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
evaluation

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:
mfraser@email.unc.edu. 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
Hill.

138

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

CCC
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1997,
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status of research on FPS. Special emphasis is placed

on FPS designed for children who are on the verge
of placement, because these programs have received
the most attention from researchers, advocates, and
critics.
DEVELOPMENT OF FAMILY PRESERVATION SERVICES
Modern child welfare services, where family preservation first developed, have roots in the efforts of
charitable organizations in the 19th century to rescue children from abandonment, abuse, neglect, and
poverty. During that era, placement in foster families and institutions was seen as necessary to protect
children from the harsh conditions associated with
urban industrial growth, including the perceived
drunkenness, pauperism, and promiscuity of immigrant parents (Nelson, 1980). Representing the
countrys nascent concern about delinquency, placement was also seen as a humane and desirable alternative for youths in the countrys first gangsabandoned children attempting to survive on the streets
of New York, Boston, and other cities (Nelson,
1996). In reaction to the specter of children being
raised in institutions, shipped en masse to foster farm
families in the Midwest, and sent to jails where they
shared cells with adult offenders, the notion of providing services to strengthen families and thereby
reduce the need for placement arose at the turn of
the century (Kadushin & Martin, 1988; McDonald,
Allen, Westerfelt, & Piliavin, 1996).
In 1899 the first juvenile court was established
in Chicago to regulate the treatment and control
of dependent, neglected, and delinquent children
(Abbott, 1938, p. 392). 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, the court created
a set of community-based services to augment parental supervision with supervision from probation
workers. Harvey Baker (1910), Bostons first juvenile court judge, described the duties of the probation worker as investigating all available information about the family and . . . environment of the
boy, the boys personal history at home, in school,
at work, and on the street, and the circumstances . . .
which got him into court . . . and then . . . to address . . . the question of how permanently to prevent the recurrence (p. 318).
Social work, which emerged as a profession during this period, has long been concerned with services for children and families (Adams, 1910). In
1909 the first White House Conference on Children declared that no child should be deprived of

family life for reasons of poverty alone. And in one

of the first attempts to articulate both an assessment
and services strategy for social workers, Mary Richmond wrote in 1917:
In some forms of social work, notably family
rebuilding, a clients 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, acting and reacting upon one
another, each taking a share in the development of the clients story, each revealing in ways
other than words social facts of real significance.
(p. 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, 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., 1994; Kamerman & Kahn, 1990).
Moreover, far from its original conceptualization of
augmenting parental supervision, probation has
devolved to child-centered monitoring of compliance with court orders. Although not hostile to family-centered services, public programs have placed vastly
more resources in substitute care and social control.
In this context, the recent growth of short-term,
largely home-based family-strengthening programs
to reduce out-of-home placement of children stands
as a remarkable public policy development. Supported by programs of research in state and local
agencies and at the Childrens Bureau of the U.S.
Department of Health and Human Services, by the
requirement of the Adoption Assistance and Child
Welfare Act of 1980 (P.L. 96-272) that states undertake reasonable efforts to prevent placement,
by widespread belief that a continuum of child welfare services should include options for families besides placement, by advocacy of the Edna McConnell
Clark and other foundations, and by modifications
of Title IV-B of the Social Security Act (under the
Omnibus Budget Reconciliation Act of 1993, P.L.
103-66), family-centered services programs grew
rapidly in the 1980s and 1990s (Heneghan,
Horwitz, & Leventhal, 1996). These services were
designed to resolve crises that place children at risk
of placement, improve family functioning so that
children might remain safely at home, and reduce
burgeoning out-of-home care budgets (for an early
report, see Jones, 1985).

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

139

A response in part to rising caseloads generated

by the Child Abuse Prevention and Treatment Act
of 1974 (P.L. 93-247) and later by the reasonable
efforts provision of P.L. 96-272, the rapid adoption of these services was fueled by positive early
evaluation findings; however, the findings of later,
more rigorous studies on the effectiveness of FPS
were equivocal (Blythe, Salley, & Jayaratne, 1994;
Rossi, 1992; Wells & Tracy, 1996). An outspoken
critic of family preservation programs, Gelles (1993)
has argued that it is not clear whether family preservation is penicillin or poison (p. 557). Critics
suggest that FPS neither resolves crises nor improves
family functioning so that children may remain home
safely. They charge that emphasis on family preservation endangers abused or neglected children and,
in the case of delinquency, compromises public safety
(Gelles, 1996; MacDonald, 1994). Thus, in the context of this uncertainty and debate, this article assesses the research knowledge regarding the effectiveness of family preservation and services closely
related to family preservation.
CHARACTERISTICS OF FAMILY
PRESERVATION PROGRAMS
FPS differs markedly from routine protective,
probation, and mental health services. Typically, FPS
has the following characteristics:
Services are provided to the family, although a
variety of activities may be undertaken with or
on behalf of individuals.
Services are targeted to families with children at
risk of out-of-home placement in family foster
care, group homes, residential treatment, or correctional facilities.
Services are time limited, ranging from one to
five months in duration. Historically, many intensive family preservation programs such as
HomeBuilders were four to eight weeks in length.
These programs were influenced by the brief
treatment and crisis intervention literatures of
the 1970s and early 1980s. But more recently
developed programs, such as multisystemic family treatment, are longer in duration (Henggeler,
Melton, Smith, Schoenwald, & Hanley, 1993).
These latter programs are characterized by many
of the elements of family preservation, but they
spread in-home services over a three- to fivemonth period.
Services are flexibly scheduled so that family members can participate without encountering conflicts with work, school, or other commitments.
Usually, services are provided in the home.

140

Services are tailored to the needs of family members. Building on ecological, systems, social-learning, psychoeducational, and crisis theories, they
often include a mix of crisis intervention, concrete assistance, supportive counseling, skills
building, and advocacy.
Services are provided in the context of a familys
values, beliefs, and culture.
Services in many programs are available 24 hours
a day, seven days a week.
Workers have small caseloads of between two and
six families and may visit families many times
during a week. In many programs, families are
seen between two and 15 hours per week. Hence
the term intensive is sometimes used to describe FPS (Angelou, 1985; Nelson & Landsman,
1992; Yuan & Rivest, 1990).

METHOD
Sample
The authors reviewed published and unpublished
studies of FPS since 1985. 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, including foster
and group home, residential treatment, and correctional placements. Emphasis was placed on studies
of intensive, in-home services for which caseloads
were small and the intervention period lasted no
more than 20 weeks. Studies of family-centered casework, family therapy, 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, incarceration, or hospitalization were
excluded from the analysis. Because increasing numbers of oppositional, defiant children are referred to
child welfare agencies and because important tests
of family preservation have taken place in the juvenile justice system, studies involving both maltreated
and delinquent children were included in the sample.
In addition to placement prevention services in
child welfare and juvenile justice, studies of familybased services in reunification and family-centered
psychoeducation in mental health were included.
From the beginning, FPS programs have been used
to help reunify children in out-of-home care with
their families. But few studies have focused exclusively on this aspect of family preservation. In mental health, a small number of family-based services
studies have focused on strengthening families with
adults and, to a lesser degree, children who have

Social Work Research / Volume 21, Number 3 / September 1997

developed serious mental disorders. Less intensive

and longer in duration than FPS, these services are
designed to reduce relapse, hospitalization, and institutionalization. We included these studies not as
FPS, but as exemplars of the development of related
family-based services in an allied field. Across the
child welfare, juvenile justice, and mental health literatures, only studies with control or comparison
groupsachieved through random assignment,
matching, or some equivalent mechanismwere
included in the analysis. In fields of practice where
there are dozens of studies, it is often appropriate
to develop a weighting scheme for different kinds
of research designs. Because there are so few controlled studies in the field of family preservation and
because each is differentially vulnerable to strong
criticism, we elected not to weight studies. However, we limited our analysis to studies with control
or comparison groups. Studies with weaker designs
(for example, 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.
Analysis
We examined ultimate outcomes such as placement, reunification, arrest, incarceration, and hospitalization. These were defined as policy-relevant
outcomes that affected resource utilization within
the child welfare, juvenile justice, or mental health
systems. From a practice perspective, many other
outcomes related to family functioning are important. Although placement is influenced by factors
other than family conditions and the success or failure of a family preservation intervention (for example, the availability of a foster family, recent media events, and the attitude of local judges),
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, see Pecora, Fraser,
Nelson, McCroskey, & Meezan, 1995). In referring
to these outcomes as ultimate, we do not imply
that they are more important than changes in family
functioning, risk of child maltreatment, or child behavior such as delinquency and drug abuse.
For studies in mental health, 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., 1985; Hogarty et al., 1991; Leff,

Kuipers, Berkowitz, & Sturgeon, 1985; Tarrier,

Barrowclough, & Porcedu, 1988). Across all studies, outcomes were analyzed as success rather than
failure rates. Thus, if outcomes were reported in the
original studies as failure rates (for example, number of children placed out of home), these were converted to success rates (for example, number of children not placed) for our analysis. Other than this
minor calculation, outcome data were used as reported by authors.
To compare findings across studies, effect sizes
(ESs) were estimated. Effect size refers to an index
that standardizes the difference between the means
of experimental and control groups (Cordray, 1990).
For dichotomous outcomes as reported in the studies reviewed, Durlak and Lipsey (1991) recommend
computing effect size using Cohens (1988) arcsine
transformation. The arcsine ESp is given by
ESp = t c ,

where t is the arcsine transformation of a success

proportion in the treatment group, and c is the arcsine transformation of a success proportion in the
control group.
ESp is computed by subtracting arcsine values of
the success proportions for each group (Lipsey,
1990). 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, 1990):
ES = 4(2)([N (2)])

Individual effect sizes measuring change within

treatment and comparison groups were calculated.
Then the effect sizes for each experimental and control group were subtracted, yielding a difference
score effect size. 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, 1991;
Lipsey, 1990).
Interpreting effect sizes across multiple studies is
complex and must take into account the unique
specification and measurement of dependent variables, the features of the interventions, and the integrity with which they were applied, as well as the
research designs used in each study (Durlak & Lipsey,
1991; Lipsey, 1990). Caution is warranted because
effect sizes mask important differences in sample
sizes, the equivalence of control groups, and the
quality of the independent variable (the treatment).
For example, in the studies reviewed, the comparability of success rates is somewhat limited because

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

141

of the different ways in which attrition was handled

by researchers. Attrition occurred when subjects
withdrew after assignment but before treatment was
initiated, during assessment, or during treatment.
In addition, some families were lost during followup phases. The majority of studies in our sample
excluded dropouts from the original assigned treatment and comparison groups. In some studies, 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.
The decision to exclude after referral (and randomization) such a family is usually based on a workers
judgment that provision of FPS might compromise
a childs safety. Occasionally, too, it refers to cases in
which, prior to intake but after referral a placement
has been made. Clearly, in such cases, placement
prevention is not possible. Feldman (1991) referred
to such cases as turnbacks. Although a case can
be made for excluding dropouts because they are
not fully exposed to the intervention, Cook and
Campbell (1979) argued that inclusion of withdrawals provides a more conservative test of the effects
of treatment. Because most authors chose to exclude
lost cases, the findings may overestimate effect sizes.
The size of an effect can be assessed actuarially as
a relative value within a distribution of effect sizes,
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, 1991; Lipsey, 1990). Unfortunately, the limited number of controlled studies in FPS precludes
the latter interpretation at this time. In the discussion that follows, the actuarial approach is used to
discuss effect sizes of the studies reviewed in relation to Lipseys ranges of small, medium, and large.
These guidelines are based on his compilation of 186
meta-analyses of treatment effectiveness research in
the behavioral sciences. According to Lipsey, effect
sizes of .00 to .32 are small, effect sizes of .33 to .55
are medium, and effect sizes of .56 to 1.20 are large.
FINDINGS
The findings are complicated, for effect sizes are
large in some studies but not in others. Reflecting
the difficulty of conducting research in the field, the
effect of experimental services is usually estimated
by comparison to routine services. If we assume that
routine services have some effect on children and
their families, we can conclude that the impact of
FPS in the absence of any service is rarely estimated.
As opposed to the practice of excluding dropouts
(which is likely to result in an overestimation of treat-

142

ment effects), this assumption probably results in

an underestimation of treatment effects. Thus, effect sizes are not comparable to studies with no-treatment control group designs.
Family Preservation in Child Welfare
Effect sizes for family preservation programs in
child welfare are mixed (Table 1). In one study, children for whom placement proceedings had been
initiated were diverted from placement to an experimental family preservation program (Schwartz,
AuClaire, & Harris, 1991). This is perhaps the only
FPS study with a design that may approximate a notreatment control, and in this study the effect size
of treatment was large (+.88). In the Szykula and
Fleischman (1985) study of less difficult cases,
family preservation programs significantly reduced
out-of-home placement when compared with other
services (+.76). Although all families were referred
for child maltreatment, 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. In more difficult cases, parent problems were viewed as related
to serious parental and environmental deficiencies
that were not directly related to child behavior. But
the overall effect size for the Szykula and Fleischman
study was +.19, because the subsample of more difficult cases fared poorly in treatment (.38).
The effect size (+.90) of a matched-pairs case
overflow study in which FPS was compared to routine services fell in the large range (Pecora, Fraser,
Bennett, & Haapala, 1991). This study, however,
suffered from attrition. Many of the case overflow
families were lost in follow-up. In a study that used
a control condition consisting of children who were
leaving foster carea population that clearly has no
children at risk of first placementsthe effect of FPS
(+.24) was small (University Associates, 1995). In
several other studies, effect sizes were also small
(Dennis-Small & Washburn, 1986; Mitchell, Tovar,
& Knitzer, 1989). And in two large studies with
routine services control conditions, no treatment
effect on placement or child maltreatment was observed (Schuerman, Rzepnicki, & Littell, 1994;
Yuan, McDonald, Wheeler, Struckman-Johnson, &
Rivest, 1990). In fact, like the study of more difficult cases in the Szykula and Fleischman (1985) experiment, routine services in Schuerman et al.s
(1993) study had a small positive treatment effect
relative to FPS (.19).
If, as some of the studies suggest, there is an effect on placement, it does not appear to be large. In

Social Work Research / Volume 21, Number 3 / September 1997

TABLE 1Effect Sizes of Comparison- 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, 1985b
Less difficult cases
More difficult cases
Dennis-Small & Washburn, 1986c
Mitchell, Tovar, & Knitzer, 1989c
Yuan et al., 1990
Schwartz, AuClaire, & Harris, 1991
Feldman, 1991
Pecora et al., 1991
Schuerman et al., 1993, 1994c
University Associates, 1995
Family reunification
Fraser et al., 1996
Fraser et al., 1996
Prevention of abuse and neglect
Yuan et al., 1990c
Schuerman et al., 1993c
Juvenile justice
Prevention of rearrest
Borduin & Henggeler, 1990
Henggeler et al., 1992g
Henggeler et al., 1993g,h, i
Borduin et al., 1995g
Collier & Hill, 1993
Prevention of incarceration
Henggeler et al., 1992g
Collier & Hill, 1993

Not reportedc

No. of
Successes Total

Comparison Groupa
No. 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

66.6
92.3
36.4
82.8
72.7
81.7
43.6
57.3
55.6
72.0
76.4

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

96.5
70.2

17
25

53
53

110
731

143
974

76.9
75.0

113
440

150
564

75.3
78.0

+.05
.07

12 months
59 weeks
120 weeks
48 months
12 months

48
25
17
68
32

58
43
43
92
40

82.8
58.1
39.5
73.9
80.0

24
16
8
24
23

40
41
41
84
40

60.0f
39.0
19.5
28.6i
57.5

+.52
+.40
+.42
+.93
+.48

59 weeks
12 months

34
33

43
40

79.0
82.5

13
24

41
40

31.7 +1.01
60.0 +.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

58.3
61.5
54.5
75.3
75.0
82.7
8.6d
43.3
14.8
80.0
64.9e

Effect
Size

+.19
+.76
.38
+.20
.05
.03
+.88
+.28
+.90
.19
+.24

32.1 +1.54
47.2 +.47

Except where indicated, treatment in the comparison group consisted of usual or routine services.
Although all families were referred for child maltreatment, 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. In more difficult cases, parent problems
were viewed as related to serious parental and environmental deficiencies that were not directly associated with child behavior.
The differences between the experimental and control conditions were significant in the less difficult group (p < .01) and not
significant in the more difficult groups.
c
Most success rates are reported using total number of children as the denominator. However, if child-specific rates were not
available, total number of families was used. Reports here are based on the family as unit of analysis.
d
Placement list.
e
Child leaving substitute care.
f
Alternative treatment.
g
Withdrawals are included in analysis; otherwise, withdrawals are excluded from analysis.
h
Same sample as Henggeler et al. (1992), but reports on different follow-up period.
i
Individual therapy.
b

a New Jersey experiment, Feldman (1991) reported

that 57.3 percent of the families that received FPS
had avoided placement at the 12-month follow-up.
In contrast, 43.3 percent of the families in a usual
services program avoided placement. The difference

produces a small but statistically significant effect

(+.28). Although the findings are significant and cost
savings in large populations may be substantial, a
considerable percentage of the children in families
that received services were at continued risk of

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

143

placement. Moreover, a significant percentage of the

cases referred to the FPS sites (33 of 150 potential
families) were declared ineligible at intake. Although
these 33 turnback cases were not significantly different from cases that were referred and found eligible for FPS, 32.1 percent of the children in the
turnback group compared with 18.0 percent of children who ultimately received FPS had prior placements (Feldman, 1991). Because prior placement is
often a major predictor of outcome in FPS, it is possible that the experimental group was biased by excluding turnbacks from the analysis. Thus, from a
design perspective, a selection bias may account for
the small difference between the FPS and control
conditions.
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, 1996; Warsh,
Maluccio, & Pine, 1994). Only one reunification
study with random assignment has been published
to date. This study had a 15-month treatment effect (+.47), which fell in the medium range (Fraser,
Walton, Lewis, Pecora, & Walton, 1996; Walton,
Fraser, Lewis, Pecora, & Walton, 1993).
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). Three studies with usualservices control conditions produced moderate
treatment effects on rearrest and one produced a
large effect (+.93). (Henggeler et al., 1992, 1993,
reported on the same study, but findings were estimated for different follow-up periods.) Two of these
studies demonstrated significant effects on incarceration. Compared with children in the child welfare
studies, the children in these studies were older, often 13 to 15 years of age, and diverted from routine court services to experimental family-based services. In two child welfare studies with large
treatment effects (Pecora et al., 1991; Schwartz et
al., 1991), children were somewhat older than children in studies with less positive outcomes (Table
2). Moreover, in both these studies, half or more of
the children were referred for truancy, drug use, and
other oppositional behavior. With the exception of
findings by Mitchell et al. (1989), 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, 1995; Feldman, 1991; Szykula &

Fleischman, 1985).
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.
Incorporating crisis intervention services, familybased psychoeducation programs are intended to
prevent or delay relapses and shorten hospitalizations. Present focused and time limited, these services educate family members about the etiology of
mental illnesses (often emphasizing the biological
bases of disorders), the structure of the mental health
system, and the use of medications. Moreover, they
include problem-solving and communications-skills
training for working with people who have mental
illnesses, with professionals in the mental health system, and with others within the family system
(Goldstein & Miklowitz, 1995).
Because services are rendered for up to one year,
they cannot be considered FPS per se. However,
because they have the goal of reducing out-of-home
care and strengthening families, we included them.
They are part of the mosaic of innovative familybased services that has begun to emerge across fields
of practice. Of the studies summarized, those of
Falloon et al. (1982, 1985) and Leff et al. (1985)
used a home delivery method (Goldstein, Rodnick,
Evans, May, & Steinberg, 1978); the interventions
of Hogarty et al. (1986, 1991) and Randolph et al.
(1994) were delivered in clinic settings. McFarlane
et al. (1993) compared single-family psychoeducation
with a unique multifamily group format. Whether
provided in the home or clinic, these services appear
to have moderate to large effects on relapse, hospitalization, and symptoms (Table 3).
This article describes only the first generation of
studies of family-based psychoeducation. These
studies compare family-based education to medications-only or usual services. Currently, a second generation of studieslargely dismantling or factorial
designsis examining the relative effectiveness of
elements of the psychoeducation model. (For a review, see Goldstein & Miklowitz, 1995.)
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. Provisionally, we think that

Social Work Research / Volume 21, Number 3 / September 1997

TABLE 2Comparison of Child Welfare Studies by Effect Sizes

Study by Size of Treatment Effect

Large effect
Pecora et al., 1991
Schwartz et al., 1991
Szykula & Fleischman, 1985e
(less difficult cases only)
Medium effect
Fraser et al., 1996f (reunification)
Small or negative effect
Feldman, 1991
University Associates, 1993, 1995
Dennis-Small & Washburn, 1986
Szykula & Fleischman, 1985d
(all cases)
Yuan et al., 1990
Mitchell, Tovar, & Knitzer, 1989h
Schuerman et al., 1993, 1994
Szykula & Fleischman, 1985e
(more difficult cases only)

Referral
Reason (%)

Effect
Size

Child Age
(years)a

Parentb

+.90
+.88

12.5
14.3

50
0

Childc

Programs Sites

No. of
Familiesd

Control
Placement (%)

50
100

1
1

2
1

54
113

85
91

more

26

38

62

38

110

47

+.28
13.0
27
+.24
5.0g
81
+.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
1,538

42
17
25
20

less

22

45

+.76 not reported less

+.47

+.19
.03
.05
.19

10.7

312
6.7
13.3
8.0

.38 not reported more

Unless provided as a range, average age of oldest, target, or all children.

Neglect, physical abuse, sexual abuse, and other parent-related reasons for referral.
Oppositional behavior, status offenses, delinquency, and emotional disturbance.
d
Experimental and control groups.
e
Although all families were referred for child maltreatment, 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. In more difficult cases, parent
problems were viewed as related to serious parental and environmental deficiencies that were not directly associated with child
behavior. Further description of the two groups is not provided by the authors. Therefore, we use the terms more and less to
describe the subsamples.
f
See also Walton et al. (1993). Placement outcome was defined as the percentage of successful family reunifications at 15-month
follow-up.
g
Median.
h
All cases in this overflow comparison study were referred by Pope Pius XII because of child incorrigibility.
b
c

at least two conclusions may be drawn. First, a set

of core service elements appears to characterize innovative family-based services in child welfare, juvenile justice, and mental health. Although they are
not present in every study, these appear to be the
essential and cross-cutting elements of family preservation programs with promising findings. They
include
in vivo focusServices are present focused and
delivered in a home or community setting. They
are action oriented, are culturally sensitive, and
address problems by working collaboratively with
family members.
empowermentFamily members assist in or set
service goals and are viewed as colleagues in defining a service plan.

crisis interventionSupportive or backup services

are available 24 hours a day.
skills buildingCommunication, problem-solving, parenting, household management, management of peer influences, use of medications,
agency-level advocacy, and other skills are taught
on the basis of the individual needs of family
members.
marital and family interventionWhere needed,
services are provided to de-escalate parentchild
or marital conflict.
collateral servicesWorkers make referrals to and
coordinate community resources. They build
partnerships with collateral services; for example,
for children with behavior problems, negative
school and peer influences are addressed both by

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

145

At 24 months

At 12 months

Prevention of hospitalization
Falloon et al., 1985a

Randolph et al., 1994

Services delivered primarily in the home.

At 12 months

13

14

18

16

At 24 months

Randolph et al., 1994

21

At 9 months

Tarrier et al., 1988, 1994

60

15

At 24 months

At 24 months

10

At 24 months

McFarlane et al., 1993

15

At 24 months

Hogarty et al., 1991

15

At 24 months

At 24 months

No. of
Successes

Leff et al., 1985a

Reducing or delaying relapse

Falloon et al., 1985a

Type of Outcome by Study

Data
Collection
Period

21

18

21

24

24

83

20

20

21

10

18

Total

61.9

77.7

85.7

66.6

87.5

72.3

75.0

50.0

71.4

60.0

83.3

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,
social-skills training,
and medications
Multifamily therapy
and medications

Family therapy
and medications

Type of
Service

TABLE 3Effect Sizes of Exemplary Studies in Family-Based Psychoeducation in Mental Health Cases

10

12

15

52

11

11

11

No. of
Successes

20

18

20

29

29

89

29

29

29

18

Total

50.0

44.4

45.0

41.4

51.7

58.4

37.9

37.9

37.9

22.2

16.7

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

+.24

+.71

+.90

+.53

+.82

+.30

+.77

+.24

+.68

+.80

+1.44

Effect
Size

developing family plans regarding school and

friends and by actively engaging resources in the
school and community.
concrete servicesWorkers help family members
meet food, housing, clothing, financial assistance,
transportation, health care, and other needs.
Second, FPS appears to be moderately effective
in preventing the placement of children who are in
early adolescence and who are referred for truant,
oppositional, or delinquent behavior. In the juvenile justice studies, the findings suggest that arrests
and incarcerations are reduced by risk focused,
multisystemic family intervention models. Moreover,
with the exception of Mitchell et al. (1989), 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, group, and residential treatment care placements for the population of child welfare families referred for child behavior problems (Feldman, 1991; Pecora et al., 1991;
Schwartz et al., 1991; Szykula & Fleischman, 1985).
It is possible that the ages of children and reasons for referral explain, in part, the comparatively
poor outcomes of large (in terms of sample sizes)
child welfare studies in California (Yuan et al., 1990)
and Illinois (Schuerman, Rzepnicki, Littell, & Chak,
1993), and the comparatively more positive outcomes of other child welfare studies. In both of the
former studies (Table 2), children averaged seven
to eight years of age and had been referred to FPS
because they had been abused or neglected. Neglect
has proved to be a particularly intractable problem
in studies of child welfare interventions. Ever since
the St. Paul Project discovered that a small proportion of families consumed a major share of the available resources (Buell, 1952), families with multiple
problems have been of concern to providers of human services. In the one child welfare study in which
families were rated and stratified on a problem index before random assignment, treatment was less
effective with families with multiple problems and
more effective with families in which problems were
limited to a childs conduct (Szykula & Fleischman,
1985).
Even comprehensive treatment programs, designed to reach out and engage families resistant to
services, appear to have lower levels of success with
families referred for child neglect (Berry, 1992;
Hartley, Showell, & White, 1989; Nelson &
Landsman, 1992; Yuan & Struckman-Johnson,
1991). However, in an experimental study of the
use of family preservationlike techniques with fami-

lies with young children (average age 6.3 years) referred to child protective services, Lyle and Nelson
(1983) found that an extended service model of
approximately 315 days produced positive effects.
Comparable to studies in reunification and prevention of rearrest in juveniles, the difference in placement outcomes between the experimental and control groups in this unpublished study produce an
effect size of +.45. Unfortunately, posttreatment
placement prevention outcomes were not reported.
But during the course of the service provision period, the placement prevention rate in the experimental group (76 percent, 26 of 34) was significantly different from the placement prevention rate
in the control group (55 percent, 22 of 40). 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, 1997; Kolko, 1996).
Relatedly, Schuerman et al. (1994) have pointed
out that the difference in outcomes across studies in
child welfare may be explained by a system effect.
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. Conversely, 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.
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; however, this conclusion must be conditioned on serious limitations in the research on
family preservation in child welfare. Counterintuitively, in many of the smaller studies in which power
should be low, positive findings were observed, and
in larger studies in which power should be high, 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. As with any
research, negative findings may signify failure to
achieve a desired outcomein this case failure to
avert placement or protect children from abuse and
neglector they may represent a failure of the research to detect the successes of the program
(Bickman, 1990).
Two problems have been encountered by researchers conducting large experimental evaluations

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

147

in which younger children at risk of abuse or neglect constituted the majority of referrals. First, children in the samples do not appear to have been at
high risk of placement (Table 2). Thus, the variation in the placement outcome has been constrained
by referral and subject selection (that is, sampling)
problems. In the California and Illinois studies, fewer
than 25 percent of the children in control groups
were placed at the conclusion of the 12-month follow-up (Schuerman et al., 1993; Yuan et al., 1990),
indicating that routine services were sufficient to
avert the need for placement, that a needed placement did not occur (perhaps because of foster care
shortages), or that placement was not imminent. 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.
Second, larger studies do not seem to have been
successful in consistently implementing services that
contain the core elements of family preservation
(Table 4). Making comparison of outcomes difficult, experimental services differ markedly across
studies and even across sites within studies. The research on FPS cannot be interpreted without a careful analysis of these differences. In some studies, it
is scarcely clear how family preservation may have
differed from traditional family casework, which has
a tepid history (for example, Meyer, Borgatta, &
Jones, 1965; Powers & Witmer, 1951). In other
studies, it appears that family preservation provided
a method for delivering relatively intensive services
to families who might not otherwise come into a
clinic, office, or school. These include services that
have strong empirical support, such as parenting,
problem-solving, and other skills-building interven-

tions (Chamberlain & Rosicky, 1995; Estrada &

Pinsof, 1995; Jenson & Howard, 1990; Weisz,
Weiss, Han, Granger, & Morton, 1995). It appears
also that workers in some programs more consistently addressed the concrete needs of families and
involved family members in empowering activities,
such as setting service goals or building parenting
skills. For example, the service models appear compromised by variation across sites in the large California (Yuan et al., 1990) and Illinois studies
(Schuerman et al., 1994) (Table 4). One cannot
conclude in an unqualified fashion that FPS is an
insufficient response to child maltreatment, 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.
EMERGING PRACTICE AND RESEARCH CHALLENGES
Child welfare systems have enormous inertia and
appear capable of absorbing much innovation without substantive change. Given the implementation
problems encountered by highly skilled researchers
from very capable organizations, one has to wonder
whether large studies with treatment fidelity can be
mounted successfully. These problems notwithstanding, more controlled intervention research is clearly
needed.
Perhaps the paramount challenge facing FPS researchers in child welfare is the control of withingroup differences. In addition to the variance among
programs (often with contracted services) and
among sites (in statewide or multistate evaluations),
substantial variation arises from the failure of researchers to use sampling criteria for client characteristics, such as the nature of referral problems.

TABLE 4Comparison of Large Child Welfare Studies by Service Characteristics

Contact (Mean)
Study

Length
(Days)

Yuan et al., 1990

Grand mean
49
Site means
3767
Schuerman et al., 1993, 1994
Grand mean
108a
Site means
91123a

Element of Service (% of Families Receiving Service Element)

Direct Contact
(Hours)

Individual
Counseling

Family
Counseling

Parent Skills
Crisis
Concrete
Training
Intervention Services

32
1745

NA
4290

NA
4491

NA
461

NA
1754

<10
NA

91
35131

62
NA

43
NA

49
NA

48
3957

89
7896

NOTE: NA = not available or reported.

a
Median.

148

Social Work Research / Volume 21, Number 3 / September 1997

Obtaining large sample sizes has come at the cost of

increased within-group variance. Moreover, large
samples are often obtained at the expense of targeting appropriate families for intervention and constructing appropriate comparison groups. The inclusion of a variety of FPS programs and a large
number of experimental sites is associated with
smaller effect sizes (Table 2).
The two largest studies in our sample drew families from eight to 18 programs with markedly different services. And illustrating the truism that it is
difficult to prevent something that is not going to
happen in the first place, with the exception of the
Szykula and Fleischman (1985) study, 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).
To compensate for the variability in and across
FPS programs, it is essential to study more homogenous samples of children (preferably separating the
relatively distinct phenomena of neglect, abuse, serious mental illness, and delinquency), families who
are genuinely at risk of outcomes such as placement,
and programs that implement consistent service
models. In our view, this homogeneity is more likely
to be accomplished by engendering a variety of smaller
efficacy and effectiveness studies across the country (for example, Kolko, 1996). Efficacy studies exercise considerable control over sample selection, the
delivery of services, and the conditions under which
services occur (Hoagwood, Hibbs, Brent, & Jensen,
1995). Although interventive knowledge is thought
to arise from the conduct of randomized clinical trials in controlled settings (for example, universities
and medical centers) followed by the development
of field trials in less controlled settings (for example,
agencies), the sequencing of efficacy and broader
effectiveness studies is rarely so linear (Hoagwood et
al., 1995). Such is the case with FPS, for which with
a paucity of efficacy studies, effectiveness studies were
undertaken.
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, cases primarily involving neglect), to
sample children at risk of placement (always a knotty
problem), and to implement a consistent intervention across sites, it is much more difficult in studies
that involve multiple programs and settings.
Many studies are needed. A study with experimental and control conditions of 65 to 75 families
each is usually sufficient to detect moderate group

differences. Because small effects rarely influence

public policies, research should seek to identify medium to large effects. From the detection of larger
effects, subsequent studies with factorial designs can
focus on partitioning treatment effects by elements
of service and characteristics of service recipients.
Compared to studies with 150 or more subjects in
experimental groups, studies of modest size have
lower, but acceptable, statistical power. And in such
studies, fewer sites are required, allowing the evaluators to work more closely with practitioners and
counterbalance the contextual and organizational
conditions that often compromise intervention research (for a discussion, see Henggeler, Schoenwald,
& Pickrel, 1995).
In this regard the work of Tarrier et al. (1988) in
the area of family-based psychoeducation is instructive. The effectiveness of treatment was estimated
by partitioning treatment and control groups by family characteristics related to environmental stress.
Evaluations target highly defined populations on the
basis of levels of symptomatology. Like research in
psychoeducation, early descriptive work in FPS suggested that more difficult cases produced more negative outcomes (Fraser, Pecora, & Haapala, 1991;
Nelson & Landsman, 1992; Szykula & Fleischman,
1985). But, unlike evaluations of family-based
psychoeducation, this knowledge has not made its
way into the sampling strategies of experiments and
quasi-experiments in FPS.
In the context of more targeted studies that measure outcomes ranging from child behavior and family functioning to the recurrence of maltreatment,
efforts should focus on the construction of exemplary services, including the training and supervision
of workers. In the field of juvenile justice, in which
a multisystemic treatment model has emerged as
promising, recent data suggest that poor treatment
fidelity, insufficient staff training, and inadequate ongoing staff supervision significantly erode outcomes
(Henggeler, Melton, Brondino, Scherer, & Hanley,
in press). In placing emphasis on the design of an
exemplary service and treatment adherence, the researcher should be a full participant in the development of intervention guidelines, the construction of
detailed service protocols or manuals, the training of
practitioners, and ongoing staff development. In
short, researchers must begin to conceptualize a range
of outcomesmore comprehensive than mere placement preventionas 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.

Effectiveness of family preservation services / Fraser, Nelson, and Rivard

149

CONCLUSION
Studies of the effectiveness of FPS are both promising and disturbing. A program of rigorous intervention research is needed. The effect sizes estimated
in this study suggest that family preservation may
be an effective tool in the fight against youth violence. Findings are consistent with the pioneering
family-centered work of other researchers (for example, Alexander & Parsons, 1973, 1982; Gordon,
Graves, & Arbuthnot, 1995; Klein, Alexander, &
Parsons, 1977; Patterson, Reid, & Dishion, 1992).
To improve FPS for families and children who are
referred to juvenile justice and child welfare agencies for delinquency, services must be tested in conjunction with other promising interventions that
more directly affect peer relations, academic achievement, the after-school environment, and other risk
factors for antisocial and aggressive behavior (for reviews, see Fraser, 1996a, 1996b; Williams, Ayers, &
Arthur, 1997). Henggeler et al. (1995) and Stern
and Smith (1990) have adopted this strategy.
In mental health studies, effect sizes suggest that
family-centered intervention both reduces symptoms
and lowers the risk of hospitalization. A program of
research to further tease out the effects of medications management, family involvement, skills training, and advocacy is needed. 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.
Testing in different community care environments
is needed. In addition, it is not clear in these programs whether service delivery in the home is necessar y and, when home-based programs are
mounted, whether they succeed in involving families who might not otherwise participate in a
psychoeducation program.
In child welfare, most of the studies fielded so far
have not been able to establish a margin of benefit in
child protection and placement prevention. 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, as Wells and Tracy (1996) recently suggested,
prevention of placement be abandoned as a rationale
of FPS? That is, 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, 1996,
p. 682)? Can a brief intervention be expected to offer

150

protection against complex problems like child maltreatment? As has been done in juvenile justice, should
the duration of service be extended? And through
the development of family reunification programs,
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, see Thomlison, 1997).
Finally, we know almost nothing about a next
generation of important questions: Across all fields
of practice, what is the relation between treatment
outcome and a childs gender, race or ethnicity, and
socioeconomic status? Do workers with professional
training produce better outcomes than paraprofessionals or students in field placements? Other than
placement prevention, do services affect family functioning or child development? And what is the differential contribution of elements of servicesskills
training, concrete problem-solving, and empowermentto outcomes? To date, the findings are mixed,
complex, and given to misinterpretation. To sort
promise from compromise, a program of rigorous
intervention research is urgently needed.
In the meantime, practitioners, program managers, and policymakers can take heart that FPS has
been shown to be effective in some settings and with
some populations. A set of core or common service
elements has begun to emerge. 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. However, neither should the
benefits of these services be discounted through the
mistaken conclusion that they have been proven
ineffective.
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Original manuscript received February 1, 1997
Accepted May 2, 1997

The authors thank Malcolm Gordon,

John Landsverk, Robert Lewis, William
Meezan, Peter Pecora, John Schuerman,
Marie Weil, and John Zalenski for
helpful comments on this article. An
earlier version of this article was
presented at a symposium on Psychosocial
Intervention Research: Social Works
Contribution, National Institutes
of Health and Institute for the
Advancement of Social Work Research,
September 1996, Bethesda, MD.

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