NDSU Department of Child Development and Family Science
North Dakota Department of Human Services
June 1999 -- Volume 2, Number 3
James T. Decker, Ph.D.
Associate Professor • Department of Social Work • University of North Dakota • Grand Forks, ND 58202 • Phone: (701) 777-3709 • Fax: (701) 777-4257
Tammy Lynn Bailey, Rh.D.
Assistant Professor • Department of Social Work • University of North Dakota • Grand Forks, ND 58202
John G. Red Horse, Ph.D.
Professor • Native American Studies/Department of Social Work • University of Minnesota • Duluth, MN 55805
Thomasine Heitkamp, M.S.W.
Associate Professor • University of North Dakota • Department of Social Work • Grand Forks, ND 58202-7135
This report is based on a client survey conducted by the Department of Human Services and the Children and Family Services Division. The purpose of this study was to identify (a) the demographics of those families being served, (b) the experiences of those families being served, (c) the placement outcome of the children served, and (d) the current services the families are receiving. The study was conducted through personal delivery of the surveys by the therapists to over 100 families. The respondents consisted of families who received Intensive In-Home Family Therapy services from January 1, 1996 through December 30, 1996. A total of 56 surveys were completed and returned by parents.
In-Home Family Therapy, which began within the last two decades, is one of several human services programs aimed at family preservation. Goals of this program are to prevent placement of children outside the home, to ensure the safety of children in their homes, or to reunify family members when placement exists prior to Intensive In-Home Services (NDDHS Service Chapter 627-02-1991). Such placement may occur for a variety of reasons, including one or a combination of the following broad problem domains: abuse, neglect, offending/unruly behavior, and psycho-pathology (NDDHS 02-13-1991).
Family preservation services exist along a continuum of care which includes primary, secondary, and tertiary levels of service. Primary or preventative services typically involve educational goals and programs. Secondary services respond to family crises as they emerge and include such programs as early-intervention, juvenile tracking, respite care, and family therapy. Tertiary services tend to be the most invasive and usually involve severe structural change within the family. The most common of these "last resort" methods is out-of-home placement, either in foster care (therapeutic or custodial with relative or non-relative), juvenile detention, or residential treatment.
In-Home Family Therapy, while differing based on the worker's theoretical orientation and agency policy, typically involves working to build a collaborative, genuine, and supportive relationship with a family in order to help family members make the changes necessary for preservation, maintenance, and growth. What makes this kind of therapy unique is that it takes place in the family's home (NDDHS 627-02-1991). The belief is that to be most effective, one should see a family in it's own environment, not in an artificial environment like an office (Hartman and Laird, 1983). In-Home Family Therapy techniques focus on helping the family change its structure (what it is), strategies (what it does), or systems (how it does what it does) by identifying and drawing on the family's strengths.
Children are referred for Intensive In-Home Services because they are at risk of being placed outside their homes, they need to be reunited with family members after placement has already been made, or because they have been involved in the juvenile justice system. Common underlying issues prevalent in families that receive Intensive In-Home Services include: stress and coping (grief, loss, trauma), family communication problems, and parenting skills training (discipline, boundaries, nurturance). In-Home Family Therapy sessions may last from one to three hours, one or more days each week, for a duration of one to six months. In some cases the duration of services can be longer than six months, depending on the treatment model agencies utilize.
Over the years, Intensive In-Home Program Services has utilized four different treatment models. Respondents in this study may have received family-based intensive services under the Iowa, Homebuilders, North Dakota, or Crisis Intervention models (Woods, 1988). Currently, most agencies in North Dakota utilize the Iowa model, an evolutionary model developed by maximizing elements from existing models previously used in North Dakota (Decker, Bailey, Heitkamp & Tierney, 1998). The Iowa model focuses on services to meet clients' needs through outcome-based treatment plans developed collaboratively by family members, the Intensive In-Home therapist, and the referring case manager. Since treatment needs vary from family to family, so does the length of treatment prescribed in the Iowa model (Decker etal., 1998). No minimum length of service is required; however, it is expected that families will complete services within a six month time period. Some exceptions may be made if services are needed beyond six months.
The purpose of this study was to identify: (a) demographics of those families being served, (b) experiences of those families being served, (c) placement outcome of the children served, and (d) current services the families are receiving.
Respondents consisted of families who received Intensive In-Home Family Services from the Department of Human Services and the Children and Family Service Division in North Dakota from January 1, 1996 through December 30, 1996. One hundred surveys were handed to families who terminated services and a total of 56 families completed and returned surveys.
A survey instrument was developed consisting of both quantitative and qualitative questions. Included in this instrument was demographic and service information regarding families who received Intensive In-Home Services. Open and closed-ended questions addressed the demographics of families, experiences with placement outcome of children, and services that were currently being provided to their families.
Surveys were introduced to the client by the worker, along with a self-addressed postage paid envelope, during the final week of services. Intensive In-Home therapists uniformly dispersed surveys, as no formal instructions accompanied the questionnaires. One hundred clients who received service between January 1, 1996 and December 30, 1996 received surveys. Completed forms were returned either by mail, or directly to the worker upon termination of services.
The survey was outcome-based, utilizing both demographic and satisfaction responses. SPSS for Windows 6.1 was used to figure the frequencies and percentages for the survey responses. A database was built, a data directory and codebook assembled, and the numerical data entered. In addition, comments were included in this report for the qualitative questions addressed in the survey.
The specific variables under consideration were: a) demographics of person completing survey — a variable with nine levels (i.e., gender, race, marital status, education level, age, number of children, number of children currently living at home, gross income, and source(s) of income); b) demographics of the children in the family — a variable with four levels (i.e., age, gender, race, lives at home); c) demographics of significant other — a variable with seven levels (i.e., gender, race, marital status, education level, age, is the person your spouse, is the significant other the biological parent of the children); d) past experiences with services provided — a variable with seven levels (i.e., overall satisfaction with Intensive In-Home Services, satisfaction with services received in prior year, significance of services in keeping the family together, areas of services received, services recommended at end of treatment, ways services met the family's needs, and ways in which services could be more helpful); e) update report on children since last service received — a variable with six levels (i.e., were children placed outside the home while they receiving services in 1996, how many children were placed, location of placement, if children were returned to home, length of time children had been in out-of-home placement, if the child has not returned home is there a plan for that child to return home); and f) current services received — a variable with five levels (i.e., services currently receiving, parenting education, parent aid, support group and addiction counseling).
This section is divided into two major parts. Part one presents results from the demographic information. The second part reports results from the qualitative analysis. To ensure easy comprehensibility of the results, most descriptive statistics have been reported using tables. The following discussion highlights the major points of the results. It is important to note that there were several cases that had missing data in different areas of the survey.
Seventy-nine percent of the respondents were female, 71% were white, 21% Native American, 46% were married, and 38% were divorced from their significant other. Respondent's educational background ranged from 16% with less than 12 years to 6% having some graduate classes. The mean age of the respondents was 41 with a range between 26 to 56 years. Income ranged between $0 and $72,000 with most noted gross income between $10,001 and $15,000. Only 27 of the 56 families surveyed reported their income.
Respondents were also asked to report the total number of children in the family. This number included children that were either in or out of the home during Intensive In-Home Services. For example, some children may have left home when they became of age to be independent and some may have been subsequently placed during Intensive In-Home Services.
Total number of children in this study was 176. Number of children in the family ranged from one to six. The average number of children in the family was three, and approximately 29% of the families reported having three children in the family.
The total number of children in the home was 106 at the time this survey was completed. While the average number of children at home was two, most families reported that they had only one child living at home at the time of the survey. Seven families had no children in the home at the time of the survey. Of the 70 children no longer at home, 29 of them were in out-of-home placements. It is assumed that the other 41 children, had became of age and left home of their own accord. Children at home for two cases is an unknown factor.
Five percent of the children were between 0-4, with 29% in the 10-14 age range. The gender of the respondent children ran fairly evenly with 88 female children and 89 male children. There was one missing case. The majority of the children were white (61%), Native American (22%), African American (2%), white and Native American (4%), Hispanic and Asian Pacific (4%) and 7% were missing data.
Respondents were asked to provide information about their significant other. The data indicated that 41% were white, 38% male, and most were over 30 years of age. Most had an education level of 12 or more years. Of the significant other information provided, 20% were biological parents to the respondent children and 43% were married to the respondent.
Table 1 indicates the overall rating of the respondent satisfaction with past services they had received. Ratings on how significant Intensive In-Home Services were in keeping the family together are also presented and ranged from very insignificant to very significant. For satisfaction with services, ratings ranged from very unsatisfied to satisfied.
Table 1. Significance in keeping family together and overall
satisfaction with past services.
-------------------------------------------
Respondents Served Frequency Percent
-------------------------------------------
Total n=52
Significance Rating
Very significant 7 12.5
Significant 14 25.0
Neutral 21 37.5
Insignificant 6 10.7
Very insignificant 4 7.1
-------------------------------------------
Total n=54
Overall Satisfaction
Satisfied 17 30.4
Very satisfied 19 33.9
Neutral 12 21.4
Unsatisfied 4 7.1
-------------------------------------------
* Note: Percent based on n of 56, therefore does not total 100%.
** Note: There is missing data of 4 and 2 respectively.
Seven respondents rated services as very significant in keeping families together (12.5%).
Another 14 respondents indicated services were significant in keeping families together
(25.0%). Seventeen respondents were satisfied with services (30.4%) while 19 respondents
reported they were very satisfied with services provided by Intensive In-Home Therapy
(33.9%). Some examples from respondents were: Respondents were satisfied with their
counselors; "My child admired the counselor. I liked the one to one service. They
came into the homes to begin counseling, big help. Our worker was always there when we
needed him", were but a few of the families positive reaction to their counselors.
Some of the past issues that instigated the involvement of Intensive In-Home Services are listed in Table 2. Parenting skills and assess family issues were the most frequently cited problems that the respondents reported. Some other issues that were listed had to do with chemical addiction both for the parent and the child. Adolescent behavioral problems were another issue cited.
Table 2. Past issues involving intensive in-home services.
-------------------------------------------------- Issues Frequency -------------------------------------------------- Anger management/conflict resolution 20 Assess family issues 26 Chemical dependency-child 4 Chemical dependency-family 1 Child abuse/neglect 5 Child/adolescent behavior problems 23 Developmental delays/disabilities 1 Domestic violence 3 Family communication problems 23 Financial/resource issues 3 Individual, marital, family counseling 9 Mental health-child 12 Mental health-family 4 Other addiction treatment 3 Parenting skills 32 Referrals long-term support services 2 Other 3 --------------------------------------------------
The following section highlights the qualitative replies of the respondents. Results describing other services recommended by the clients worker, shows that fifty-four percent of the respondents didn't have a need for service. For the remaining 22 families, a total of 31 services were recommended. Individual counseling was suggested to 10 individuals and support groups to 7. Services are presented in Table 3 along with service recommended.
Table 3. Recommendations for other services after in-home therapy.
----------------------------------------------- Respondents Frequency *Percent ----------------------------------------------- **Total n=52 Were services recommended Yes No ----------------------------------------------- Services recommended Another in-home model 1 Foster care 4 Individual counseling 10 Parent aide 3 Parenting education 3 Support group 7 Other 3 ----------------------------------------------- * Note: Percent based on n of 56, therefore does not total 100%. ** Note: There is missing data for 4 cases.
The ways the respondents felt Intensive In-Home Services met their family needs were
answered by
having the respondents answer in their own words as to how they felt the services could
have been more helpful. For example, one respondent stated that the family was helped with
the need to communicate with each other. Another answered that the services could have
been more helpful by having a worker followup on services they received. Another felt
referral for counseling should have been made to other family members. Other comments were
provided on the way the families felt their needs were met.
On the other hand, respondents stated Intensive In-Home Services could have been more helpful if workers would have explained what information would be shared back to the courts, how the worker's role of an Intensive In-Home Therapist was different from a CPS (child protection service) workers, and how to interface with other services like foster care.
The survey requested information about what happened to the children since the families last Intensive In-Home Services in 1996. Twenty children were placed after in-home services had been terminated. Of the 20 children placed since the last Intensive In-Home Services, most often only one child in the family was in an out-of-home placement. Three families had two children placed, and three had three children placed.
A total of 14 children were placed out of their home since the last Intensive In-Home Service. One family had two children placed, one family had three children placed, and the remaining eight had one child placed. Forty-two families had no out-of-home placements. Twelve of the 14 families who had a child placed had that child return home. Two have not returned home yet.
There were 20 out-of-home placements in the first referral to Intensive In-Home Treatment. Of the 20, seven were in a correctional setting. Of the 13 remaining, 12 have returned home and a plan for the other child is in place.
Table 4 depicts information about the number of children placed and location of placement.
Table 4. Location of placement and number of children
at each placement.
--------------------------------------- Location Number Placed --------------------------------------- Family Foster Care 5 Harmony House 2 River's Edge 1 Luther Hall 1 Youth Correctional Center 4 Manchester House 1 Dakota Center - RTC 2 Home on the Range 3 Out-of-State Placement 1 Dakota Center - RCC 2 Prairie Learning Center 5 Other 7 ---------------------------------------
Thirty-six of the 56 respondents reported on the current services they were receiving at
the time they filled out the survey. Twelve indicated that they were receiving Individual
counseling at the time they completed the survey. Current services included the following
(the number following each listing indicates the number of families involved in that
particular service):
Parent aide .............. 3 Stress training ............. 3 Foster care .............. 1 Coping skills training ...... 3 Parenting education ...... 4 Grief counseling ............ 2 Support group ............ 1 Trauma counseling ........... 3 Individual counseling ... 12 AA/NA groups ................ 2 Chemical dependency ...... 1 Other addiction treatment ... 1
The next section of the survey considered the current Intensive In-Home Services. The respondents indicated that most were not receiving current Intensive In-Home Services. Only one case indicated that they were receiving services. They did not indicate who they were receiving services from, but did report the service was received in March of 1997. The respondent reported that the child at risk in 1996 was not the same child at risk of out-of-home placement currently. There were one or two missing cases. It was difficult to tell since their information was not complete. When analyzing the current issues, it became clear that more than one case may have been receiving current Intensive In-Home Services.
The following list indicates that some service issues were reported by more than one case (the number behind each issue indicates number of cases reporting that issue).
---------------------------------------------- Current Intensive In-Home Service Issues ---------------------------------------------- Parenting Skills ......................... 1 Family Communication Problems/ Mental Health Child .................... 1 Family Communication Problems/ Mental Health Parent ................... 1 Family Communication Problems/ Anger Management/Conflict Resolution ... 2 Family Communication Problems/Child/ Adolescent Behavioral Problems ......... 1 Family Communication Problems/ Assessment Family Issues ............... 1 Family Communication Problems ............ 2 Developmental Delays/Disabilities ........ 1 ----------------------------------------------
Of the 56 families involved in Intensive In-Home Services 64% of these families expressed overall satisfaction. Thirty-seven percent of the families involved in Intensive In-Home Services reported that services were significant in keeping their family together. The therapist/counselor received high marks for both problem solving and empathetic interviewing. An analysis by race, sex and age show no difference between groups when comparing those families who rated their experiences as very satisfactory to those families who said they had a poor experience. Qualitative statements from both families and counselors highlight their significant concerns, those concerns are expressed both positivity and negatively.
- 77% were kept in home
- To ensure the safety of children; this was accomplished through:
- Parent Education
- Family Communication Counseling
- Individual Counseling
- Support Groups- Reunification of children back to their home:
- 12 of the 13 children who are out of the home were positively placed in the home along with a plan for the one remaining child.
To overcome client dissatisfaction, the following suggestions are presented based on families comments on their qualitative answer to our survey:
Last, but important, most of these families did not volunteer for Intensive In-Home Services and would not again. The therapist often overcame initial resistance by the families. Workers overcame that resistance by being positive, honest, helpful and respectful. On the other hand, the organizations they worked for were viewed more as a police function than a helping organization.
Decker, J.T., Bailey, T.L., Heitkamp, T. & Tierney, F.M. (1998). Profiling Family Preservation Efforts. Child Welfare Research Bureau, Department of Social Work, University of North Dakota, Research Publication.
Hartman, A., Laird, J. (1983). Family Centered Social Work Practice, New York, Free Press.
North Dakota Department of Human Service Manual, Division 20, Services 641 Program 600, Chapter One (1) through Thirteen (13), 1991.
Woods, L.J. (1988). Home-Based Family Therapy, Social Work 33, (3), 211-214.
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The North Dakota Journal of Human Services, June 1999 -- Volume 2, Number 3