An Experimental Study of the Effectiveness of Intensive In-Home Crisis Services for Children and Their Families

Abstract

In this article, we describe the outcomes associated with a 3-year research demonstration project. It is the second of a two-part article concerned with this research conducted in the Bronx, New York, to examine the efficacy of three models of intensive in-home services—Home-Based Crisis Intervention (HBCI), Enhanced Home-Based Crisis Intervention (HBCI+),and Crisis Case Management—as alternatives to hospitalization for children experiencing a psychiatric crisis. In Part I (Evans, Boothroyd, & Armstrong, 1997), we described the features of the three program models, the research design, data collection measures, and the presenting characteristics of the children and families. In Part 2, we describe the success of maintaining children at home (82%) and the increases in family adaptability, children's self-concept, and parental self-efficacy both at discharge and at 6 months postdischarge. Enrollees in two of the models (HBCI and HBCI+) experienced a significant increase in family cohesion,although this was not maintained at 6 months postdischarge. While enrollees in the enhanced program showed significant increase in social support at discharge, all enrollees experienced this at 6 months postdischarge.

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

“…Of note is the authors' reporting that "5% to 10% of the children enrolled in the in-home services did require hospitalization during the intervention period. These in-home programs did not eliminate the necessity of hospitalization for some children who posed a danger to themselves" [131,132]. The Dawn Project in Marion County, Indiana [133], developed as a system of care model, produced mixed results when examining levels of restrictiveness and degrees of recidivism in its served population.…”

Psychotherapeutic Home Intervention Program: Impact on Medicaid Readmission Rates

“…One analysis of 600 HMO patients found that those who received home-based crisis intervention had approximately four times fewer behavioral health readmissions than those patients who did not receive in-home services (Pigott & Trott, 1993). Home-based care has been found to have good treatment outcomes for (a) people with serious mental illness (Warner, 1997;Wasylenki, Gehrs, Goering, & Toner, 1997), (b) substance abusers (Gruber, Fleetwood, & Herring, 2001), as well as (c) children, adolescents, and their families (Evans et al, 2003;Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2003;Sheidow & Woodford, 2003).…”

“…Evans et al (2003) noted that little research is available on programs that provide home services to children and families experiencing psychiatric crises. Additionally, Lindblad-Goldberg, Dore, and Stern (1998), in their comprehensive guide to providing home-based therapy to families, reported that outcomes research on in-home services to children is limited.…”

Coordinated strategic action: Aspiring to wisdom in mental health service systems.

“…At the service layer, population analysis indicated a high prevalence of disruptive behavior problems and an increasing prevalence of comorbidity (about 75% of youth had multiple diagnoses at intake). At the exosystem layer, the research literature suggested community-based alternatives might be effective (e.g., Henggeler et al, 1999;Evans et al, 2003;Wilmshurst, 2002). At the system layer, local policy prioritized delivery of least restrictive but effective services.…”