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).
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