What is this?

Intensive Family Preservation Services (IFPS) are short-term, intensive interventions aimed at families in crisis, where there is an imminent risk of children entering care. IFPS work intensively with families to try to reduce family crisis, improve family functioning and keep children safely living at home with their birth parents.

1. The service is provided for families with children at imminent risk of an out-of-home placement.

2. A caseworker contacts the family within 24 hours of a referral being received.

3. Support is provided in the family’s home environment for a period of 4-6 weeks.

4. Caseworkers are available to families 24 hours a day, 7 days a week.

5. Caseworkers have a small caseload of 2-3 families at a time to ensure that they can provide an intensive and flexible service.

Typically IFPS involve supporting the family’s development of skills (e.g. in anger management or parenting), therapy (e.g. CBT or motivational interviewing) and practical or financial help, such as with housing or transport.

Various names of IFPS models include Families First and Home-based Family Preservation. Most are based on the Homebuilders model developed in the USA in the 1970s. In the UK, an IFPS model called ‘Option 2’ was developed based on Homebuilders, but specifically for families where there are serious child protection concerns related to drug or alcohol misuse.

How is it meant to work?

By intervening at times of crisis, IFPS seek to stabilise families and help them to provide ‘good-enough’ parenting, as well as helping to build resilience.

Review 2 identifies crisis intervention theory as a basis of the IFPS model. This is based on the idea that families are more motivated to change and learn new behaviours during times of crisis. Review 2 also suggests that IFPS seek to achieve both cognitive and behavioural changes in families. Key elements of the model that are important to its success are providing a quick response (e.g. within 24 hours) and working with children identified to be at risk of entering care.

What are the evaluated outcomes?

• Entry to care
• Family functioning

How effective is it?

Entry to care

Overall, IFPS has a consistently positive effect on preventing children from entering care. This is based on high strength evidence.

The ratings for this outcome are taken from review 2 because this review had a higher rating for strength of evidence. This meta-analysis included 18 studies (6 randomised controlled trials and 12 controlled studies), with 30,283 child participants. Of these children, 2,938 were allocated to intervention groups and 27,345 were in comparison or control groups.

IFPS led to children having a reduced risk of entering care:

• By 43% three months later
• By 49% six months later
• By 40% one year later
• By 49% two years later

The review did not find evidence that IFPS was effective more than two years later, as too few studies followed up children over this longer time period.

Family functioning

Overall, IFPS tend to have a positive effect on family functioning. This is based on low quality evidence.

The ratings for this outcome are taken from review 1 because review 2 did not look at effects on family functioning. The meta-analysis in review 1 included three studies involving 479 families.

It should be noted that the ‘family functioning’ outcome reflects a variety of measures of parenting factors and interactions. More studies are needed to examine the distinct features of family functioning, such as family cohesion, parenting stress, relationships between parents and particular parenting styles.

Where has it been studied?

Review 1 included 22 studies, which were mostly carried out in the USA. Only one of the included studies was carried out in the UK.

Review 2 included 33 studies; 29 of these were carried out in the USA, three were from the UK and one was from Canada.

Who does it work for?

Review 2 found that IFPS have been used with families with a variety of characteristics and circumstances. They are usually targeted at families where at least one child is at risk of entering care. The range of concerns may include:

• Family substance misuse
• Abuse (including physical, sexual or emotional abuse)
• Neglect
• Threat of harm to one or more children in the families.

The ages of children participating in the studies included in review 2 ranged from three to 13 years. Some studies focused on children of both genders and some focused on male children only.

Only 19 studies from the review reported on the children’s ethnicity and of these, 12 studies indicated that around half of the participating children were white. One programme studied was targeted at African-American or mixed-race families. Another programme worked with a local population in Tennessee and Philadelphia that was 80% African American.

When, where and how does it work?

Review 2 suggests that IFPS are most effective at preventing children from entering care:

• When the intervention is delivered to children at risk of entering care imminently
• When case workers make contact with the family within 24 hours of referral.

The review also suggests that caseworkers need to have small caseloads so that they can provide flexible and intensive support.

What are the costs and benefits?

Review 1 did not look at the costs and benefits of IFPS.

Review 2 found that seven studies reported on cost-effectiveness, but no studies involved a full economic evaluation. Four studies drew conclusions on cost-effectiveness and all four found that IFPS was cost-effective. However, the review found that all four of these studies had limitations, such as a lack of detail about their methods, about how costs were calculated or in how the analysis was performed. (See the Technical Summary in ‘Further resources’ for more information on these studies.)

Overall, review 2 had mixed findings on whether IFPS is a cost-saving intervention. The limitations of the studies available for review mean firm conclusions could not be drawn.

In summary...

• A consistently positive effect on preventing children entering care, based on high strength evidence
• IFPS is effective in reducing the risk of children entering care up to two years after delivery
• Tends to have a positive effect on family functioning, based on low strength evidence
• IFPS are most effective when delivered to children at imminent risk of entering care, when caseworkers contact families within 24 hours of the referral and when caseworkers have low caseloads
• Most studies are from the USA, with a small number from the UK and Canada
• Further economic research is needed to identify whether IFPS is a cost-saving intervention