•  

Intervention Summary

Back to Results Start New Search

HOMEBUILDERS

HOMEBUILDERS is an intensive family preservation services program designed to improve family functioning and children's behavior and to prevent out-of-home placement of children into foster or group care, psychiatric hospitals, or correctional facilities. Drawing on social learning and crisis intervention theories, the program is structured to reduce barriers to family support services and maximize opportunities for family members to learn new personal and social skills. Families with one or more children (up to age 18) who are at imminent risk of out-of-home placement or have been placed out of the home and need intensive services to reunify with the family are typically referred to HOMEBUILDERS by protective services, foster care and adoption agencies, community mental health professionals, probate courts, or domestic violence shelters. These families are usually experiencing problems such as child abuse and neglect, other family violence, juvenile delinquency, mental illness, and/or substance abuse.

Within 24 hours of referral, participating families begin receiving services from trained, master's-level therapists, who meet with families in their homes and neighborhood during sessions that are scheduled on a flexible basis. Services provided by therapists include social support services (e.g., assistance with transportation, budgeting, household maintenance, and home repair), counseling, modeling of parenting skills, extensive interagency treatment planning, and family advocacy within the community context. Each therapist serves two or three families at a time, typically spending 40 or more hours in face-to-face contact with family members. In addition, therapists are on call to families 24 hours per day, 7 days per week. Program services usually last 4-6 weeks, although extensions are allowed, and two booster sessions are offered in the 6 months after services end.

Descriptive Information

Areas of Interest Mental health treatment
Outcomes Review Date: December 2011
1: Child behavior problems
2: Out-of-home placement
Outcome Categories Family/relationships
Mental health
Social functioning
Ages 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
White
Race/ethnicity unspecified
Settings Home
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Since its initial implementation in 1974, HOMEBUILDERS has been implemented by more than 200 public and private organizations in 23 States and, internationally, in Australia, Belgium, Canada, Germany, the Netherlands, and the United Kingdom. An estimated 100,000 families have participated in the intervention. In the United States, programs in California, Kentucky, Michigan, Missouri, New York, North Carolina, Utah, and Washington have been evaluated; internationally, programs in Belgium, the Netherlands, and the United Kingdom have been evaluated.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations HOMEBUILDERS has been adapted for use in Australia (with Aboriginal and non-Aboriginal populations), Belgium, and the Netherlands.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: December 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Morris, E., Suarez, L., & Reid, J. C. (1997). Behavioral outcomes of home-based services for children and adolescents with serious emotional disorders. Family Preservation Journal, 2(2), 21-32.

Study 2

Kirk, R. S., & Griffith, D. P. (2002). Annual report to the Governor and the General Assembly of the State of North Carolina on the Intensive Family Preservation Services program for the 2001-2002 State fiscal year. Raleigh: North Carolina Department of Health and Human Services, Division of Social Services.

Kirk, R. S., & Griffith, D. P. (2004). Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research, 28(1), 5-18.

Study 3

Blythe, B. J., & Jayaratne, S. (1999). Michigan Families First effectiveness study: A summary of findings. Report submitted to the State of Michigan, Family Independence Agency.

Supplementary Materials

Fidelity Checklist for Michigan

Fidelity Checklist for Missouri

Fidelity Checklist for North Carolina

Outcomes

Outcome 1: Child behavior problems
Description of Measures Child behavior problems were assessed with the Child Behavior Checklist (CBCL), a 113-item measure of a child's externalizing and internalizing behaviors, as reported by a parent or other caretaker. Using a 3-point scale ranging from 0 (not true) to 2 (very true or often true), respondents rate each item. From these responses, a total score, internalizing and externalizing scale scores, and eight subscale scores (withdrawn, somatic, anxious/depressed, social, thought, attention, delinquent, and aggressive) are derived.
Key Findings Children ages 4-17 who were at risk for out-of-home placement, demonstrated internalizing or externalizing behavior problems, and met the diagnosis for at least one DSM-III-R psychiatric disorder received intensive in-home services through Missouri's Families First program, which used the HOMEBUILDERS model. The CBCL was administered to one parent, usually the mother, at the initial intake screening (pretest) and at the end of the 4- to 6-week intervention period (posttest).

From pre- to posttest, children had an improvement in behavior problems, as indicated by the CBCL total score (p = .0001), the internalizing scale score (p = .0001), the externalizing scale score (p = .0001), and scores for all eight subscales (withdrawn, p = .0002; somatic, p = .0078; anxious/depressed, p = .0001; social, p = .0001; thought, p = .0031; attention, p = .0001; delinquent, p = .0001; and aggressive, p = .0001).

Analyses also were conducted with data from children with oppositional defiant disorder, mood disorders, or conduct disorder. Results from pre- to posttest indicated improvements in behavior problems:

  • Children with oppositional defiant disorder had an improvement in the CBCL total score (p = .0002), the internalizing scale score (p = .0027), the externalizing scale score (p = .0019), and scores for seven subscales (withdrawn, p = .0038; anxious/depressed, p = .0065; social, p = .0022; thought, p = .0062; attention, p = .0053; delinquent, p = .0074; and aggressive, p = .0040).
  • Children with mood disorders had an improvement in the CBCL total score (p = .0015), the internalizing scale score (p = .0001), the externalizing scale score (p = .0174), and scores for five subscales (somatic, p = .0083; anxious/depressed, p = .0002; social, p = .0168; attention, p = .0119; and delinquent, p = .0086).
  • Children with conduct disorder had an improvement in the CBCL total score (p = .0098), the externalizing scale score (p = .0044), and scores for two subscales (delinquent, p = .0002, and aggressive, p = .0040).
Studies Measuring Outcome Study 1
Study Designs Preexperimental
Quality of Research Rating 3.2 (0.0-4.0 scale)
Outcome 2: Out-of-home placement
Description of Measures In one study, this outcome was assessed by the number of days that children spent in out-of-home placement over a period of 1 year from the beginning of services for families who received the intervention or over a period of 1 year from the date of a substantiated report of abuse and/or neglect for families who received traditional child welfare services. These data were obtained from several of North Carolina's statewide information systems.

In another study, this outcome was assessed by the number of days that children spent in out-of-home placement, which includes State-supported foster homes, private agency foster homes, private child care institutions, public institutions, public shelters, mental health facilities, and detention facilities. These data were obtained from Michigan's Children's Services Management Information Systems.
Key Findings A 6-year retrospective study analyzed data from 51 counties that offered North Carolina's Intensive Family Preservation Services (IFPS) program (based on the HOMEBUILDERS model) to families who had a substantiated report of abuse and/or neglect and were referred by county departments of social services to receive county-based child welfare services. These families were screened with a standardized child protective services risk assessment, and those determined to be at high risk for the out-of-home placement of children were included in the study. Families who were eligible for IFPS program services but did not receive them owing to the program's limited resources received traditional services through public and contract agencies (e.g., counseling, parent skill training, mental health referral and services, protective services, day care, foster care). Findings included the following:

  • Compared with children in high-risk families who received traditional child welfare services, those in high-risk families who received services through the IFPS program had reduced out-of-home placement rates or delayed out-of-home placement (p < .01), after controlling for risk factors such as prior placement authority and prior substantiated reports of abuse and/or neglect.
  • Among high-risk families without a new substantiated report of abuse and/or neglect within 12 months of the start of services, children in high-risk families who received services through the IFPS program were 32% less likely than children in high-risk families who received traditional child welfare services were to experience an out-of-home placement (p < .001).
In another study, families were randomly assigned to the intervention group, which received intensive family preservation services from Michigan's Families First program (based on the HOMEBUILDERS model) or the comparison group, which received foster care services. During the 12 months after the intervention, children in families who received services from the Families First program spent fewer days in out-of-home care than did children in the comparison group (p < .0001).
Studies Measuring Outcome Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
57.6% Male
42.4% Female
75% White
25% Black or African American
Study 2 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
50.4% Female
49.6% Male
54.4% White
45.6% Race/ethnicity unspecified
Study 3 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
52% Male
48% Female
71.3% Black or African American
22% White
6.7% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Child behavior problems 4.0 3.0 2.8 3.6 2.3 3.4 3.2
2: Out-of-home placement 2.8 2.9 3.3 3.6 2.5 2.4 2.9

Study Strengths

The CBCL, included in one study, is a widely used and validated measure of children's internalizing and externalizing behaviors. In each of two studies, the number of days of out-of-home placement was extracted from State administrative databases; because these data are from official State records, they should be fairly reliable. In one State, the database had recently undergone improvement efforts, which may have enhanced reliability and validity. The validity of out-of-home placement based on official State records is high, as the measure is actual days rather than a proxy. In all three studies, intervention fidelity was addressed through staff training, an intervention manual, and team meetings. A fidelity checklist was provided for each study. In one study, researchers reported high intervention fidelity on the basis of such factors as response time (i.e., time from referral to first home visit), length of service, and number and distribution of contact hours; cases that did not meet strict fidelity requirements were removed from analyses. In another study, researchers noted that agency workers completed a fidelity questionnaire at the end of each case and that a questionnaire adapted for foster care workers was administered to them via telephone; the results of this assessment demonstrate that a relatively high level of treatment fidelity was obtained. Missing data and attrition were not issues in any of the three studies. The use of a longitudinal retrospective analysis with a comparison group in one study was strong. Another study used a randomized group design, which helped control for a number of potential confounding variables. The retrospective study also used a more sophisticated survival analysis to assess the out-of-home placement of children.

Study Weaknesses

Only the parent-report version of the CBCL was used, although the measure's developer recommends that data be collected from multiple informants. Standardized assessments of fidelity were not used. It is not clear who completed the fidelity review checklists, when they were completed, on how many families they were completed, and the level of adherence to the intervention. In one study, participants who received services through the IFPS program but did not have a high level of treatment fidelity were removed from analyses; however, the researchers do not explain how this may have impacted the findings. Another study used a single-group pre- and posttest design, which is subject to a number of potential confounding variables, including selection bias and history; in addition, the types and amount of other services were not taken into consideration in the analysis. One of the studies had a serious design flaw, which led to a major concern with confounding variables: children in the intervention group remained in the home and received services to prevent out-of-home placement, and children in the comparison group were removed from the home and placed in foster care; thus, the outcome regarding out-of-home placement did not have an equivalent likelihood of occurring between intervention and comparison groups. Two of the studies did not apply corrections for conducting multiple tests, thus increasing the probability of inflating the experiment-wide error rate. The analyses conducted in one study were overly simplistic and did not include multivariate analyses of some key factors that probably impacted the outcome.

Readiness for Dissemination
Review Date: December 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Behavioral Science Institute--HOMEBUILDERS. (1992). Skills for family and community living [DVD and leader's guide]. Federal Way, WA: Author.

Institute for Family Development. (2003). Job description: QUEST consultant. Federal Way, WA: Author.

Institute for Family Development. (2003). Program consultation and quality assurance skills for HOMEBUILDERS supervisors. Federal Way, WA: Author.

Institute for Family Development. (2007). HOMEBUILDERS quality enhancement system. Federal Way, WA: Author.

Institute for Family Development. (2009). HOMEBUILDERS clinical paperwork guidelines. Federal Way, WA: Author.

Institute for Family Development. (2009). HOMEBUILDERS sample site development plans. Federal Way, WA: Author.

Institute for Family Development. (2009). HOMEBUILDERS standards (version 3.0). Federal Way, WA: Author.

Institute for Family Development. (2010). Assessment, goal setting and service planning. Federal Way, WA: Author.

Institute for Family Development. (2010). Drug-affected clients: Motivational interviewing and relapse prevention. Federal Way, WA: Author.

Institute for Family Development. (2010). Fundamentals of supervising HOMEBUILDERS: Intensive family preservation services. Federal Way, WA: Author.

Institute for Family Development. (2011). HOMEBUILDERS core curriculum. Federal Way, WA: Author.

Institute for Family Development. (2011). Improving decision making through critical thinking. Federal Way, WA: Author.

Institute for Family Development. (2011). Teaching skills to families. Federal Way, WA: Author.

Institute for Family Development. (2011). Utilizing behavioral principles and strategies with families. Federal Way, WA: Author.

Institute for Family Development. (2011). Utilizing cognitive strategies with families. Federal Way, WA: Author.

Institute for Family Development. (n.d.). Active listening: John [DVD]. Federal Way, WA: Author.

Institute for Family Development. (n.d.). Client family session: Jack [DVD]. Federal Way, WA: Author.

Institute for Family Development. (n.d.). Crisis card demo [DVD]. Federal Way, WA: Author.

Institute for Family Development. (n.d.). Your deal [Card game]. Federal Way, WA: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 3.5 3.5 3.5

Dissemination Strengths

The implementation and standardized training materials are comprehensive, detailed, and very well organized. Training materials include DVDs and supplemental resources, which present guidance on how to integrate motivational interviewing into the intervention. Optional trainings for specific populations are easy to identify, and the materials for these trainings are well outlined. Tools and resources for measuring fidelity and replicating the program are available and include performance benchmarks, standardized forms, and guided reviews of the program processes.

Dissemination Weaknesses

There is no overview document that clearly defines the scope of the program. Implementing staff must attend time-intensive trainings and follow complex quality assurance procedures, which may be barriers to implementation for some agencies.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
HOMEBUILDERS site development and implementation readiness consultation (in person or by phone) Varies depending on site needs and travel expenses Yes
4-day, on-site HOMEBUILDERS Core Curriculum Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $120 per participant for materials
Yes
1-day, on-site Goal Setting and Paperwork Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $20 per participant for materials
Yes
2-day, on-site Motivational Interviewing Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $40 per participant for materials
Yes
1-day, on-site Relapse Prevention Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $20 per participant for materials
Yes
1-day, on-site Utilizing Cognitive Strategies With Families Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $20 per participant for materials
Yes
1-day, on-site Utilizing Behavioral Principles and Strategies With Families Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $20 per participant for materials
Yes
1-day, on-site Teaching Skills to Families Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $15 per participant for materials
Yes
2-day, on-site Improving Decision Making Through Critical Thinking Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $25 per participant for materials
Yes
2- to 5-day, on-site Fundamentals of Supervising HOMEBUILDERS: Intensive Family Preservation Services Training (2-part training)
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $275 per participant for materials
Yes
2- to 3-day, on-site Program Consultation and Quality Assurance Skills for HOMEBUILDERS Supervisors Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $75 per participant for materials
Yes
1.5- to 2-day, on-site Online Data Manager Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $15 per participant for materials
Yes
2-day, on-site Addressing Domestic Violence: Strategies for In-Home Practitioners Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $45 per participant for materials
No
1-day, on-site Ethical Issues in In-Home Services Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $15 per participant for materials
No
1-day, on-site Self-Advocacy Skills for Families: A Territorial Model of Assertiveness Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $10 per participant for materials
No
1-day, on-site Working With Parents With Cognitive Limitations Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $15 per participant for materials
No
1-day, on-site Substance Exposed Newborns Training
  • $1,250 per day for 1 trainer (up to 15 participants) or $2,500 per day for 2 trainers (up to 30 participants), plus travel expenses
  • $15 per participant for materials
No
Phone consultations (held weekly in the first 2 years of implementation, monthly in year 3, and quarterly thereafter) $100 per hour Yes
3- to 4-day, on-site visits (2 times per year) $1,250 per day, plus travel expenses Yes
Technical assistance as needed via phone or email $100 per hour Yes
File and fidelity reviews (2 times per year) $100 per hour Yes
Access to the Online Data Manager, a Web-based client information and data system that includes assessments, service plans, service summaries, contact logs, referral information, and other quantitative data tools for program fidelity
  • $4,900 activation fee (year 1 only)
  • $350 monthly fee
  • $980 annual upgrade fee
Yes
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Blythe, B. J., & Jayaratne, S. (1999). Michigan Families First effectiveness study: A summary of findings. Report submitted to the State of Michigan, Family Independence Agency.

Fraser, M. W., Pecora, P. J., & Haapala, D. A. (1991). Families in crisis. New York, NY: Aldine de Gruyter.

Fraser, M., Walton, E., Lewis, R., Pecora, P., & Walton, W. (1996). An experiment in family reunification services: Correlates of outcomes at one year follow up. Children and Youth Services Review, 18(4/5), 335-361.

Kentucky Department for Community Based Services. (2008, January). Kentucky's Family Preservation program: Comprehensive program evaluation. Frankfort, KY: Author.

* Kirk, R. S., & Griffith, D. P. (2004). Intensive family preservation services: Demonstrating placement prevention using event history analysis. Social Work Research, 28(1), 5-18.

* Morris, E., Suarez, L., & Reid, J. C. (1997). Behavioral outcomes of home-based services for children and adolescents with serious emotional disorders. Family Preservation Journal, 2(2), 21-32.

Rodenhiser, R. W., Chandy, J., & Ahmed, K. (1995). Intensive family preservation services: Do they have any impact on family functioning? Family Preservation Journal, 1(1), 69-85.

Wood, S., Barton, K., & Schroeder, C. (1988). In-home treatment of abusive families: Cost and placement at one year. Psychotherapy, 25, 409-414.

Contact Information

To learn more about implementation, contact:
Shelley Leavitt, Ph.D.
(253) 874-3630
sleavitt@institutefamily.org

To learn more about research, contact:
Charlotte Booth, M.S.W.
(253) 874-3630
cbooth@institutefamily.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):