Monthly Archives: April 2013

Essential Components of IFPS Interventions

Let’s focus this time on some key intervention components:

Flexible Scheduling

IFPS therapists have a flexible schedule, serving only two families at a time, which allows them to give clients as much time as needed, when they need it.

Individually Tailored Services

IFPS programs offer flexible service packages, individually tailored to the needs of each family. Clients may need help with parenting skills, communications skills, managing depression or anger, problem solving, overcoming the effects of past trauma,  drug or alcohol use, or learning other life skills. They may request help in meeting such basic needs as food, clothing or shelter. They may work on building a social support network or relating to school or other social service personnel. Therapists are expected to have a wide array of treatment options and approaches available to them.

In IFPS, the therapist is responsible for addressing all the needs of the family. Providing hard services, such as helping clean an apartment or driving a client to the grocery store, is a powerful way to engage clients. Clients are grateful for the help, and are often the most willing to share information when they are involved in doing concrete tasks with their therapist.

Engagement and Motivation

The IFPS therapist takes responsibility for engaging clients and helping them increase their motivation for change. Engagement strategies include Reflective Listening, Motivational Interviewing, showing respect, acting as a guest in the family’s home, including family members in assessment and goal setting, meeting individually with family members as well as the family as a group, and meeting at times and places convenient to the family.

Assessment and Goal Setting

Workers conduct a client-directed assessment across the family’s life domains, including safety assessment and safety planning, domestic violence assessment, suicide assessment, and crisis planning. Behaviorally specific and measurable goals and outcomes are developed and evaluated with the family.

Behavior Change

Perhaps the most critical aspect of the IFPS intervention is the use of cognitive and behavioral research-based practices. Therapists directly employ these practices with family members, and also teach members how to use these strategies. These practices include:

  • Motivational Interviewing,
  • Cognitive Behavior Therapy (CBT),
  • Rational Emotive Behavior Therapy (REBT),
  • Relapse Prevention, and
  • Harm Reduction Strategies,

Teaching families new skills lies at the heart of the intervention, as this empowers family members and allows them to continue to improve their family functioning after IFPS has ended:

  • The most common skills taught include parenting, communication, assertiveness, bargaining and negotiation, anger management, depression management, time management, and household management.
  • Therapists follow specific protocols for teaching skills including presentation of the skill to be learned, modeling, behavioral rehearsal, corrective feedback, coaching, praise, and encouragement, and generalization/maintenance training.
  • Therapists break new skills into small steps to simplify the change process and help family members experience success.
  • Therapists recognize and take advantage of unplanned opportunities (i.e., “teachable moments”) to use or teach behavior change strategies with family members.
  • Therapists provide written materials to reinforce rationales and discussion regarding skills introduced during sessions, and assign homework and encourage frequent practice of new skills so family members have many opportunities to strengthen and integrate behavior changes.

_______________
Posted by Peg Marckworth

Advertisements

IFPS Retention and Compensation Survey

We are off to a great start with the IFPS Coast-to-Coast Blog!

We have received the first request: to address the issue of retention and compensation of IFPS therapists. Nationwide, there is very little information available on this issue.

In order to give this issue the attention and time that it deserves, we have developed an online survey to obtain critical data:
http://www.surveymonkey.com/s/PZXKQN6

First, please review the entire survey. Then, consider who in your agency has the necessary information to complete the survey form. We realize that your agency may not have all of the data requested but we would like to have responses to as many questions as possible. We ask that only one person complete the form for each agency.

The survey will close at midnight the evening of April 30. Please respond by then.

The National Family Preservation Network (NFPN) is assisting us with this survey. If you have any questions or need additional information in order to complete the survey, please contact NFPN: Priscilla Martens, Executive Director, director@nfpn.org or phone 888-498-9047.

Thank you so much for helping us take an in-depth look at this important issue!

Click here to take the survey.

Definition, Benefits, and Safety Record of IFPS

Definition of IFPS

Intensive Family Preservation Services (IFPS) are concentrated, in-home services designed to prevent unnecessary out-of-home placement of children. Families are referred at the point where an out-of-home placement is imminent. Referrals may come from a variety of child and family-serving systems including child welfare, mental health, juvenile justice, and developmental disabilities. In home contact with families occurs within 24 hours of referral. IFPS therapists receive special training to provide families a mix of cognitive behavioral therapy, family counseling, teaching skills, and help with basic needs. Therapists serve only a few families at a time and are available 24 hours a day, seven days a week. Most families receive approximately 40 hours of face to face service over the 4–6 weeks of the intervention.

IFPS is a model of service, not a philosophy to preserve families at all costs. If children cannot be safely maintained at home, then removal is in their best interest. On the other hand, IFPS is not appropriate for families whose children are not at high risk of removal. There are less intensive service models that can provide support to these families. IFPS is reserved for families facing imminent placement of a child.

Benefits of IFPS = Better Outcomes for Children

  • Children in foster care spend an average of more than two years away from their homes.
  • A child is twice as likely to die from abuse in foster care as in his own home.
  • Maltreated children placed out-of-home exhibit significant behavior problems in comparison to maltreated children who remain in their homes.
  • Maltreated children removed from their homes later experience higher delinquency rates, teen birth rates, and lower earnings than children who remain in their homes.

With appropriate targeting, IFPS diverts 80–90+ percent of children from out-of-home placement, but it is estimated that states provide IFPS to fewer than 1 in 10 children about to be placed in foster care.  IFPS programs adhering to the Homebuilders® model are very cost-effective: $2.54 of benefits for each dollar of cost due to reduced out-of-home placements and lowered incidence of abuse and neglect.

Safety Record

In over three decades of IFPS nationwide with thousands of families served, there has been less than a handful of child deaths linked to IFPS, either during or after the intervention.

To what can this strong safety record of IFPS be attributed?

  • The safety of the child is the highest priority.
  • IFPS therapists respond immediately to family crises.
  • IFPS therapists meet with families in the home, which allows for a more thorough assessment and opportunities for effective intervention.
  • IFPS therapists see families frequently, sometimes for hours at a time, in order to provide a quick response to emergencies and to teach skills during a crisis when families are most willing to learn new behaviors
  • Prior to closing the intervention, IFPS therapists connect families with other community services to reinforce gains.
  • Therapist training, supervision, and ongoing monitoring and quality assurance provide additional measures to ensure the safety of families.

We’d like to hear your views on the benefits of IFPS.
What is your experience with the safety record of IFPS interventions?

_______________
Posted by Peg Marckworth

Welcome to the IFPS Coast-to-Coast Blog!

We are avid supporters of Intensive Family Preservation Services (IFPS) with one of us (Peg Marckworth) on the west coast in Seattle and one (Moneefah D. Jackson) on the east coast in New Jersey. And, we’re hoping to reach everyone in between!

We are starting this blog in order to:

  1. Increase visibility of IFPS, one of the most effective yet relatively unknown interventions to strengthen families and keep children safe at home. It will be easy to email, post, or tweet content from the blog and we hope that you will do so in order to spread the word about IFPS!
  2. Increase knowledge of IFPS. We want to share cutting-edge information that will strengthen IFPS programs.
  3. Share expertise. We want to provide the IFPS community (administrators, supervisors, therapists/counselors, and advocates) with a forum to share tips and resources.
  4. Extend the reach of IFPS. We want to create more awareness of IFPS and its value in order to build and expand IFPS programs. We also want more advocates!

Here’s some information about who we are:

Peg MarckworthPeg Marckworth is the principal of Marckworth Associates, which creates brands and marketing strategies for companies that set them apart from the competition and catch the attention of the right clients.

Peg worked extensively in Intensive Family Preservation Services, beginning in 1979 as a MSW student in the original Homebuilders ® program. She worked as a Homebuilders therapist, supervisor and program manager. Peg provided IFPS training through the Institute for Family Development (IFD) and was part of the team that developed the original standards and quality enhancement program for IFPS. She participated in joint research projects and teaching through IFD and the University of Washington School of Social Work. She worked as a consultant to the Department of Social and Health Services on the implementation and utilization of IFPS in Washington State. Peg spent ten years as a Washington State lobbyist.

Moneefah D. JacksonMoneefah D. Jackson has been an employee of The Bridge, Inc. since 2002, which is a private, non-profit community organization that has been assisting families in Essex County since 1971. The agency focuses on strengthening families and promoting the personal growth of children, adolescents, adults and seniors. Moneefah oversees two programs (Family Preservation Services and Step Down) in the State of New Jersey. Moneefah supervises a team of five counselors and her duties include accompanying them on visits, holding case conferences, conducting quality assurance reviews, and assisting with hiring and training. Some of Moneefah’s other interests include counseling in response to disasters and training professionals on sexual abuse.

The National Family Preservation Network and the Institute for Family Development are pleased to provide start-up assistance for the blog.

Please note that the blog will be moderated: all comments will be reviewed in advance. Our vision is to promote meaningful and productive conversations void of attacks on others who are commenting.

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.

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