Families First

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Families First has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent) and Home Visiting Programs for Child Well-Being.

Target Population: Families and referred children who are at-risk as a result of family conflict, lack of parenting skills, child abuse, childhood emotional issues, disruptive behavioral problems including criminal misconduct and other at-risk situations children, parents, and families face.

For children/adolescents ages: 0 – 17

For parents/caregivers of children ages: 0 – 17

Brief Description

The Families First program utilizes the Risk, Need, and Responsivity Model for intervention with at-risk youth and families through 3-4 home visits per week totaling 6-10 hours per week, typically lasting 10-12 weeks. Individual responsivity factors are assessed so the worker can tailor the intervention to the youth and family. While the youth’s specific risk factors are targeted, the risk factors related to the home environment (e.g., parental relationships, supervision, structure, discipline, etc.) and the social environment (e.g., peer associations, community involvement, relationships, etc.) are also targeted.

The specific implementation of the Families First program is carried out using a 6-phase model within the framework of the Teaching-Family Model. This treatment approach began in the 1960s at the University of Kansas. Its basis is in cognitive behavioral approaches, social learning theory, modeling, and a strength-based emphasis on actively teaching and role-playing skills that promote positive client and family outcomes.


Program Goals:

The goals of the Families First program are:

  • In home visits and skills will empower parents to be able to effectively intervene with their children using proven effective parenting techniques
  • In home visits that actively teach children, parents, and families prosocial skills will promote long-term sustainable change
  • Family relationships will improve through intensive in-home visits that will help decrease parent-child conflict
  • As a result of the in-home intervention, risk factors associated with at-risk populations will be turned into protective factors

Essential Components

The essential components of the Families First program include:

  • Program Introduction
    • A family or professional working with a family identifies a need for in-home services to address child and adolescent behavioral problems.
    • A referral form must be filled out and submitted prior to service beginning.
    • The family will receive services if it does not fall under the following exclusionary criteria:
      • A patient is actively substance/chemically dependent and requires detoxification.
      • There is an active suicide risk or attempts that require hospitalization.
      • There is active domestic violence which creates an unsafe environment for the in-home worker to be in.
      • A referral specifically treating a clinical issue (i.e., depression, anxiety, etc.) is outstanding and the patient is not yet receiving treatment from a licensed clinician. (If the patient is in treatment as stated, then Families First is an appropriate behavioral in-home intervention.)
    • Cases are staffed before assigning to determine the best fit with an in-home professional.
    • The in-home professional should contact the family and referring worker within 48 hours and schedule an initial visit.
    • The in-home professional administers a Youth Outcome Questionnaire (YOQ-2.0).
    • The in-home professional administers standardized responsivity assessment(s).
    • The in-home professional identifies each family member’s strengths and risk factors.
    • The in-home professional begins building rapport and a positive relationship as well as praising strengths on which family members can build.
    • The in-home professional fills out an assessment form to identify presenting problems, family and individual history, previous treatment, community resources, medication and allergies, and support system.
  • Direct Service
    • The in-home professional should visit the home 3 or more times a week, spending 8-10 hours each week, with frequency and duration decreasing based on skill acquisition.
    • The in-home professional is on-call to the family 24/7 for crisis management.
    • A 6-phase model is used:
      • The first phase is focused on building rapport, exploring agenda, and identifying strengths and risk factors.
      • The second and third phases focus on teaching specific skills that target the identified behavioral risk factors in a systematic manner, including the use of role plays, modeling, constructive feedback, and specific assignments to increase the understanding and use of the new skills taught.
      • During Phase 4, the in-home professional works with the youth, their parent(s), and the family unit to refine the skills they have been taught so they can be used more consistently on a long-term basis without the in-home professional having to be present.
      • In Phase 5, the in-home professional’s focus is on helping generalize the skills taught to multiple situations. This process involves helping the youth, parent(s), and family identify specific problematic situations that may occur in the future and role playing how they would use the skills taught to them in those situations.
      • The final sixth phase is focused on building the youth, parent(s), and family’s belief in their ability to independently use the skills taught to them and help them identify the specific changes they have made and formalize their plans for the future.
      • Each phase has individual completion criteria requiring specific documentation of the reduction of identified disruptive behavioral risk factors and skill attainment.
    • Follow-up services are initiated by the in-home professional at 30, 90, 180, and 360 days after completing the intervention, with the first follow-up being a face-to-face visit; the in-home professional remains on-call to the family 24/7 for this year.
    • In-home professionals participate in a weekly staff meeting to receive related training and share staff successes as well as review difficult cases.
    • In-home professionals attend weekly consultation with a direct supervisor to staff cases and review the Teaching-Family Model and implementation of phases.
    • In-home professionals carry a small caseload of 2-4 families at a time.
    • Case notes are completed after each visit and these notes are submitted as a service log weekly.
    • Treatment and discharge plans are submitted within 10 days after starting or ending services with a family.
  • Staff Characteristics
    • In-home professionals must have a bachelor’s degree in a related field.
    • In-home professionals are then selected based on their personal characteristics (i.e., ability to establish rapport, non-judgmental, teaching abilities, self-motivated).
    • All staff must participate in preservice training, training on the Teaching-Family Model, and phases manual training prior to working with families.
    • All staff shadow 6 in-home professionals on in-home visits, shadow an experienced in-home professional for one full intervention, and complete a 50/50 family before fully trained.
    • In-home professionals participate in at least 40 hours of additional job training yearly, in addition to preservice training.
    • Full-time supervisors have 7-8 in-home professionals to supervise and oversee program fidelity.

Child/Adolescent Services

Families First directly provides services to children/adolescents and addresses the following:

  • Including, but not limited to:
    • delinquent and disruptive behavior
    • depression
    • truancy
    • drug and alcohol use
    • running away
    • school learning or misbehaviors
    • suicide threats and ideation
    • sexually reactive behaviors
    • authority conflicts
    • neglect or abuse
    • hyperactivity
    • physical and verbal aggression
    • anger management
    • poor decision-making

Parent/Caregiver Services

Families First directly provides services to parents/caregivers and addresses the following:

  • Lack of parenting skills to address disruptive behavior, managing parent tolerance differences, family conflict, instability, appropriate child supervision and correction techniques
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: All family members living at home will be included in learning and implementing skills addressing at-risk issues and will be given homework assignments to ensure implementation and skill use outside of Families First visits. Family members may also include any external party such as, grandparents, aunts and uncles, or other adults in the home, as long as they are willing and the client desires their participation. They will be taught the same skills as the in-home family members and the In-home professionals will follow-up on their skill acquisition

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home

Homework

Families First includes a homework component:

Homework assignments are given as a means to bolster and practice the skill(s) being taught. This can be through worksheets, practicing skills after the in-home worker has left, reading assignments, and/or other similar assignments.

Languages

Families First has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Personnel costs; since the position is a telecommuting position in-home professionals will need access to a car, phone, and computer to complete paperwork; minimal office space for consultations and staff meetings.

Minimum Provider Qualifications

A Bachelor’s Degree in a related field

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • Wayne Arner, LPC, Families First Program Director
    phone: (801) 308-1052
Training is obtained:

Locally at Utah Youth Village or at an on-site location

Number of days/hours:

Approximately 4 days at 25 hours; this doesn’t include shadow visits, which are included for training at Utah Youth Village

Additional Resources:

There currently are additional qualified resources for training:

For the Teaching-Family Model part of the training - Teaching-Family Association: www.teaching-family.org

Implementation Information

Since Families First is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Families First.

Formal Support for Implementation

There is formal support available for implementation of Families First as listed below:

Following the formal onsite training, ongoing consultation/coaching is available for further implementation.

Fidelity Measures

There are fidelity measures for Families First as listed below:

Fidelity measures to ensure the components of the Families First program are implemented have been developed. These are completed through direct in-home observations by supervisors. They are not publicly available.

Implementation Guides or Manuals

There are implementation guides or manuals for Families First as listed below:

There is a detailed training manual for implementing the Families First program along with other educational training materials. It is not publicly available.

Research on How to Implement the Program

Research has not been conducted on how to implement Families First.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Lewis, R. E. (2005). The effectiveness of Families First services: An experimental study. Children and Youth Services Review, 27, 499–509.

Type of Study: Randomized controlled trial
Number of Participants: 164

Population:

  • Age — 4-17
  • Race/Ethnicity — Minority 28%
  • Gender — Male 75% and Female 25%
  • Status — Child had been identified by school or juvenile court as having serious problems in functioning

Location/Institution: Utah Youth Village

Summary: (To include comparison groups, outcomes, measures, notable limitations)
An intensive, short-term, family-based intervention, Families First, was employed to help families overcome serious problems in child behavior and child management. This service was an adaptation of the Teaching-Family Model of therapeutic group home programming with some elements of child welfare intensive family preservation services. Families were randomly assigned to treatment or control group at a ratio of 2:1. Measures included a 63-item questionnaire developed specifically for the study. Families receiving this service were found to report significant improvement in child behavior, physical care and resources, parental effectiveness, and parent–child relationships, when compared with similar difficulties in families who were referred for the service but not served. Not only were the improvements for treatment families apparent shortly after the conclusion of the service, but these changes were also maintained over a number of months’ period, suggesting that the improved skills, behaviors, and relationship changes developed during the intervention may have become solidly implanted in parental and family functioning. Limitations of the study included that findings were based on parent perceptions and used a project-developed outcome measure.

Length of postintervention follow-up: 3 months.

Hess, J. Z., Arner, W., Skyes, E., Price, A. G., & Tanana, M. (2012). Helping juvenile offenders on their own turf: Tracking the recidivism outcomes of a home-based intervention. OJDDP Journal of Juvenile Justice, 2(1). Retrieved from http://www.journalofjuvjustice.org/JOJJ0201/article02.htm

Type of Study: Nonequivalent control group design
Number of Participants: 154 intervention, 3,064 control

Population:

  • Age — Intervention: 83% age 15 – 17 years. Control: Not specified
  • Race/Ethnicity — Intervention: 48% Caucasian, 36% Latino, and 11% Other; Control: Not specified
  • Gender — Intervention: Male 79%, Control: Not specified
  • Status — Participants were youth who were referred by the juvenile court system, with a subset coming directly to the program without a referral

Location/Institution: Utah Youth Village

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy of the Families First intervention for court- referred youth. Youth who enrolled in Families First were compared to youth who had received similar sanctions from the juvenile court, but were not referred to Families First. Measures included the Protective and Risk Assessment, based on Washington State's Prescreen Risk Assessment, and several measures from the Communities that Care Survey. Analyses showed that the Families First group has a significantly lower recidivism rate than the comparison group, based on a one-year follow-up of new misdemeanor or felony charges, as well as significant reductions in rebellious and anti-social attitudes. Limitations include a lack of randomization, no information provided on the differences between the intervention and control groups, and lack of matching between intervention and control group..

Length of postintervention follow-up: 12 months.

References

Hess, J. Z. (2010). Families First outcomes, 2004-2009. Jacob Hess: Utah Youth Village, Salt Lake City, UT. Copies available via email request: jhess@youthvillage.org

University of Utah Utah Criminal Justice Center. (2014). The evidence-based correctional program checklist. Salt Lake City, UT. Retrieved from http://www.youthvillage.org/uploads/pdf/FF_FinalReport_14.pdf

Gray, D. M. (n.d.) Utah youth suicide study: Evidence-based suicide prevention for juvenile offenders; University of Utah School of Medicine and Department of Psychiatry. University of Utah School of Medicine, Psychiatric Department. Salt Lake City, UT. Copies available via request by email: douglas.gray@hsc.utah.edu

Contact Information

Name: Wayne Arner, LPC
Title: Families First Program Director
Agency/Affiliation: Utah Youth Village
Website: www.youthvillage.org/theme/default/programs/families-first.php
Email:
Phone: (801) 308-1052
Fax: (801) 272-9976

Date Research Evidence Last Reviewed by CEBC: June 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: September 2012