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

Logic Model

The program representative did not provide information about a Logic Model for Families First.

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.

Program Delivery

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

Recommended Intensity:

3-4 in-home visits per week lasting 6-10 hours per week.

Recommended Duration:

Typically lasts 8-12 weeks based on the progress of skill acquisition and phase completion.

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.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

A Bachelor's Degree in a related field

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

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

Training Type/Location:

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

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

Child Welfare Outcome: Child/Family Well-Being

Additional References