Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Home-Based Services
This section describes the strong record of effectiveness for home-based
services, which provide very intensive services within the homes of children and
youth with serious emotional disturbances. A major goal is to prevent an
out-of-home placement (i.e., in foster care, residential, or inpatient
treatment). Home-based services are usually provided through the child welfare,
juvenile justice, and/or mental health systems. They are also referred to as
in-home services, family preservation services, family-centered services,
family-based services, or intensive family services.
Stroul (1988) identified three major goals of home-based services: to preserve
the family’s integrity and prevent unnecessary out-of-home placements; to put
adolescents and their families in touch with community agencies and individuals,
thus creating an outside support system; and to strengthen the family’s coping
skills and capacity to function effectively in the community after crisis
treatment is completed. The specific services provided most often include
evaluation, assessment, counseling, skills training, and coordination of
services. The historical evolution of home-based services is discussed further
under Support and Assistance for Families in Service Delivery.
The evidence for the benefits of home-based services was recently evaluated in a
meta-analysis of controlled studies only (Fraser et al., 1997). The analysis
referred to home-based services as “family preservation services”; these were
sponsored either by the child welfare or juvenile justice systems. For 22
studies the authors analyzed specific measures such as out-of-home placement,
family reunification, arrest, incarceration, and hospitalization, with the
control group defined as youth receiving “usual” or “routine” services. While a
majority of the studies demonstrated marginal gains in effectiveness, other
services appeared to be significantly more effective than usual services. The
findings are presented below according to their organizational sponsorship by
either child welfare or juvenile justice system.
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