

We’ve all done stupid things. Looking back I realize inexperience contributed to many of mine. I was only five years older than many of the probationers I was trying to help and I had a lot of maturing to do. Amazingly, five years later I encountered far fewer ethical dilemmas.

Here’s something that young IFPS therapists today will have a hard time believing: I started out with no mobile phone, laptop, computer…not even a beeper! I did have a tablet (white paper with lines) on which to keep notes. The advantage I had was that my mistakes were viewed by and mainly of interest only to those who were present at the time. Now, everyone is only a click away from fame or infamy. I know, it’s not fair!

There are many resources available to guide us through ethical dilemmas, and I’ll provide a link to one of them at the end of this post. I understand now that one of the reasons why supervisors and administrators are so important is they can offer advice about how to handle ethical dilemmas. What seems confusing and complicated gets much easier to unravel when two people are looking at the situation.

The following are some things I’ve learned over the years that may be of help:

  1. Never violate your conscience. You only have one and you need to be able to rely on it. Violating it continually will render it useless when you need it most.
  2. Never do anything that you (or your mom!) wouldn’t mind reading about on the front page of the newspaper. I learned this handy rule early on during 18 years of legislative work. Unfortunately, some of the legislators learned it the hard way.
  3. If you like second chances, offer them to others. I have many opportunities to recall my own wrong behavior when I observe what others are doing. People forgave me and willingly offered me another chance to get it right. I can make a choice to do the same for others.
  4. Seek friends, mentors, supervisors, and administrators with the highest standards. These people will help you grow in the right direction and you’ll become a better person than you ever thought possible.
  5. Suffer fools gladly. You’re sometimes one too! Say, “I’m sorry,” overlook offenses, reduce defensiveness, and be ever on the lookout for ways to make other people happy.

The North Carolina Family Based Services Association has graciously shared their Ethical and Safety Guidelines which can be viewed here:
http://nfpn.org/articles/ethical-and-safety-guidelines

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Posted by Priscilla Martens, NFPN Executive Director