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Effectiveness of family

preservation services
Mark W. Fraser, Kristine E. Nelson, and Jeanne C. Rivard

This article reviews recent studies of family
preservation and related family-strengthening
programs, estimates the effect sizes of outcomes in
studies with control or comparison conditions, and
discusses the status of research on family preservation
services. A set of core services that characterize
innovative family preservation programs in child
welfare, multisystemic family treatment in juvenile
justice, and family-based psychoeducation in mental
health is identified. Family preservation services may
be useful in preventing youth violence; family-based
psychoeducation in mental health may prevent or
delay relapse and hospitalization; and aside from
promising data on family reunification programs, the
findings in child welfare are equivocal.

Key words: effect size; family preservation;
family support programs; outcome

Mark W. Fraser, PhD, is John A. Tate
Professor for Children in Need, School of
Social Work, University of North
Carolina at Chapel Hill, 301 Pittsboro
Street, Chapel Hill, NC 27599; e-mail: Kristine E.
Nelson, DSW, is professor, Child Welfare
Partnership, School of Social Work,
Portland State University, Portland,
OR. Jeanne C. Rivard, MSW, is
doctoral student, School of Social Work,
University of North Carolina at Chapel



espite long-standing political, religious, and
social concerns for the value of family life,
the United States has never developed an
overarching public policy commitment to
families. Only since 1980 have specific policies and programs to strengthen families and family
life become widespread. Developed as an alternative to out-of-home placement in situations where
children can remain safely in their homes or communities while services are provided (Bryce & Lloyd,
1981; Goldstein, 1973; Hutchison, Dattalo, &
Rodwell, 1994; Maluccio, Pine, & Warsh, 1994),
family preservation programs emerged in child welfare; in juvenile justice; and to a lesser degree, in
mental health settings in the late 1970s and early
1980s. Since that time, they have flourished in both
public and nonprofit human services organizations
across the country.
Recently, critics have attacked these fledgling programs and begun to question the wisdom of trying
to strengthen and preserve families (MacDonald,
1994; Weisman, 1994). In child welfare, some advocate a return to a single-purpose, child-centered,
protective service system (Gelles, 1993; Ingrassia &
McCormick, 1994), and others advocate the separation of child welfare services, such as foster care
and adoption, from child protective ser vices
(Lindsey, 1994a, 1994b, 1994c; Pelton, 1991). In
juvenile justice, a growing number of scholars argue
that the court should abandon the goal of rehabilitation and focus exclusively on deterrence, incapacitation, and “just desserts” (Bazemore & Umbreit,
1995; Feld, 1990; Von Hirsch, 1984). In both child
welfare and juvenile justice, arguments rest on convictions that family preservation should not be a
primary goal in public policy; that family preservation services (FPS) are ineffective in strengthening
families; and that programs too often fail to prevent
out-of-home placement, child maltreatment, and delinquency. This article reviews recent studies of family preservation and related family-strengthening
programs, describes the outcomes of studies with
control or comparison conditions, and discusses the

© 1997,
of Social Workers,
Work Research$3.00
/ Volume
3 / September

and then . advocates. Although not hostile to family-centered services.L. . and poverty. and delinquent children” (Abbott. . the notion of providing services to strengthen families and thereby reduce the need for placement arose at the turn of the century (Kadushin & Martin. 1996). Special emphasis is placed on FPS designed for children who are on the verge of placement.. These services were designed to resolve crises that place children at risk of placement. Horwitz. neglect. the question of how permanently to prevent the recurrence” (p. Nelson. pauperism. each taking a share in the development of the client’s story. Westerfelt. McDonald. P. improve family functioning so that children might remain safely at home. see Jones. public programs have placed vastly more resources in substitute care and social control. 1996).S. largely home-based family-strengthening programs to reduce out-of-home placement of children stands as a remarkable public policy development. and on the street. Allen. 96-272) that states undertake “reasonable efforts” to prevent placement. to address . by advocacy of the Edna McConnell Clark and other foundations. In addition to the creation of a systematic and professionally managed process for the suspension of parental rights and the placement of children out of the home. . Social work. notably family rebuilding. and other cities (Nelson. have roots in the efforts of charitable organizations in the 19th century to rescue children from abandonment. During that era. In reaction to the specter of children being raised in institutions. & Leventhal. 1980). Harvey Baker (1910). described the duties of the probation worker as investigating “all available information about the family and . 103-66). and Rivard 139 . probation has devolved to child-centered monitoring of compliance with court orders. including the perceived drunkenness. the recent growth of short-term. by the requirement of the Adoption Assistance and Child Welfare Act of 1980 (P. 1990). where family preservation first developed. and the circumstances . child protection and out-ofhome placement continued to enjoy strong support and dominated the missions of most child welfare agencies and juvenile courts across the country (Hutchison et al.L. Effectiveness of family preservation services / Fraser. . . neglected. Mary Richmond wrote in 1917: In some forms of social work. Kamerman & Kahn. Moreover. & Piliavin. which got him into court . because these programs have received the most attention from researchers. 1938. 1988. In 1909 the first White House Conference on Children declared that no child should be deprived of family life for reasons of poverty alone. acting and reacting upon one another. family-centered services programs grew rapidly in the 1980s and 1990s (Heneghan. at work. In 1899 the first juvenile court was established in Chicago to “regulate the treatment and control of dependent. Supported by programs of research in state and local agencies and at the Children’s Bureau of the U. 1994. each revealing in ways other than words social facts of real significance. . 318). . p. which emerged as a profession during this period. Representing the country’s nascent concern about delinquency. and sent to jails where they shared cells with adult offenders. In this context. placement was also seen as a humane and desirable alternative for youths in the country’s first gangs—abandoned children attempting to survive on the streets of New York. the boy’s personal history at home. Department of Health and Human Services. . a client’s social relations are so likely to be all important that family case workers welcome the opportunity to see at the very beginning of intercourse several of the members of the family assembled in their own home environment. far from its original conceptualization of augmenting parental supervision. DEVELOPMENT OF FAMILY PRESERVATION SERVICES Modern child welfare services. 137) Despite this early focus on family in both social services and juvenile justice and the emergence of a modest financial safety net provided by the Social Security Act of 1935. environment of the boy. 1910). And in one of the first attempts to articulate both an assessment and services strategy for social workers. . and reduce burgeoning out-of-home care budgets (for an early report. 1985).status of research on FPS. abuse. and by modifications of Title IV-B of the Social Security Act (under the Omnibus Budget Reconciliation Act of 1993. placement in foster families and institutions was seen as necessary to protect children from the harsh conditions associated with urban industrial growth. shipped en masse to foster farm families in the Midwest. . and promiscuity of immigrant parents (Nelson. by widespread belief that a continuum of child welfare services should include options for families besides placement. (p. Boston. has long been concerned with services for children and families (Adams. the court created a set of community-based services to augment parental supervision with supervision from probation workers. 392). 1996). Boston’s first juvenile court judge. and critics. in school.

seven days a week. and culture. 1993). or correctional facilities. family therapy. Services are provided in the context of a family’s values. METHOD Sample The authors reviewed published and unpublished studies of FPS since 1985. & Hanley. Emphasis was placed on studies of intensive. In many programs. Salley.L. Workers have small caseloads of between two and six families and may visit families many times during a week. 1996. studies involving both maltreated and delinquent children were included in the sample. children who have Social Work Research / Volume 21. Usually. 1992. 557). social-learning. These latter programs are characterized by many of the elements of family preservation. this article assesses the research knowledge regarding the effectiveness of family preservation and services closely related to family preservation. Yuan & Rivest. Hence the term “intensive” is sometimes used to describe FPS (Angelou. school. Services in many programs are available 24 hours a day. 140 ■ ■ ■ ■ Services are tailored to the needs of family members. Melton. Thus. concrete assistance. systems. and mental health services. 1996). group homes. Number 3 / September 1997 . in-home services for which caseloads were small and the intervention period lasted no more than 20 weeks. services are provided in the home. fivemonth period. including foster and group home. In addition to placement prevention services in child welfare and juvenile justice.L. In mental health. residential treatment. MacDonald. psychoeducational. ■ Services are targeted to families with children at risk of out-of-home placement in family foster care.A response in part to rising caseloads generated by the Child Abuse Prevention and Treatment Act of 1974 (P. compromises public safety (Gelles. Studies of family-centered casework. to a lesser degree. or hospitalization were excluded from the analysis. 1990). Wells & Tracy. But few studies have focused exclusively on this aspect of family preservation. and correctional placements. 1994). Family preservation services was defined broadly as family-centered services designed to prevent the removal of children from their homes or to reunify with their families children who are in out-of-home care. These programs were influenced by the brief treatment and crisis intervention literatures of the 1970s and early 1980s. such as multisystemic family treatment. FPS programs have been used to help reunify children in out-of-home care with their families. But more recently developed programs. the rapid adoption of these services was fueled by positive early evaluation findings. Nelson & Landsman. in the context of this uncertainty and debate. FPS has the following characteristics: ■ Services are provided to the family. residential treatment. 1992. they often include a mix of crisis intervention. defiant children are referred to child welfare agencies and because important tests of family preservation have taken place in the juvenile justice system. and advocacy. 96-272. Typically. and other family services for which contact with families averaged one hour or less per week and children were not viewed as at risk of placement. & Jayaratne. are longer in duration (Henggeler. Smith. Because increasing numbers of oppositional. Building on ecological. CHARACTERISTICS OF FAMILY PRESERVATION PROGRAMS FPS differs markedly from routine protective. Rossi. more rigorous studies on the effectiveness of FPS were equivocal (Blythe. many “intensive” family preservation programs such as HomeBuilders were four to eight weeks in length. Schoenwald. a small number of family-based services studies have focused on strengthening families with adults and. Critics suggest that FPS neither resolves crises nor improves family functioning so that children may remain home safely. or other commitments. families are seen between two and 15 hours per week. although a variety of activities may be undertaken with or on behalf of individuals. studies of familybased services in reunification and family-centered psychoeducation in mental health were included. 1985. incarceration. probation. Historically. ■ Services are flexibly scheduled so that family members can participate without encountering conflicts with work. From the beginning. beliefs. but they spread in-home services over a three. An outspoken critic of family preservation programs. ■ Services are time limited. skills building. in the case of delinquency. ranging from one to five months in duration. They charge that emphasis on family preservation endangers abused or neglected children and. 93-247) and later by the “reasonable efforts” provision of P. however. Gelles (1993) has argued that “it is not clear whether family preservation is ‘penicillin’ or ‘poison’” (p. and crisis theories. the findings of later. supportive counseling.

Hogarty et al. Lipsey. as well as the research designs used in each study (Durlak & Lipsey.” we do not imply that they are more important than changes in family functioning. prevention of relapse is treated as an ultimate outcome because reducing clinical exacerbation of schizophrenic or other severe symptomatology is a principal treatment goal of psychoeducational family intervention (Falloon et al. Lipsey. reunification. and mental health literatures. see Pecora. The arcsine ESp is given by ESp = φt – φc . These were defined as policy-relevant outcomes that affected resource utilization within the child welfare. Durlak and Lipsey (1991) recommend computing effect size using Cohen’s (1988) arcsine transformation. effect sizes (ESs) were estimated. Fraser. 1990). these services are designed to reduce relapse. number of children placed out of home). if outcomes were reported in the original studies as failure rates (for example. number of children not placed) for our analysis. 1985. The resulting effect size for a particular finding is positive when results in the treatment group are superior and negative when they are inferior to the control group (Durlak & Lipsey. We included these studies not as FPS. Thus. yielding a difference score effect size. Barrowclough. To compare findings across studies. 1988). juvenile justice. 1991.developed serious mental disorders. Nelson. Effect size refers to an index that standardizes the difference between the means of experimental and control groups (Cordray. the comparability of success rates is somewhat limited because Effectiveness of family preservation services / Fraser. For example. the equivalence of control groups. and φc is the arcsine transformation of a success proportion in the control group. or mental health systems. hospitalization. and the attitude of local judges). In referring to these outcomes as “ultimate. Although placement is influenced by factors other than family conditions and the success or failure of a family preservation intervention (for example. However. Caution is warranted because effect sizes mask important differences in sample sizes. recent media events. In fields of practice where there are dozens of studies. Nelson. outcomes were analyzed as success rather than failure rates. outcome data were used as reported by authors. Then the effect sizes for each experimental and control group were subtracted. 1985. the features of the interventions. An equivalent method for calculating the effect size of dichotomous outcomes is to convert a chi-square statistic for the difference in proportions of both groups (Lipsey. juvenile justice. incarceration. 1990). it is often appropriate to develop a weighting scheme for different kinds of research designs. Interpreting effect sizes across multiple studies is complex and must take into account the unique specification and measurement of dependent variables. Other than this minor calculation. only studies with control or comparison groups—achieved through random assignment. McCroskey. For studies in mental health. & Porcedu. these were converted to success rates (for example. we elected not to weight studies. 1991. Across the child welfare. Studies with weaker designs (for example. where φt is the arcsine transformation of a success proportion in the treatment group. & Meezan. many other outcomes related to family functioning are important. in the studies reviewed.. ESp is computed by subtracting arcsine values of the success proportions for each group (Lipsey. Analysis We examined ultimate outcomes such as placement. and hospitalization. 1990). we limited our analysis to studies with control or comparison groups. and institutionalization. 1990): ES = 4(χ2)(√[N – (χ2)]) Individual effect sizes measuring change within treatment and comparison groups were calculated. and the integrity with which they were applied. From a practice perspective. & Sturgeon. and Rivard 141 . Berkowitz.. Kuipers. matching. or some equivalent mechanism—were included in the analysis. 1991. Tarrier. the availability of a foster family. Leff. case overflow studies) were included only if experimental and control conditions were made equivalent at pretest through matching or were shown to be equivalent at pretest through statistical comparison of experimental and control groups. Across all studies. Because there are so few controlled studies in the field of family preservation and because each is differentially vulnerable to strong criticism. arrest. Less intensive and longer in duration than FPS. or child behavior such as delinquency and drug abuse. 1990). For dichotomous outcomes as reported in the studies reviewed. and the quality of the independent variable (the treatment). risk of child maltreatment. but as exemplars of the development of related family-based services in an allied field. 1995). legislators and policymakers often want to know whether services affect resource allocations (for a detailed discussion of the limitations and strengths of placement as an outcome.

some families were lost during followup phases.32 are small. 1991). the findings may overestimate effect sizes. Lipsey. In some studies. for effect sizes are large in some studies but not in others. in such cases. & Rivest. The majority of studies in our sample excluded dropouts from the original assigned treatment and comparison groups. Unfortunately. and in this study the effect size of treatment was large (+. If we assume that routine services have some effect on children and their families. This study. Attrition occurred when subjects withdrew after assignment but before treatment was initiated. Family Preservation in Child Welfare Effect sizes for family preservation programs in child welfare are mixed (Table 1). effect sizes of .90) of a matched-pairs case overflow study in which FPS was compared to routine services fell in the large range (Pecora. it refers to cases in which. 1991. In “more difficult” cases. In several other studies. This is perhaps the only FPS study with a design that may approximate a notreatment control. Mitchell. effect sizes of . because the subsample of “more difficult” cases fared poorly in treatment (–.55 are medium. In a study that used a control condition consisting of children who were leaving foster care—a population that clearly has no children at risk of first placements—the effect of FPS (+. The effect size (+.of the different ways in which attrition was handled by researchers. In the Szykula and Fleischman (1985) study of “less difficult” cases.56 to 1. 1995).88). there is an effect on placement. Rzepnicki. we can conclude that the impact of FPS in the absence of any service is rarely estimated. The size of an effect can be assessed actuarially as a relative value within a distribution of effect sizes. routine services in Schuerman et al. like the study of more difficult cases in the Szykula and Fleischman (1985) experiment. McDonald. Bennett. 1991). 1986. Cook and Campbell (1979) argued that inclusion of withdrawals provides a more conservative test of the effects of treatment. In the discussion that follows.19. FINDINGS The findings are complicated. In fact. the term “dropout” is also used to describe families that were referred for FPS but were deemed subsequently to be ineligible for a placement prevention service. Tovar. Struckman-Johnson. as some of the studies suggest. 1989). Although all families were referred for child maltreatment. however. And in two large studies with routine services control conditions. and large. family preservation programs significantly reduced out-of-home placement when compared with other services (+. placement prevention is not possible. suffered from attrition. & Haapala. parent problems were viewed as related to serious parental and environmental deficiencies that were not directly related to child behavior. Yuan.33 to . Fraser. These guidelines are based on his compilation of 186 meta-analyses of treatment effectiveness research in the behavioral sciences. 13 of 24 families in the experimental group were rated as “less difficult” because parenting problems were viewed as related to serious conduct problems in children. Feldman (1991) referred to such cases as “turnbacks. or during treatment. & Harris. 1994. the limited number of controlled studies in FPS precludes the latter interpretation at this time. Number 3 / September 1997 . the effect of experimental services is usually estimated by comparison to routine services. Reflecting the difficulty of conducting research in the field. In Social Work Research / Volume 21. children for whom placement proceedings had been initiated were diverted from placement to an experimental family preservation program (Schwartz.20 are large.00 to .” Although a case can be made for excluding dropouts because they are not fully exposed to the intervention. Occasionally. effect sizes are not comparable to studies with no-treatment control group designs. the actuarial approach is used to discuss effect sizes of the studies reviewed in relation to Lipsey’s ranges of small. & Littell. AuClaire. Wheeler. medium. But the overall effect size for the Szykula and Fleischman study was +. prior to intake but after referral a placement has been made. Clearly. this assumption probably results in an underestimation of treatment effects. during assessment. or it can be interpreted in relation to normed or criterion values from a population of effects from similar studies within fields of practice (Durlak & Lipsey. In one study. As opposed to the practice of excluding dropouts (which is likely to result in an overestimation of treat- 142 ment effects).38). If. The decision to exclude after referral (and randomization) such a family is usually based on a worker’s judgment that provision of FPS might compromise a child’s safety. no treatment effect on placement or child maltreatment was observed (Schuerman. Many of the case overflow families were lost in follow-up. Thus. In addition. & Knitzer. According to Lipsey. it does not appear to be large. too. 1990).’s (1993) study had a small positive treatment effect relative to FPS (–. and effect sizes of .76).24) was small (University Associates. effect sizes were also small (Dennis-Small & Washburn.19). 1990). Because most authors chose to exclude lost cases.

05 –..5 +. 1995g Collier & Hill. 1993g. & Knitzer. 43. of Successes Total % Comparison Groupa No. otherwise. total number of families was used. Reports here are based on the family as unit of analysis. 1993 Prevention of incarceration Henggeler et al. 1991 Feldman.3 55.01) and not significant in the more difficult groups.. if child-specific rates were not available. 1996 Fraser et al..3 61.1 39.9 80.5 70. 1993c Juvenile justice Prevention of rearrest Borduin & Henggeler.h.6d 43.5 54.24 32.7 81. 13 of 24 families in the experimental group were rated as “less difficult” because parenting problems were viewed as related to serious conduct problems in children.8 58..01 60. & Harris. AuClaire.or Control-Group Studies in Intensive Family Preservation Experimental Group Data Collection Period Type of Outcome by Study Child welfare Prevention of placement Szykula & Fleischman.47 a Except where indicated.7 +1. c Most success rates are reported using total number of children as the denominator.3 36.19 +.38 +. Although all families were referred for child maltreatment..48 59 weeks 12 months 34 33 43 40 79. 1993. i Borduin et al. of Successes Total % 16 12 4 72 16 276 24 67 15 701 172 24 13 11 87 22 338 55 117 27 974 225 66. b a New Jersey experiment.3 78.0 64.4 82. 1992g Collier & Hill.. 1991 Schuerman et al. i Individual therapy. 1996 Prevention of abuse and neglect Yuan et al. a considerable percentage of the children in families that received services were at continued risk of Effectiveness of family preservation services / Fraser.6 72.20 –. 1993 Not reportedc No.05 –. 1986c Mitchell.0 82.0 +.9e Effect Size +. h Same sample as Henggeler et al. The differences between the experimental and control conditions were significant in the less difficult group (p < .0f 39.TABLE 1—Effect Sizes of Comparison. In “more difficult” cases.0 113 440 150 564 75.0 19. withdrawals are excluded from analysis. 1995 Family reunification Fraser et al. Nelson.52 +.5 73. 1990 Henggeler et al. The difference produces a small but statistically significant effect (+. 1992g Henggeler et al. (1992).07 12 months 59 weeks 120 weeks 48 months 12 months 48 25 17 68 32 58 43 43 92 40 82.8 80.28).5 28. g Withdrawals are included in analysis.03 +. parent problems were viewed as related to serious parental and environmental deficiencies that were not directly associated with child behavior. but reports on different follow-up period.0 82. Although the findings are significant and cost savings in large populations may be substantial.90 –.9 75. 1990 Schwartz.42 +. Feldman (1991) reported that 57.. f Alternative treatment.3 percent of the families that received FPS had avoided placement at the 12-month follow-up..0 24 16 8 24 23 40 41 41 84 40 60. 1989c Yuan et al.7 43.. In contrast. 1990c Schuerman et al. d Placement list.5 13 24 41 40 31.5 75.7 8.49 Not reported At 12 months Eight months At 12 months At 12 months 12 to 16 months At 12 months At 12 months Eight months 12 months 58..6 57.0 +.2 +. 1985b Less difficult cases More difficult cases Dennis-Small & Washburn.54 47.28 +. 1994c University Associates.4 14 8 6 64 9 291 5 42 4 451 146 24 13 11 85 12 352 58 97 27 564 225 Reunited at six months 55 In home at 15 months 40 57 57 96..19 +.6i 57. Tovar.3 14. However.88 +. and Rivard 143 .2 17 25 53 53 110 731 143 974 76.93 +.8 72.76 –.0 76.3 75. e Child leaving substitute care.3 percent of the families in a usual services program avoided placement.40 +.1 +1. 1991 Pecora et al.6 92. treatment in the comparison group consisted of usual or routine services.

but findings were estimated for different follow-up periods. Currently. (Henggeler et al. 1995). because they have the goal of reducing out-of-home care and strengthening families. 1993). Warsh. children were somewhat older than children in studies with less positive outcomes (Table 2). these services educate family members about the etiology of mental illnesses (often emphasizing the biological bases of disorders). hospitalization. Number 3 / September 1997 . and the use of medications. Because services are rendered for up to one year.1 percent of the children in the turnback group compared with 18. the interventions of Hogarty et al. 1991) and Randolph et al. these services appear to have moderate to large effects on relapse. Moreover. and with others within the family system (Goldstein & Miklowitz. we included them. in both these studies. Thus. we think that Social Work Research / Volume 21.0 percent of children who ultimately received FPS had prior placements (Feldman. Lewis. Schwartz et al. Only one reunification study with random assignment has been published to date. With the exception of findings by Mitchell et al. These studies compare family-based education to medications-only or usual services. 1995. 32.47). half or more of the children were referred for truancy. Three studies with usualservices control conditions produced moderate treatment effects on rearrest and one produced a large effect (+. Whether provided in the home or clinic. Because prior placement is often a major predictor of outcome in FPS. Walton. (1982.93). Present focused and time limited. McFarlane et al. Pecora. 1991. Feldman. 1985). Compared with children in the child welfare studies. drug use. reported on the same study. 1991). the findings across child welfare and juvenile justice studies imply that FPS may be more effective with older children and with referrals in which child behavior is identified as a major problem (see also Butts & 144 Bar ton. (1985) used a home delivery method (Goldstein. 1996. Pecora. (1986. & Walton. 1995. In two child welfare studies with large treatment effects (Pecora et al. This study had a 15-month treatment effect (+. 1991). (1993) compared single-family psychoeducation with a unique multifamily group format. they cannot be considered FPS per se. May.. Maluccio. a second generation of studies—largely dismantling or factorial designs—is examining the relative effectiveness of elements of the psychoeducation model.placement. Moreover. Walton. & Pine. & Walton. familybased psychoeducation programs are intended to prevent or delay relapses and shorten hospitalizations. Although these 33 turnback cases were not significantly different from cases that were referred and found eligible for FPS. This article describes only the first generation of studies of family-based psychoeducation. with professionals in the mental health system. However. 1992. they include problem-solving and communications-skills training for working with people who have mental illnesses. which fell in the medium range (Fraser. from a design perspective. & Steinberg. and diverted from routine court services to experimental family-based services. it is possible that the experimental group was biased by excluding turnbacks from the analysis. 1985) and Leff et al. 1991.) DISCUSSION The findings are complicated because treatment effects are related both to the differential implementation of FPS and to a heterogeneity of case characteristics across studies. see Goldstein & Miklowitz.. Evans. Of the studies summarized. a significant percentage of the cases referred to the FPS sites (33 of 150 potential families) were declared ineligible at intake. Family Preservation in Juvenile Justice Effect sizes of studies in juvenile justice suggest that a treatment effect in the moderate range is produced by FPS (Table 1). 1994). (1994) were delivered in clinic settings. Fraser. a selection bias may account for the small difference between the FPS and control conditions. 1978). and other oppositional behavior. often 13 to 15 years of age. (For a review. the children in these studies were older. Family-Based Psychoeducation in Mental Health Family-based psychoeducation is an emerging form of service designed to augment community support for people who develop serious mental disorders from late adolescence through adulthood. those of Falloon et al. Provisionally. the structure of the mental health system. Szykula & Fleischman. 1993. (1989). 1996. Incorporating crisis intervention services. Somewhat more promising findings in child welfare have been observed in the use of family preservation to promote family reunification by providing family-based services that help children in placement return home safely (Festinger. and symptoms (Table 3).) Two of these studies demonstrated significant effects on incarceration. Lewis. They are part of the mosaic of innovative familybased services that has begun to emerge across fields of practice. Rodnick.. Moreover.

physical abuse. ■ ■ ■ ■ crisis intervention—Supportive or backup services are available 24 hours a day.20 not reported 100 73 9 0 1 1 1 4 7 1 214 450 172 57 35 25 100h 100 0 100 0 0 100g 0 1 8 1 18 1 8 1 6 48 690 34 1.. 1985d (all cases) Yuan et al. target. and other parent-related reasons for referral.05 –. Nelson.0 –. 1985e (more difficult cases only) Referral Reason (%) Effect Size Child Age (years)a Parentb +. They include ■ in vivo focus—Services are present focused and delivered in a home or community setting. e Although all families were referred for child maltreatment. status offenses. 1991 University Associates. 1996f (reunification) Small or negative effect Feldman.0g 81 +. 13 of 24 families in the experimental group were rated as “less difficult” because parenting problems were viewed as related to serious conduct problems in children. 1993. First.24 5. skills building—Communication. 1995 Dennis-Small & Washburn. or all children. Placement outcome was defined as the percentage of successful family reunifications at 15-month follow-up.19 10. h All cases in this overflow comparison study were referred by Pope Pius XII because of child incorrigibility. collateral services—Workers make referrals to and coordinate community resources. Neglect. 1990 Mitchell.. 1993. these appear to be the essential and cross-cutting elements of family preservation programs with promising findings.19 –. parent problems were viewed as related to serious parental and environmental deficiencies that were not directly associated with child behavior. services are provided to de-escalate parent–child or marital conflict. and other skills are taught on the basis of the individual needs of family members. 1989h Schuerman et al. of Familiesd Control Placement (%) 50 100 1 1 2 1 54 113 85 91 more 1 1 26 38 62 38 1 4 110 47 +. delinquency. Although they are not present in every study. 1985e (less difficult cases only) Medium effect Fraser et al. and mental health. Therefore.28 13. 1986 Szykula & Fleischman. management of peer influences.47 +. 1991 Schwartz et al. use of medications.538 42 17 25 20 less 1 1 22 45 +. household management. 1994 Szykula & Fleischman.TABLE 2—Comparison of Child Welfare Studies by Effect Sizes Study by Size of Treatment Effect Large effect Pecora et al. Further description of the two groups is not provided by the authors.7 13. marital and family intervention—Where needed.. They are action oriented.. In “more difficult” cases. Oppositional behavior.3 8. sexual abuse. for example. and Rivard 145 . agency-level advocacy.0 27 +.88 12..90 +. 1991 Szykula & Fleischman.7 3–12 6. and emotional disturbance. f See also Walton et al.76 not reported less +. problem-solving.3 50 0 Childc Programs Sites No. They build partnerships with collateral services. (1993). negative school and peer influences are addressed both by Effectiveness of family preservation services / Fraser. are culturally sensitive. and address problems by working collaboratively with family members. a set of core service elements appears to characterize innovative family-based services in child welfare. g Median. Tovar. b c at least two conclusions may be drawn. parenting.38 not reported more a Unless provided as a range. average age of oldest. & Knitzer. for children with behavior problems.03 –.5 14. we use the terms “more” and “less” to describe the subsamples. ■ empowerment—Family members assist in or set service goals and are viewed as colleagues in defining a service plan. juvenile justice. d Experimental and control groups.

0 44.4 51.7 58.. 1985a Type of Outcome by Study Data Collection Period 21 18 21 24 24 83 20 20 21 10 18 Total 61.At 24 months At 12 months Prevention of hospitalization Falloon et al.6 87.9 37. 1994 60 15 At 24 months At 24 months 10 At 24 months McFarlane et al.90 +. a At 12 months 13 14 18 16 At 24 months Randolph et al. of Successes Leff et al.. and medications Multifamily therapy and medications Family therapy and medications Type of Service TABLE 3—Effect Sizes of Exemplary Studies in Family-Based Psychoeducation in Mental Health Cases 10 8 9 12 15 52 11 11 11 2 3 No.44 Effect Size .4 60.0 50.53 +.4 37.9 22.0 83.7 % Comparison Group Individual case management and medications Customary care Single-family therapy and medications Education and routine care Education and routine care Customary care Individual case management and medications Medication only Support and medications Support and medications Support and medications Type of Service +.9 37.30 +..80 +1.24 +. of Successes 20 18 20 29 29 89 29 29 29 9 18 Total 50. 1994 Services delivered primarily in the home.0 41. 1988.2 16. social-skills training.7 66. 1994 21 At 9 months Tarrier et al. 1985a Randolph et al. 1993 15 At 24 months Hogarty et al.24 +.68 +.3 75..3 % Experimental Group Family treatment and customary care Family therapy and medications Family intervention and medications Family intervention and medications Family treatment and customary care Psychoeducation and medications Family therapy and medications Social skills training and medications Family therapy.4 45.9 77.5 72.77 +.0 71... 1985a Reducing or delaying relapse Falloon et al.7 85...82 +.71 +. 1991 6 15 At 24 months At 24 months No.

1991). Even comprehensive treatment programs.. Schuerman et al. and in larger studies in which power should be high. 1992. In the one child welfare study in which families were rated and stratified on a problem index before random assignment. housing. But during the course of the service provision period. and other needs. 1993).45. financial assistance. Schwartz et al. Showell. & White. null findings were observed. These results imply that design problems exist not so much in the use of control or comparison conditions (or even in data analyses) as in the sampling of families and the implementation of the independent variable. and Rivard 147 .3 years) referred to child protective services. Neglect has proved to be a particularly intractable problem in studies of child welfare interventions. families with multiple problems have been of concern to providers of human services. However. As with any research. FPS appears to be moderately effective in preventing the placement of children who are in early adolescence and who are referred for truant. 26 of 34) was significantly different from the placement prevention rate in the control group (55 percent. In both of the former studies (Table 2). Family Preservation and Child Protection The data might be construed as suggesting that FPS does not offer a sufficient response to child abuse and neglect. designed to reach out and engage families resistant to services. Relatedly. Unfortunately. Hartley.. Second. (1989). 1985). Szykula & Fleischman. Yuan & Struckman-Johnson. children averaged seven to eight years of age and had been referred to FPS because they had been abused or neglected. the comparatively poor outcomes of large (in terms of sample sizes) child welfare studies in California (Yuan et al. Littell. Ever since the St. 1985). the difference in placement outcomes between the experimental and control groups in this unpublished study produce an effect size of +. the placement prevention rate in the experimental group (76 percent. 22 of 40). this conclusion must be conditioned on serious limitations in the research on family preservation in child welfare. Courts and workers may be far more likely to use a family preservation strategy with an older child who may be viewed as less vulnerable to the effects of abuse and neglect. Comparable to studies in reunification and prevention of rearrest in juveniles. 1997. Pecora et al. they may be less willing to deploy and persist in a family preservation effort for a younger child who is at risk of serious injury. the findings suggest that arrests and incarcerations are reduced by risk focused. Nelson.. group. Moreover. clothing. Counterintuitively. Lyle and Nelson (1983) found that an extended service model of approximately 315 days produced positive effects. or delinquent behavior. negative findings may signify failure to achieve a desired outcome—in this case failure to avert placement or protect children from abuse and neglect—or they may represent a failure of the research to detect the successes of the program (Bickman. in many of the smaller studies in which power should be low. ■ concrete services—Workers help family members meet food. & Chak. with the exception of Mitchell et al. and residential treatment care placements for the population of child welfare families referred for child behavior problems (Feldman.developing family plans regarding school and friends and by actively engaging resources in the school and community. In the juvenile justice studies. 1990). however. (1994) have pointed out that the difference in outcomes across studies in child welfare may be explained by a system effect. the effect sizes of the few family preservation studies in child welfare that involved older children or children with conduct problems suggest that FPS may be effective in preventing foster. 1990) and Illinois (Schuerman. posttreatment placement prevention outcomes were not reported. oppositional. 1991. positive findings were observed. appear to have lower levels of success with families referred for child neglect (Berry. It is possible that the ages of children and reasons for referral explain. in an experimental study of the use of family preservation–like techniques with fami- lies with young children (average age 6. Two problems have been encountered by researchers conducting large experimental evaluations Effectiveness of family preservation services / Fraser. transportation. Rzepnicki. These figures suggest that the brief model of FPS that is currently used in many states and that was used in the California and Illinois studies may be of insufficient duration to affect the complex parental and environmental factors that place children at risk of neglect (see also Guterman. multisystemic family intervention models. 1991. 1992. health care. Conversely. 1952). in part. Kolko. 1996). Nelson & Landsman. treatment was less effective with families with multiple problems and more effective with families in which problems were limited to a child’s conduct (Szykula & Fleischman. 1991. and the comparatively more positive outcomes of other child welfare studies. 1989. Paul Project discovered that a small proportion of families consumed a major share of the available resources (Buell.

A placement prevention service is not likely to show an effect on placement rates if the large majority of clients are not at risk of some form of substitute care. 1993. In addition to the variance among programs (often with contracted services) and among sites (in statewide or multistate evaluations). 1994) (Table 4). Making comparison of outcomes difficult. which has a tepid history (for example. EMERGING PRACTICE AND RESEARCH CHALLENGES Child welfare systems have enormous inertia and appear capable of absorbing much innovation without substantive change. 1995). fewer than 25 percent of the children in control groups were placed at the conclusion of the 12-month follow-up (Schuerman et al. First. Jenson & Howard... Perhaps the paramount challenge facing FPS researchers in child welfare is the control of withingroup differences. children in the samples do not appear to have been at high risk of placement (Table 2). problem-solving. 1965. 1990 Grand mean 49 Site means 37–67 Schuerman et al. & Morton.. Powers & Witmer. sampling) problems. Thus. a Median. It appears also that workers in some programs more consistently addressed the concrete needs of families and involved family members in empowering activities.. The research on FPS cannot be interpreted without a careful analysis of these differences. 1993. TABLE 4—Comparison of Large Child Welfare Studies by Service Characteristics Contact (Mean) Study Length (Days) Yuan et al. and other skills-building interven- tions (Chamberlain & Rosicky. for it is not clear that a high-quality and consistent family preservation service was provided in the two largest studies of FPS in child welfare. 1995. Given the implementation problems encountered by highly skilled researchers from very capable organizations. Meyer. such as the nature of referral problems.. These include services that have strong empirical support. the service models appear compromised by variation across sites in the large California (Yuan et al. substantial variation arises from the failure of researchers to use sampling criteria for client characteristics. 1995. In the California and Illinois studies. larger studies do not seem to have been successful in consistently implementing services that contain the core elements of family preservation (Table 4). more controlled intervention research is clearly needed. & Jones. One cannot conclude in an unqualified fashion that FPS is an insufficient response to child maltreatment. 1990). Weiss. Second. the variation in the placement outcome has been constrained by referral and subject selection (that is. 1990) and Illinois studies (Schuerman et al. These problems notwithstanding. or that placement was not imminent. one has to wonder whether large studies with treatment fidelity can be mounted successfully. Han. In some studies. Weisz.. that a needed placement did not occur (perhaps because of foster care shortages). 1994 Grand mean 108a Site means 91–123a Element of Service (% of Families Receiving Service Element) Direct Contact (Hours) Individual Counseling Family Counseling Parent Skills Crisis Concrete Training Intervention Services 32 17–45 NA 42–90 NA 44–91 NA 4–61 NA 17–54 <10 NA 91 35–131 62 NA 43 NA 49 NA 48 39–57 89 78–96 NOTE: NA = not available or reported. indicating that routine services were sufficient to avert the need for placement. it appears that family preservation provided a method for delivering relatively intensive services to families who might not otherwise come into a clinic. Borgatta. experimental services differ markedly across studies and even across sites within studies. In other studies. such as parenting. 148 Social Work Research / Volume 21. 1951). 1990. office. Yuan et al. Number 3 / September 1997 . For which younger children at risk of abuse or neglect constituted the majority of referrals. it is scarcely clear how family preservation may have differed from traditional family casework. or school. such as setting service goals or building parenting skills. Granger. Estrada & Pinsof.

Efficacy studies exercise considerable control over sample selection. and the conditions under which services occur (Hoagwood. unlike evaluations of family-based psychoeducation. The effectiveness of treatment was estimated by partitioning treatment and control groups by family characteristics related to environmental stress. In placing emphasis on the design of an exemplary service and treatment adherence. allowing the evaluators to work more closely with practitioners and counterbalance the contextual and organizational conditions that often compromise intervention research (for a discussion. and inadequate ongoing staff supervision significantly erode outcomes (Henggeler. in which a multisystemic treatment model has emerged as promising. and Rivard 149 . The inclusion of a variety of FPS programs and a large number of experimental sites is associated with smaller effect sizes (Table 2). And in such studies. In our view. But. Brondino. the sequencing of efficacy and broader effectiveness studies is rarely so linear (Hoagwood et al. Moreover. this knowledge has not made its way into the sampling strategies of experiments and quasi-experiments in FPS. including the training and supervision of workers. Because small effects rarely influence public policies. To compensate for the variability in and across FPS programs. Effectiveness of family preservation services / Fraser. Evaluations target highly defined populations on the basis of levels of symptomatology. statistical power. with the exception of the Szykula and Fleischman (1985) study. 1995). early descriptive work in FPS suggested that more difficult cases produced more negative outcomes (Fraser. in press). subsequent studies with factorial designs can focus on partitioning treatment effects by elements of service and characteristics of service recipients. Pecora. there is a linear association between the magnitude of treatment effects and the proportion of children in control or comparison groups who were placed out of the home at 12-month follow-up (Table 2). From the detection of larger effects. and programs that implement consistent service models. Scherer. studies of modest size have lower. it is much more difficult in studies that involve multiple programs and settings. Compared to studies with 150 or more subjects in experimental groups. efforts should focus on the construction of exemplary services. Hibbs.. & Hanley. and ongoing staff development. and to implement a consistent intervention across sites. abuse. it is essential to study more homogenous samples of children (preferably separating the relatively distinct phenomena of neglect. Nelson. serious mental illness. And illustrating the truism that it is difficult to prevent something that is not going to happen in the first place. 1985). In short. In the context of more targeted studies that measure outcomes ranging from child behavior and family functioning to the recurrence of maltreatment. agencies). & Pickrel. Such is the case with FPS. the delivery of services. 1991. & Haapala. the researcher should be a full participant in the development of intervention guidelines. Schoenwald. research should seek to identify medium to large effects. the construction of detailed service protocols or manuals. Like research in psychoeducation. (1988) in the area of family-based psychoeducation is instructive. Many studies are needed. large samples are often obtained at the expense of targeting appropriate families for intervention and constructing appropriate comparison groups. to sample children at risk of placement (always a knotty problem). In this regard the work of Tarrier et al. fewer sites are required. Nelson & Landsman.Obtaining large sample sizes has come at the cost of increased within-group variance. recent data suggest that poor treatment fidelity. but acceptable. universities and medical centers) followed by the development of field trials in less controlled settings (for example. effectiveness studies were undertaken. The two largest studies in our sample drew families from eight to 18 programs with markedly different services. Szykula & Fleischman. Although interventive knowledge is thought to arise from the conduct of randomized clinical trials in controlled settings (for example. & Jensen. Brent. the training of practitioners. for which with a paucity of efficacy studies. and delinquency). researchers must begin to conceptualize a range of outcomes—more comprehensive than mere placement prevention—as a function not just of a binary independent variable (treatment or control) but of adherence to explicit treatment principles and practices over the course of an intervention period. see Henggeler. 1996). Melton. this homogeneity is more likely to be accomplished by engendering a variety of smaller “efficacy” and “effectiveness” studies across the country (for example. insufficient staff training. A study with experimental and control conditions of 65 to 75 families each is usually sufficient to detect moderate group differences. 1995). cases primarily involving neglect). In the field of juvenile justice. families who are genuinely at risk of outcomes such as placement. Although it is certainly possible to conduct a large study that has sufficient size to separately analyze outcomes for different subgroupings of participants (for example. Kolko. 1992. 1995).

. should the duration of service be extended? And through the development of family reunification programs. practitioners. see Thomlison. V. it is not clear in these programs whether service delivery in the home is necessar y and. p.. can FPS strategies be used to shorten lengths of stay for children who are already in foster care? The success of future research in answering these questions will depend in part on the development of intervention models that address more fully the risk factors associated with various types of maltreatment (for review. Graves. we know almost nothing about a next generation of important questions: Across all fields of practice. Alexander. (1973). (1910). Alexander. 1996a. most of the studies fielded so far have not been able to establish a margin of benefit in child protection and placement prevention. whether they succeed in involving families who might not otherwise participate in a psychoeducation program. Williams. complex. Adams. as Wells and Tracy (1996) recently suggested. Functional family therapy. J. program managers. New York: Macmillan. Gordon. the findings are mixed. what is the relation between treatment outcome and a child’s gender. 1996b. The child and the state (Vol. P. CA: Brooks/Cole. Ayers. Testing in different community care environments is needed. & Arthur. Klein. To sort promise from compromise. Number 3 / September 1997 . V. Twenty years at Hull House. In the meantime. A set of core or common service elements has begun to emerge. the after-school environment. and socioeconomic status? Do workers with professional training produce better outcomes than paraprofessionals or students in field placements? Other than placement prevention. B. Findings are consistent with the pioneering family-centered work of other researchers (for example. 1977. In mental health studies. J. A program of research to further tease out the effects of medications management. To improve FPS for families and children who are referred to juvenile justice and child welfare agencies for delinquency. In child welfare. race or ethnicity. New York: Greenwood Press. Alexander. 1996. do services affect family functioning or child development? And what is the differential contribution of elements of services—skills training. and advocacy is needed. G. (1938). 1982. family involvement. services must be tested in conjunction with other promising interventions that more directly affect peer relations. Social Work Research / Volume 21.L. academic achievement. A program of rigorous intervention research is needed. Alexander & Parsons. effect sizes suggest that family-centered intervention both reduces symptoms and lowers the risk of hospitalization. F. 500. & Parsons. (1995) and Stern and Smith (1990) have adopted this strategy. and empowerment—to outcomes? To date. Adoption Assistance and Child Welfare Act of 1980. However. and other risk factors for antisocial and aggressive behavior (for reviews. 1995. F. Monterey. when home-based programs are mounted. see Fraser. and given to misinterpretation. should we conceptualize FPS not as a last resort to placement but as “an initial response to all maltreating families in which children do not require immediate placement” (Wells & Tracy. 1973.CONCLUSION Studies of the effectiveness of FPS are both promising and disturbing. Abbott. and policymakers can take heart that FPS has been shown to be effective in some settings and with some populations. Patterson. Henggeler et al. J. The effect sizes estimated in this study suggest that family preservation may be an effective tool in the fight against youth violence. 219–225. B. 682)? Can a brief intervention be expected to offer 150 protection against complex problems like child maltreatment? As has been done in juvenile justice. ■ REFERENCES References marked with an asterisk indicate studies included in the analysis. Reid. 1997). 94 Stat. The challenge of further testing and elaborating these elements to elucidate what combinations of service are effective with specific types of problems and families should not be underestimated. neither should the benefits of these services be discounted through the mistaken conclusion that they have been proven ineffective. Journal of Abnormal Psychology. & Dishion. 1997). Finally. 96272. a program of rigorous intervention research is urgently needed. skills training. In addition. Future research must address vexing questions: Are different kinds of services needed for families and children who are referred for abuse and for neglect? Can overburdened and underfunded child welfare systems provide a sufficient response to child maltreatment? Should. & Parsons. It is not clear whether these programs contribute a measure of support over what might be available in a community with a fully articulated continuum of care that includes psychosocial clubhouses and assertive treatment teams. & Parsons. (1982). 2). 1992). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. 81. concrete problem-solving. prevention of placement be abandoned as a rationale of FPS? That is. & Arbuthnot.

*Falloon. J. Family management in the prevention of morbidity of schizophrenia: Clinical outcome of a two-year longitudinal study. J. B. M. Statistical power analysis for the behavioral sciences (2nd ed.. (1991). Feld. (1952). B. W.. Quasi-experimentation: Design and analysis issues for field settings. J.. B. Blaske. Assessing the effectiveness of family preservation services in New Jersey within an ecological context. Williamson. R. (1994). W. (1982). M. New York: Columbia University Press. NJ: Lawrence Erlbaum. Rockville. W. 21. U. (1996b). 151–172). 21. Social Work Research. 317–321. M. New York: Department of Juvenile Justice. The effectiveness of family therapies for selected behavioral disorders of childhood. Rodnick. M. J. Hearing of Senate Labor and Human Resources Committee on improving the well-being of abused and neglected children. J. 77. Journal of Consulting and Clinical Psychology. J. Archives of General Psychiatry. 1169–1177. G. & Gilderman. L. J. (1995). B. In H. Bunker (Eds. & Barton.). J. (1995). (1986). 36. (1973). C. A. Yuan & M. J. (1978). 18. Festinger. Study design. Perrin. 347– 361. R. R. 63–80). R. B.. Cook. 441–459.. 383–402. 2–7. The effectiveness of family therapy in the treatment of adolescents with conduct disorders and delinquency. 93247. Behavior disorders of adolescence: Research. Chamberlain. May. AuClaire (Eds. Salley. & Lloyd... Goldstein. E. (1991. *Feldman.. (1996).A. Journal of Marital and Family Therapy. 34(46). & Lipsey. J.. C. Rivest (Eds. An evaluation of family preservation services: Fitting agency services to family needs. New England Journal of Medicine.). 21. & Haapala. Austin: Texas Department of Human Services. J. Springfield. Peters (Eds. T. 41. & Simpson. Gelles. (1990). Nelson. DeV. 557–562. Goldstein. W. H. & Walton. (1992). Drug and family therapy in the aftercare of acute schizophrenics. 291–332. Strengthening causal interpretations of nonexperimental data: The role of meta-analysis. 296–316. M. 2(4). M. L. H. M. (1910). New York: Charities Publication Committee. Pecora. 41.. C. An experiment in family reunification: Correlates of outcomes at one-year follow-up. Children Today.. (1995). AHCPR Conference Proceedings: Research methodology— Strengthening causal interpretations of nonexperimental data (pp. 30. Proceedings of the Boston Juvenile Court. Hart (Ed.. H. Washington Social Legislation Bulletin. Goldstein. Aggressive behavior in childhood and early adolescence: An ecological–developmental perspective on youth violence. MD: U. Children and Youth Services Review.. K. E. R. & J. Crime and Delinquency. M. P. Families in Society. P. 2. Evans. W. The effect of functional family therapy for delinquents on adult Effectiveness of family preservation services / Fraser. CA: Sage Publications. & Steinberg. Archives of General Psychiatry. New York: Edna McConnell Clark Foundation. K. Boston: Houghton-Mifflin. New York: Plenum.. M. A practitioner’s guide to meta-analyses. J. (1979).. A review of intensive family preservation services research.). W. *Borduin. 569–578. J. 1437–1440. D. 63. J. Berry. S. Fraser. Providing services to children in their own homes: An approach that can reduce foster placement. & Hill.. Agency for Health Care Policy and Research. 461–473. R.. V. In L. P. 18. J. Bickman. D. A. *Collier. The punitive juvenile court and the quality of procedural justice: Disjunctions between rhetoric and reality. Henggeler. M. & Jayaratne. IL: Charles C Thomas.R. (1985). Gelles. W. P.). L. T. M. 35. Preventive treatment of neglected children (pp.Angelou.. B. intervention. A. Rethinking the sanctioning function in juvenile court: Retributive or restorative response to youth crime? Crime and Delinquency. M. (1995). Pecora. D. Family-centered home-based intervention project for protective services clients: Final report. Estrada. Social Work. Moss.).. Cone. & Arbuthnot. P. & Williams. H. Lewis. 213–224. (1996a). The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. 77–101). W. Children and Youth Services Review. 443–464. Moss. A. D. Razani. H. M. Cordray. Durlak.. 318–327).. (1990). *Fraser. H. Child Abuse Prevention and Treatment Act of 1974. In I. & Umbreit. & Henggeler. (1990).. A. (1985). (1990).). P. W. 8. American Journal of Community Psychology. Blythe. November 20). 19–32. Community planning for human services. New York: Aldine de Gruyter. (1981).. In R. & Pinsof.. Gilderman. 131–156). M. L.H. T. Sechrest. D. Boyd. J. Walton. Newbury Park. T. *Borduin. Cognitive problem-solving and aggressive behavior among children. D. D..R.. M. Family reunification/family preservation: Are children really being protected? Journal of Interpersonal Violence. Evaluation and Quality Assurance... In Y. T. S. McMahon & R.. R. W. I.. Lincoln: University of Nebraska Press. Fucci. Buell. W. In-home programs for juvenile delinquents.. *Dennis-Small. Boyd. J. Going home and returning to foster care. Gordon. C. M. L. G.S. Department of Health and Human Services. & Miklowitz. G. E. 4. W. B. Social Work.. 361–376. Bryce... & Rosicky. (1991). C.. Fraser. (1993). and policy in clinical and school settings (pp. Family Ties intensive family preservation services program: An evaluation report.. E. Schwartz & P. 887–896. Journal of Marital and Family Therapy. (1995).H. Families in crisis: The impact of intensive family preservation services.. A. Graves. December). Evaluation resources for services to families and children (pp. M. J.. Family management in the prevention of exacerbations of schizophrenia: A controlled study.R.L. A. 335–361. Trenton: New Jersey Division of Youth and Family Services. Hillsdale. M. (1988). 37. H. A. Mann. Cohen. *Falloon. Baker. W. M. M. Razani. M. Fraser. H. McGill. S. (1996). and Rivard 151 . McGill. J. 18. Bureau of Research. 42. Home-based services for troubled children (pp. R. K. (1993). Public Health Service. J... Bazemore. L. 88 Stat. (1995). (1996. I. S. Keeping families together: The case for family preservation. Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. & Campbell. 19.. A multisystemic approach to the treatment of serious delinquent behavior. Butts.. J. & Washburn. Journal of Marital and Family Therapy. Treating families in the home: An alternative to placement. (1995).. M.

D. McLaughlin-Toran. J. Number 3 / September 1997 .752 families. S. 2. R. E. Jones. (1996). Showell. Deakins. traditional child protection services: A study of the home-based services demonstration project in the Ramsey County Community Human Services Department. A. N. S. B. MacDonald. G. Criminal Justice and Behavior.. & Parsons.. W.. Tovar. A. Washington. (1992). OR: Castalia. E.. & Leventhal.. Dunne. Humphrey Institute. Individual cognitive behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Design sensitivity: Statistical power for experimental research. R. B. 48. 22. (1989.. Skills deficits. social skills training. Evaluating intensive family preservation programs: A methodological review. Kornblith. 44. Smith. W. Kolko. & Hanley.. Social services for children. B. Kamerman. M. Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. G. M. (1990). P. C. Lindsey. Reiss. A. J. A second chance for families: Five years later. C. G. D. 469–474. Social Work Research / Volume 21. Impact of family systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. K. M. Assessing the long-term effects of foster care: A research synthesis. L. S. 594–600. B. M. 1. Girls at vocational high.. Unpublished doctoral dissertation. T.. Berkowitz. Kornblith. and maintenance chemotherapy in the aftercare treatment of schizophrenia: One-year effects of a controlled study on relapse and expressed emotion. & White. 213–228. 42. Children and Youth Services Review.. Two-year effects of a controlled study on relapse and adjustment. (1997). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. 97.. Social Work Research. Lipsey. Springfield. M. Children and Youth Services Review. M. Eugene. V. J. W.. & Martin. (1996). J.. J. Madonia... Jenson. L. M. D. R. (1985). K. The Bronx Homebuilders program: An evaluation of the first 45 families. (1993). (1977). Children and Youth Services Review. British Journal of Psychiatry. B... B. Children and Youth Services Review. (1995). IL: Charles C Thomas. & Landsman. 107 Stat. Alternative models of family preservation: Family-based services in context. & Kahn.. F.. W. 312. Hutchison. Schoenwald. Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. New York: Child Welfare League of America. R. G. C. I. 319–338. 16. W. B.. The best asylum: Charles Loring Brace and foster family care. 52–57. (1994). E. Kuipers. *Henggeler. 115. Home-based vs. Nelson. (1965). 11–80. social skills training. Maluccio. 63. M. & Jensen. & Dishion. M. Child welfare services (4th ed... Borgatta. & Pickrel. Ulrich. *Hogarty. Journal of Consulting and Clinical Psychology. A.... Anderson. *Mitchell. S. G. D. Scherer. Protecting children by preserving their families.. Pediatrics. P. Lindsey. and families in the United States. New York: Russell Sage Foundation. J. (1994a). Newmark... Klein. (1991). & Warsh. N. D. 152 Kadushin. Newbury Park.. 72. I. Lindsey.. (1996). and maintenance chemotherapy in the aftercare treatment of schizophrenia: II. J. Allen.. & Rodwell. Reiss. 295–307. The ideology of “family preservation. A. K. Melton. W. A. P. F. K.. (1994). Antisocial boys. Family preservation and child protection: Striking a balance. & the Environmental–Personal Indicators in the Course of Schizophrenia Research Group. and delinquency. J. 41–54. Reorganizing child protective services: Protecting children and providing family support.. (1990).. & Jones. D. G. Hartley. Carter. 709–717. 12–34. J.. (1986). & McCormick. D. T. Journal of Consulting and Clinical Psychology. Hoagwood. Outcomes of Oregon’s family treatment programs: A descriptive study of 1.. The welfare of children.L.. Why leave children with bad parents? Newsweek. J. (1993). Journal of Consulting and Clinical Psychology. 535–542.. D.. 146. 18. J. Mandated reporting and child abuse fatalities: Requirements for a system to protect children. Ingrassia. O. G. Family psychoeducation. H.. *Leff.and community-based treatment. (1985).criminal behavior. P. P.. M. Early prevention of physical child abuse and neglect: Existing evidence and future directions.. Nelson. (1989). 2. S. (1990).. Pine. Family psychoeducation. (1983). D. Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. C. R. 340–347. J. & Piliavin. Child Welfare. & Knitzer.. A controlled trial of social intervention in the families of schizophrenic patients: Two-year follow-up. (1994c). & Smith. Patterson.. University of California at Berkeley. Greenwald.). Melton. April 25). J. Cleveland. E. Multisystemic therapy: Bridging the gap between university. J. Archives of General Psychiatry. (1980). Westerfelt.. 279–294. J. S. McDonald. September). Brondino. D. New York: Macmillan. 633–642. H. 322–342. C. (in press). 60–73. Minneapolis: University of Minnesota. Child Maltreatment. A. 63. S. 45–60. Melton. G. A. Heneghan. M. 953–961. A. S.. Journal of Consulting and Clinical Psychology.. S. D. E. J. (1994b). New York: Oxford University Press. skills training. S.. *Hogarty. E. M. Children and Youth Services Review. H. Henggeler. (1996). Javna. M. (1992). From research to clinical practice: Dissemination of New York State’s Family Psychoeducation Project. M.. J. M. Horwitz. Dattalo. 283–293. CA: Sage Publications.... Archives of General Psychiatry. 341–354. Anderson. Hospital and Community Psychiatry. DC: Child Welfare League of America Press. B..” Public Interest. The child welfare response to youth violence and homelessness in the nineteenth century. K. 60. N. Alexander. (1995). Paper presented at the Intensive Family Preservation Research Conference. P.. J. & Sturgeon. Journal of Child and Family Studies. & the Environmental–Personal Indicators in the Course of Schizophrenia Research Group.. S. Brent. B. *Henggeler. C. New York: Bank Street College of Education. L. *McFarlane. E. 683–687. Guterman. (1994). K. 1. Reid. R.. J. Greenwald. P. Hubert H. Meyer. Journal of Consulting and Clinical Psychology. R. Henggeler.. Nelson. H.. Lyle. pp... youth. J. Lukens. A. S. K. J. & Hanley. G. W. E. E. & Howard. Child Maltreatment. & Horen. 103-66. W. M. 45. D. E. S. Hibbs. (1994. D... J. 16. 265–270. 16. (1992). 12. Omnibus Budget Reconciliation Act of 1993. Schoenwald. J. & Nelson. (1988).

L. A. (1994). 77–98. Thomlison. & Pine. (1994). A.. C. L.. (1990. McCroskey. T.). 829–832. In M. *University Associates. (1995). *Tarrier.. Office of Child Abuse Prevention. Family preservation services as an alternative to the out of home placement of adolescents: The Hennepin County experience. Risk and resilience in childhood: An ecological perspective (pp.. September 1996.. Lansing... H. E. & Harris. Teaching family reunification: A sourcebook.. Fraser. McDonald. Placement rates of children and families served by intensive family preservation services programs. A. Evaluating family-based services. Rzepnicki. (1991). R. Fraser (Ed. W. R. J. Evaluation of AB 1562 in-home care demonstration projects: Volume I—Final report. Wheeler.. (1985). Social Service Review. R. B. (1997).. K. Beyond permanency planning: Restructuring the public child welfare system. C. (1951). & Porcedu. Weisman. Weiss. Risk and protective factors in the development of delinquency and conduct disorder.. Washington. National Institutes of Health and Institute for the Advancement of Social Work Research. P. Glynn.. M.. M. Powers. W.. John Schuerman. B. W. K.. W.. An earlier version of this article was presented at a symposium on Psychosocial Intervention Research: Social Work’s Contribution. P. Behavioural family management in schizophrenia: Outcome of a clinicbased intervention. Evaluation of Michigan’s Families First program: Summary report. N. (1994. W. and John Zalenski for helpful comments on this article. P. New York: Russell Sage Foundation. Placement outcomes for neglected children with prior placement in family preservation programs.. A. Robert Lewis. Washington. Marie Weil. British Journal of Psychiatry. Fraser (Ed. Children and Youth Services Review. William Meezan. 30. (1994). K. M. A. E.. Preserving families. M. 175–194. W. (1995). Newbury Park. Atlantic Monthly. J. 92–118). 165. & Fitzpatrick. 69. L.. Han. Lewis. Wells & D. Weisz. (1993). Child Welfare. R. Reducing outof-home placements of abused children: Two controlled field studies. H. MD. 149–180). Washington. L. S. S. *Randolph. May).. M. T.. 43–63. DC: Child Welfare League of America. J. E. The community management of schizophrenia: A controlled trial of a behavioral intervention with families to reduce relapse. P. Effects of psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies. 164. When parents are not in the best interests of the child. A. W. A. 36. W. W. The Salford Family Intervention Project: Relapse rates of schizophrenia at five and eight years. Warsh. Newbury Park. Effectiveness of family preservation services / Fraser. & Tracy. L. Chicago: University of Chicago. pp. Paz. In-home family-focused reunification: An experimental study. D. Rossi. Newbury Park. D. DC: NASW Press. Yuan. M. Peter Pecora. Reorienting intensive family preservation services in relation to public child welfare practice. (1988). & Morton. E. Y. Lansing. T. & Meezan. Barrowclough. & Smith. The ethics of selective incapacitation: Observations on the contemporary debate. M. W... Nelson. 153. T. B. Porcedu. *Schuerman. and Rivard 153 . Littell. Family preservation services: Research and evaluation (pp. Ayers. Pecora. Strachan. (1996). C. In K. *Tarrier. E. & Littell. 117. Families in crisis: The impact of intensive family preservation services (pp. C.. J. B. StruckmanJohnson. DC: NASW Press. T.. 72. 140–170). 337–434.). A. Shaner. John Landsverk. Putting families first: An experiment in family preservation. Fraser. Family processes and delinquency in an ecological context. I. Risk and protective factors in child maltreatment. *Szykula. J.. K... & Haapala. 75. Pecora.. 14. S. B. Social Work. Biegel (Eds. Leong. Sacramento.. & Arthur. Bennett. & Fleischman. In K. S. N. J. & Witmer.. J. (1917). K. J. Nelson. *Schwartz. In M... G. D. Social diagnosis. (1995). July). CA: Sage Publications. Barrowclough. (1991). (1993).. *Yuan. Richmond. C. 703–731. Eth. A. T. Evaluation of Michigan’s Families First program: Summary report. & Rivest. 473–487. 532–542. Wells. Psychological Bulletin. In M.. C. MI: Author. P. Williams. M. & D. Crime and Delinquency. B. D... Maluccio. E. CA: Department of Social Services. R. R.. Fraser. *Schuerman. Assessing family preservation programs. Bethesda. I. N. (1990). 33–46). *University Associates. British Journal of Psychiatry. A. Wells & D. 1997 Accepted May 2. AuClaire. Escobar. E. British Journal of Psychiatry. Child Welfare.. Stern.). J. 50–72).. Family preservation services: Research and evaluation (pp. & Liberman. E. P. *Walton. New York: Aldine de Gruyter. H. (1991). (1984). Pelton. R. Von Hirsch. & Struckman-Johnson. (1993). A.. Chapin Hall Center for Children. (1991). Granger. P. van Vort. Original manuscript received February 1. Rzepnicki.. (1997). Yuan. New York: Aldine de Gruyter. L. L. CA: Sage Publications. M. G. (1992)... MI: Author. & Walton. H.. & Chak. Risk and resilience in childhood: An ecological perspective (pp.. L. Child Abuse & Neglect. Biegel (Eds.*Pecora. J.). 667–692. W. 501–506. J. New York: Columbia University Press. D. The Cambridge– Somerville youth study. 450– 468. & Rivest. 277–283. T. J. Haapala (Eds. Fraser. J. New York: Aldine de Gruyter. CA: Sage Publications.). Y. M.. 9. Evaluation of the Illinois Families First placement prevention program: Final report. Pecora.. 1997 The authors thank Malcolm Gordon. R. Y.. M. (1995). E. H.. A. S. H. (1994).