1. Shelley Leavitt, Ph.D. Institute for Family Development
The HOMEBUILDERS® Model: What We Have Learned Over the Last Thirty Years
Shelley Leavitt, Ph.D.
Institute for Family Development

2. What is Homebuilders?
Homebuilders is an intensive in-home family treatment program designed to keep children and families safe and prevent the unnecessary out of home placement of children, and to safely reunify children and families.

3. Homebuilders Program Philosophy
It is best for children to be raised
in their own families whenever
possible.

4. Applications of the Homebuilders Model
Placement Prevention
Reunification
Adoption and Long-Term Foster Care Stabilization

5. Program Model Intervention Activities Program Structure
Values and Beliefs

6. Homebuilders Program Structure: Values Based Orientation
The Homebuilders model is based on a clearly articulated set of values and beliefs, which guides program design and staff behavior.

7. Homebuilders Values and Beliefs
Safety is our highest priority
We cannot predict which situations are most amenable to change
A crisis is an opportunity to change
It is our job to motivate clients and instill hope
Family members are our partners
We can make life worse for families

8. Homebuilders Values and Beliefs (Continued)
Children can be brought up in different kinds of families
People are doing the best they can
It is our basic job to empower family members
It is helpful for us and the family to think of ourselves as “personal scientists”
It is important to minimize barriers to service

9. Homebuilders Program Components
Program Components are designed to minimize barriers to service:
Focus on a Specific Target Population- Children at imminent risk of out of home placement and children in placement who are at the point of reunification
Immediate Availability and Response to Referrals- Referrals are accepted 24 hours a day, 7 days a week. The Homebuilders therapist meets with the family as soon as possible and no later than 24 hours after the referral is received

10. Homebuilders Program Components
Services Provided in the Natural Environment –Primarily in the home and in the community where the problems occur
Intensive Services – Average of 8-10 face to face hours/week
Brevity of Services – Average of 4-6 weeks; extensions and booster sessions
Low Caseload – Average 2 families

11. Homebuilders Program Components
Twenty-Four Hour a Day Availability to Clients – Primary therapist and supervisor available to families 24/7
Single Therapist Operating within a Team - Assures consistency, enhances engagement, minimizes duplication of services and increases accountability

12. Homebuilders Program Components
Supervision and Consultation – Supervisor available 24/7; weekly individual and group consultation
Accountability – Goal oriented interventions, evaluations of outcomes, family and referring worker feedback
Ongoing Training and Quality Enhancement (QUEST)

13. Homebuilders Intervention Activity: Promoting Safety
Throughout the intervention, the therapist assesses child, family, therapist and community safety and develops safety plans, structures the environment and uses clinical strategies to promote safety.

14. Homebuilders Intervention Activity: Individually Tailored Services
Services and teaching strategies are “tailored” to the family’s needs, goals, values, learning styles and specific circumstances. The therapist flexibly schedules sessions with family members, based on the family’s schedule and situation.

15. Homebuilders Intervention Activity: Engagement and Motivation Enhancement
The therapist develops and maintains a positive, collegial working relationship with family members and assumes responsibility for motivating the family.

16. Homebuilders Intervention Activity: Comprehensive Assessment
The therapist conducts a behaviorally specific, interactive, ongoing, and holistic assessment, which includes information on family strengths, problems, needs, values, skills and potential barriers to goal attainment.

17. Homebuilders Intervention Activity: Goal Setting and Service Planning
The therapist collaborates with family members and referring workers in developing behaviorally specific, attainable intervention goals and service/treatment plans.

18. Homebuilders Intervention Activity: Cognitive and Behavioral Approach
The Homebuilders therapist utilizes research-based cognitive and behavioral intervention strategies to facilitate behavior change in children, youth and parents/caregivers.

19. Homebuilders Intervention Activity: Teaching and Skill Development
The therapist uses a variety of teaching methods including role playing, coaching, direct teaching, work sheets, audio/visual materials and homework to help family members learn and use new skills.

20. Homebuilders Intervention Activity: Provision of Concrete Services
The therapist advocates for and provides concrete good and services including transportation, food, clothing and accessing funds to pay for rent, utilities etc, which are directly related to achieving the family’s goals.

21. Homebuilders Intervention Activity: Collaboration and Advocacy
The therapist collaborates and advocates with formal and informal community resources and systems while teaching family members to advocate and access services and supports for themselves.

22. Homebuilders Intervention Activity: Transition and Service Closure
Prior to the conclusion of services, the therapist and family assess goal attainment, plan for the maintenance of progress, and collaborate with the referring worker and other organizations and resources to address ongoing service needs.

23. Development and Expansion of the Homebuilders Model
1974 – Program began in Washington state
1978 – 1994 Homebuilders expanded statewide in Washington
1987 – 1990 Homebuilders project in
New York City

24. Dissemination of the Homebuilders Model
National Dissemination begins 1988
New Jersey – First state to attempt replication
Disseminated in 40 states including: Alabama, Indiana, Kentucky, Louisiana, Michigan, Missouri, New York, Pennsylvania and Washington

25. International Dissemination of the Homebuilders Model
International Dissemination – Since 1990
Australia, Belgium (Flanders), Bermuda, Canada, Finland, Germany, The Netherlands, Portugal and the United Kingdom.

26. Changes/Enhancements to the Intervention Model
Focus on “Critical Thinking” and a “Reflective Practice Framework”
Use of Motivational Interviewing Strategies
Incorporation of the NCFAS/NCFAS-R into the assessment, goal setting and service/treatment planning process
Greater focus on Functional Analysis of Behavior

27. Reflective Practice Model
Personal Framework
Planning
Implementation
Assessment
Evaluation/Outcome

28. North Carolina Family Assessment Scale (NCFAS/NCFAS-R)
NCFAS: Assessment of family functioning on 5 domains of interest
Environment
Parental Capabilities
Family Interactions
Family Safety
Child Well-Being
NCFAS-R: includes all of NCFAS plus two additional domains unique to reunification
Ambivalence
Readiness for Reunification

29. NCFAS Rating Scale +2 +1 -1 -2 -3 Clear Strength Mild Strength
Baseline/
Adequate
Mild Problem
Moderate Problem
Serious Problem +2 +1 -1 -2 -3

30. Changes/Enhancements to the Program Development Process
Comprehensive Training for Therapists and Supervisors
Site Development Process: Program Start-up and Ongoing Consultation Process
Homebuilders Standards and Fidelity Measures

31. Homebuilders Training: 1970’s-1980’s
Initial Homebuilders Training (3-4 Days)
Special Topics (Anger Management, Depression, Assertiveness Skills) (3-4 Days)

32. Homebuilders Training: 2008
Homebuilders Core Curriculum (4-5 Days)
Working with Drug Affected Clients: Motivational Interviewing and Relapse Prevention (3 days)
Assessment and Outcome-based Goal Setting (2 Days)
Implementing Cognitive and Behavioral Interventions (2 Days)

33. Homebuilders Training: 2008
Improving Decision Making through Critical Thinking (2 Days)
Domestic Violence: Strategies for In-Home Practitioners (2 Days)
Working with Parents with Cognitive Limitations (1 Day)
Issues in Reunification (1 Day)
Ethical Issues for In-Home Practitioners (1 Day)

34. Homebuilders Training for Supervisors: 2008
Core Curriculum for Homebuilders Supervisors (3-4 Days)
Program Consultation and Quality Assurance Skills for Homebuilders Supervisors (2-3 Days)

35. Program Development and Implementation Strategies
Program replication in Washington State and New York City: Homebuilders staff relocate to start new programs
Program development across the United States: Development of “site development” strategies and process

36. Site Development Strategies
Program start up TA and consultation
Initial and ongoing training
Weekly telephone consultation
Client record reviews
Quarterly on-site consultation visits including observations of home visits and team consultation

37. Fidelity Measures: Immediate Availability and Response to Referrals
Indicator: Provider agency does not maintain a waiting list.
Performance Measure: When provider agency has an announced opening, eligible referrals are assigned to a therapist on the day of referral.
Indicator: Therapists meet with families within 24 hours of referral.
Performance Measure: 75% of families receive their first face-to-face visit within 24 hours of referral; 85% of families receive their first face-to-face visit no later than the end of the day after the referral. If intake is NOT achieved within 24 hours, 95% of those records document the reason for not achieving this standard as being due to the family’s

38. Fidelity Measures: Promoting Safety
Indicator: Family safety is increased during the intervention
Performance Measures:
When there is a threat of self-harm, child abuse or neglect, or physical violence between family members, 100% of interventions include a safety plan and, if applicable, a service goal to address the threat; in all cases when serious safety concerns exist, therapists maintain frequent contact with family members (at least daily; more if indicated); therapists strategically schedule sessions at times when there is increased potential for problem behavior to occur; therapists respond to crisis situations on a 24/7 basis.

39. Fidelity Measures: Promoting Safety
Indicator: Family safety is increased during the intervention
Performance Measures: When the NCFAS family safety domain is rated below baseline at intake, at least 80% of interventions show an increased rating in this domain at service closure; on the Homebuilders Referent Feedback Survey, therapists receive an average rating of 4.0 or higher on the question: “How satisfied were you that the therapist adequately addressed safety issues?”

40. Fidelity Measures: Comprehensive Assessment
Indicator: The therapist completes a comprehensive written assessment.
Performance Measures: Therapist completes a functional analysis of behavior; therapist completes the NCFAS/NCFAS-R; therapist gathers information in a variety of ways from various sources; family assessments include information about family strengths, values, skills, problems, needs and barriers to goal attainment.

41. Fidelity Measures: Cognitive and Behavioral Approach
Indicator: The therapist applies cognitive and behavioral principles and evidence-based strategies to facilitate behavior change.
Performance Measures: Therapist uses behaviorally specific, value neutral language to describe problems and strengths. Therapist helps family members understand how behaviors are affected by antecedents, consequences, past learning, life experiences, culture, and other factors. Therapist uses evidence-based behavioral strategies with families to increase and/or decrease behavior. Therapist helps families learn how to utilize behavioral strategies to increase, decrease or teach new behaviors to their children. Therapist use evidence-based cognitive strategies with families to effect change.

42. Program Evaluation and Outcome Measures
North Carolina Family Assessment Scale (NCFAS/NCFAS-R)
Behavior Change Measures
Placement Prevention/Reunification Rates
CPS/CAN Re-referrals
Consumer/Family Satisfaction
Referring Worker Satisfaction

43. Results of Meta Analysis of Homebuilders Model
Review and analysis of all rigorous evaluations of Intensive Family Preservation Services (IFPS) programs. WSIPP sorted these evaluations based on fidelity to the Homebuilders model.
Findings
• IFPS programs that adhered closely to the Homebuilders model significantly reduced out-of-home placements and subsequent abuse and neglect. Estimated that such programs produce $2.54 of benefits for each dollar of cost.
• Non-Homebuilders programs produced no significant effect on either outcome.
Summary from “Intensive Family Preservation Programs: Program Fidelity Influences Effectiveness”, February,

44. Evaluations Demonstrating Fidelity to Homebuilders Model
Blythe, B. & S. Jayaratne. (2002, March 22). Michigan Families First effectiveness study.
< accessed 02/07/06.
Feldman, L.H. (1991, December). Assessing the effectiveness of family preservation services in New Jersey within an ecological context. Trenton, NJ: Bureau of Research, Evaluation and Quality Assurance, Division of Youth and Family Services, Department of Human Services.
Fraser, M.W., E. Walton, R.E. Lewis, P.J. Pecora, & W.K. Walton (1996). An experiment in family reunification: Correlates of outcomes at one-year follow-up. Children and Youth Services Review 18(4/5): Note: This program is also evaluated by E. Walton (1998).
Mitchell, C., P. Tovar, & J. Knitzer (1989). The Bronx Homebuilders Program: An evaluation of the first 45 families. New York: Bank Street College of Education.
Walton, E. (1998). In-home family-focused reunification: A six-year follow-up of a successful experiment. Social Work Research 22(4): Note: This program is also evaluated by M.W. Fraser et al. (1996).

45. Rigorous Experimental Study
Blythe & Jayaratne (2002)
High-risk families (court had approved child removal), true random assignment IFPS or traditional services (including foster care)
At 6 months
94% of IFPS children at home/relative
34% of non-IFPS children at home or
with relative
At 12 months
93% of IFPS children at home/relative
43 % of non-IFPS children at home or with relative

46. Research: Random Assignment Studies
Blythe, B. & Jayaratne, S. (2002). Michigan Families First Effectiveness Study. Retrieved April 24, 2006 from
• 81% of treatment group avoided placement. • 51% to 61% of comparison group avoided placement.
Fraser, M., Walton, E., Lewis, R., Pecora, P., & Walton, W. (1996). An experiment in family reunification services: Correlates of outcomes at one year follow up. Children and Youth Services Review, 18 (4/5):
• 92% of the treatment group returned home. • 28% of the control group returned home.
Feldman, L.H. (1991, December). Assessing the effectiveness of family preservation services in New Jersey within an ecological context. Trenton, NJ: Bureau of Research, Evaluation and Quality Assurance, Division of Youth and Family Services, Department of Human Services.
• 57% of the treatment group avoided placement.
• 43% of the control group avoided placement.

47. Research: Comparison Group Studies
Fraser, M. W., Pecora, P.J., & Haapala, D.A. (Eds.). (1991). Families in Crisis: The Impact of Intensive Family Preservation Services. New York: Aldine de Gruyter.
• 71% of WA treatment group; and 62% of UT treatment group avoided placement.
• 15% of comparison group avoided placement.
Mitchell, C., Tovar, P., & Knitzer, J. (1989). The Bronx Homebuilders program: An evaluation of the first 45 families. New York: Bank Street College of Education.
• 74% of the treatment group avoided placement
• 65% of the control group avoided placement.
Wood, S., Barton, K., & Schroeder, C. (1988). In-home treatment of abusive families: Cost and placement at one year. Psychotherapy 24(3),
• 74% of the treatment group avoided placement.
• 45% of the control group avoided placement.

48. Research: Statistical Control Group
Kirk, R.S. & Griffith, D.P. (2004). Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research 28(1), 5-15.
• 81% of treatment group avoided placement.
• 51% to 61% of comparison group avoided placement.

49. What We Have Learned
Implementation of the Homebuilders Model isn’t easy and program development takes time and resources
Public and private agency support are critical to successful program implementation
Payment systems can support or hinder successful implementation
Ongoing training, consultation and quality enhancement are essential to long term success

50. What We Have Learned
Staff selection is critical – there must be a “job fit”
Supervisors are a key to successful implementation
A focus on maintenance of changes is critical – no program can be successful without other community supports and resources
Successful programs can easily be dismantled or diluted
Ongoing research is needed and difficult to accomplish

51. Keys to Successful Program Development and Implementation
Obtain wide-spread support
Ensure adequate funding and effective payment systems
Choose provider agencies with congruent values, policies and capabilities to provide needed support to program staff
Develop effective referral pathways and processes to ensure that adequate and appropriate referrals are made
Provide on-going training and consultation to public and private agency staff
Collect and review program implementation and outcome data and focus on quality enhancement

52. Other Changes Over the Past 30 Years
Technology – cell phones, internet, web-based client paperwork system phones, client computers, , text messaging etc
Gas Prices – more costly to provide in-home services
Interest, acceptance and encouragement of program models
Greater interest in research and evaluation
Work force changes

53. To learn more…. Visit our website at www.institutefamily.org
Call us at
us: Shelley Leavitt –