Building the Evidence Base for Family-Centered Practice Kristine Nelson Portland State University Todd Rofuth Southern Connecticut State University

Evidence Based Practice for Child Welfare  From the California Evidence Based Clearinghouse for Child Welfare (Wilson, nd) Modified from the Institute of Medicine  Best Research Evidence  Best Clinical Experience  Consistent with Family Values

The Homebuilders® Model  Program characteristics:  Children at imminent risk of removal from the family  Immediate agency response  In-home intensive services (up to 20 hours a week)

The Homebuilders® Model  Small caseloads (2-3 in placement prevention)  Brief services (4-6 weeks)  Services available around the clock  Both concrete and counseling services (Kinney, Madsen, Fleming, & Haapala, 1977).

Test of an Evidence Supported Practice  Is it based on an accepted conceptual/theoretical framework (is there a logic model)?  Can it be replicated (manual/training)?  How well is it supported by published research?  Is there an acceptable level of risk?

California Clearinghouse Scientific Ratings  Well supported - Effective Practice  Supported - Efficacious Practice  Promising Practice  Acceptable/Emerging Practice  Evidence Fails to Demonstrate Effect  Concerning Practice

Well Supported - Efficacious Practice  No evidence of substantial risk of harm  Has a book/manual on how to administer service  At least two rigorous randomized controlled trials in different settings  Sustained effect for at least one year  Overall weight of evidence supports efficacy of practice

Promising Practice  No evidence of substantial risk of harm  Has a book/manual on how to administer service  At least one published comparison group study has established efficacy  Reliable and valid outcome measures  Overall weight of evidence supports efficacy of practice

Evidence Fails to Demonstrate Effect  Two or more randomized controlled outcome studies have found no effect compared to usual care  Overall weight of evidence in multiple studies does not support the efficacy of the practice

Evidence Regarding Risk: Maltreatment at 12 months Intervention Group Comparison Group Portland, OR ‘98 5% 9% Westat (NC, KY, TN) ‘01 nsd Michigan ‘02nsd

At Least Two Randomized Controlled Trials ProgramExper. Group Placement Control Group Placement Effect Size at 12 months Bronx ‘8927.3%25.0%-.05 New Jersey ‘ %56.7%.28 Michigan’027%27%.77

Comparison Group Studies ProgramIFPS Placement Comparison Placement Effect Size Utah ‘9144.4%85.2%.90 Portland, OR ‘98 34%51%.26 NC ‘04 Prior CAN 29%37%.17 NC ‘04 Prior Placmt 19%44%.55

Sustained Effect for 1 Year Placement at Closure Placement at 6 mths Placement at 12 mths New Jersey ‘91 7%29%46% Utah ‘913%22%33% NCarolina ‘04 13%21%27%

Overall Weight of Evidence  Supports Efficacy  New Jersey ‘91 - less than 25% child welfare  Utah ‘91 - small case overflow study  Michigan ‘02 - not published  Does Not Support Efficacy  Bronx ‘89 - small early study  Westat ‘’01 - Implementation problems (New Jersey, Kentucky, Tennessee)

Homebuilders® = A Promising Practice  Based on cognitive behavioral, social learning, and crisis theory  Replicable (books/training)  Supported by three published studies with comparison groups  No evidence of greater risk than usual care

Other Family Preservation Models  Home-based model (6 months)  Based on family systems theory  Caseload of 10 to 12  Family Treatment model (3 months)  Counseling is primary  Caseload of 10 to 12  Multi-systemic Therapy  Work with family, school, and community (an evidence-based practice)

Components That Work  MacLeod & Nelson’s (2000) meta- analysis of 56 programs found that programs with the following features had higher effect sizes than programs without those elements:  High levels of participant involvement,  An empowerment and strengths based approach, and  A component of social support.

Front and Back End Goals of IFPS  Front end services focusing  On strengthening parenting,  Improving family functioning and  Enhancing child well-being  Back end goal to  Improve family functioning to prevent out- of-home placement or  To reunify families (McCroskey, 2001).

Examples of Child and Family Outcome Measures  Child Well-Being Scales  Abidin Parenting Stress Index  Adult-Adolescent Parenting Inventory  North Carolina Family Assessment Scale

Other Outcomes  Social Support  Domestic Violence  Family Resources  Mental Health/Depression  Substance Use  Self-Efficacy  Self-Esteem

Conclusions  Clinical experience supports IFPS  Consistent with family values  Research-based evidence is thin

Future Directions  Need to develop practice manuals and training for other models  Need more studies of all types, but especially randomized clinical trials  Need to add follow-up intervention to support sustained effect  Need to publish studies that are out there!

Reference List  Blythe, B., & Jayaratne, S. (2002). Michigan families first effectiveness study. Retrieved February 1, 2008, from _7695_ ,00.html _7695_ ,00.html  The California Evidence-Based Clearinghouse for Child Welfare. (2008). Chadwick Center for Children and Families. San Diego: Rady Children's Hospital-San Diego. Retrieved on February 28, 2008 from of-evidence-based-practice. of-evidence-based-practice  Ciliberti, P. (1998). An innovative family preservation program in an African American community: Longitudinal analysis. Family Preservation Journal, 3(2),  Feldman, L. (1991). Assessing the effectiveness of family preservation services in New Jersey within an ecological context. Trenton, NJ: New Jersey Department of Human Services, Division of Youth and Family Services.

Reference List  Fraser, M., Nelson, K., & Rivard, J. (1997). Effectiveness of family preservation services. Social Work Research, 21,  Fraser, M., Pecora, P. & Haapala, D. (Eds.). (1991). Families in crisis. New York: Walter de Gruyter, Inc.  Henggeler, S., Melton, G., & Smith, L. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, Retrieved June 1, 2002 from Expanded Academic Index On- line Database  Kinney, J., Madsen, B., Fleming, T., & Haapala, D. (1977). Homebuilders: Keeping families together. Journal of Consulting and Clinical Psychology, 45,

Reference List  Kirk, R. & Griffith, D. (2004). Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research, 28,  Mitchell, C., Tovar, P., & Knitzer, J. (1989). The Bronx Homebuilders program: An evaluation of the first 45 families. NewYork Bank Street College of Education.  MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta- analytic review. Child Abuse & Neglect, 24(9), 1127–1149.  McCroskey, J. (2001). What is family preservation and why does it matter? Family Preservation Journal, 5, 2,  Nelson, K., Landsman, M. & Deutelbaum, W, (1990). Three models of family-centered placement prevention services. Child Welfare, 69, 3-21.

Reference List  Westat, Inc., Chapin Hall Center for Children, & James Bell Associates. (2001). Evaluation of family preservation and reunification programs: Interim report. Washington, DC: US Department of Health and Human Services. Retrieved December 18,