Monthly Archives: November 2013

Creating Goals and Objectives with Families

family_goals_objectivesCreating goals with IFPS families can be challenging. Because I frequently hear concerns from IFPS staff about goal development, I’m focusing this post on how to create effective goals with the IFPS families.

1. Before You Start

Many IFPS therapists find it helpful to write a “Statement of Need” before the goal setting meeting with the family. The Statement of Need helps you collect and compare your observations with information from the referring worker and the family. It’s a tool that helps you identify priorities and potential obstacles. It includes:

  • your observation of the family situation,
  • the problem(s) the referring worker identified,
  • what changes the referring worker would like the family to make,
  • what the family says they would like to change and
  • the outcomes the family would like.

Sample Statement of Need:

The referring worker, Mr. D, reported that Ms. P is currently suffering from financial hardship (e.g., difficulty with paying her rent of $900 a month). He shared that Ms. P receives SSI in the amount of $1,500 a month and $ 900 in food stamps to meet the needs of her three children (Larry, Curly, and Moe). He stated that he would like for Ms. P to work on budgeting skills so that she can pay her rent on time. Ms. P shared that she is not having financial hardship; she just needs some assistance with budgeting her money. She stated that she shops a lot at the corner store because the supermarket is too far for her. She stated that she is behind in her rent because she needed to use the money to buy school clothes for her children. Ms. P shared that she goes out a lot to eat so that she can treat her children. Ms. P stated that she would like assistance with learning how to budget her money so that she can have money left over at the end of the month and pay her rent on time.

2. Statement of Goals: Defining behaviorally specific goals

Creating goals with families involves more than just writing the information on a flip chart. Keep the Statement of Need in mind as you and the family define the Statement of Goals. Assist families in prioritizing their goals. Remember, the goals should reflect the family that you are currently working with. They need to be realistic and achievable within the stated time frame depending on the families’ circumstances and abilities.

Each goal must be defined in behaviorally specific terms that reflects the family’s viewpoint, hopes and concerns. To set achievable goals with families you need to be SMART: Specific, Measurable, Achievable, Realistic and Timely.

Example: Ms. P will learn and use budgeting skills to manage her money so she can pay her rent on time.

3.    Measurable Objectives: What you and the family intend to achieve

The Measurable Objectives should support what is written in the Statement of Need and relate directly to the Goal. Measurable Objectives focus on the behavioral changes within the family. The Measurable Objectives should be written in behaviorally specific terms and tailored to the family. It is important to specify a time frame for achieving each Measurable Objective.

Example: Ms. P will use a budgeting sheet to list her expenses on a daily basis. Week 2

4.    Intervention Tasks: Your role in the family’s behavior change

When creating the goals, ensure the family understands the goals and measurable objectives, agrees to their value and is willing to work toward goal achievement with your help. Never force family members to participate in goal development.

It is important for you to clarify the steps you will take to assist the families in learning new skills and changing behaviors. Your intervention tasks can include a variety of intervention tools, designed for the specific family: the use of discussion, role play, “what if” scenarios, videos, therapeutic games, handouts, reading materials, etc.

Example: IFPS therapist will teach Ms. P how to list her expenses on the budgeting sheet using discussion, worksheet, and demonstration.

Review the goals weekly with the family to assess the families’ progress toward their goals; and their “motivation, capacity and opportunity.” Remember to always ask the client for their understanding concerning the goal (s) and what they have been taught. This gives you an opportunity to fine tune your intervention techniques, make the steps smaller and more achievable so that families are experiencing success.

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Posted by Moneefah D. Jackson

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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