Intensive home-based programs for youth with serious emotional disturbances: A comprehensive review of experimental findings

Abstract

In 1982, Jane Knitzer famously reported that two-thirds of youth with serious mental health challenges were either underserved or unnecessarily institutionalized (Knitzer, 1982). In the decades since, home-based interventions for these youth and their families have emerged as viable treatment options (Stroul & Friedman, 1986;Love, Mueller, Tolman & Powell, 2014; DHHS 2005; ACA II, §2402 ( 2010)). These intensive programs occupy a critical point in the continuum of care: they represent the threshold between community retention and institutional placement. As of 1999, 35 states offered some form of intensive, home-based treatment (IHBT) for children and youth with psychiatric impairments, and research pursuant to this review found

Manuscript: Defining Quality Standards for Intensive Home Based Treatment Programs for Youth with Serious Emotional Disorders

“…Step 1 of the project consisted of a literature review of relevant IHBT models using relevant search terms (e.g., "home based," "in-home," "community-based," "serious emotional disturbance," "child," "adolescent," "psychiatric," "intensive," "behavioral") using PsycINFO ad Web of Science. Unlike efforts by, for example, Lee et al (2014) and Moffett et al (2018), this search did not aim to produce a comprehensive review of controlled research studies, but rather surface unique IHBT models for youths with SED that included adequate descriptions of practice and program elements that could serve as the basis for language for initial program and practice standards.…”

“…The search was conducted in 2017 and sought articles published between 1995 and 2016. Reviews such as Lee et al (2014) and Moffett et al (2018) then provided independent summaries of models for review and specific potential program and practice elements. A summary of relevant IHBT models was compiled from this scan and reviewed by a subset of the authors (authors 4, 5, 6, and 7) for comprehensiveness.…”

“…The majority of research studies evaluating impact of intensive home-based interventions have focused on stabilizing families and reducing out of home placements for youth involved in the child welfare and juvenile justice systems (Moffett et al 2018). For example, Homebuilders (Kinney et al 1977), a 4-6 weeks "family preservation" program, has been the subject of many controlled studies and reviews.…”

“…However, while child welfare-and juvenile justicederived IHBT programs have been subjected to dozens of randomized trials, a recent review found only five controlled studies of IHBT for youth with emotional and behavioral impairment (Moffett et al 2018). Experimental evaluation of a variant of MST called MST-Psychiatric found initial gains in emotional and behavioral functioning that favored the treatment group, but a follow-up study found no maintenance of these gains at 1 year post-treatment (Henggeler et al 1999;Schoenwald et al 2000).…”

“…For all the above reasons, most IHBT programs operating in state service systems today are "home grown" programs that are less strict with respect to practice parameters, organizational requirements, training and coaching expectations, and fidelity and outcomes monitoring than manualized EBPIs (Hammond and Czyszczon 2014;Moffett et al 2018). While such flexibility may make such home-grown IHBT programs more likely to be used in "real world" service systems, it may result in lack of clarity around effective practice elements and necessary program factors, resulting in lower quality practice and poorer youth/family outcomes.…”