Title IV-E Prevention Services for Providers

Healthy Families America (HFA) is a home visiting program for new and expectant families with children who are at-risk for maltreatment or adverse childhood experiences. HFA is a nationally accredited program that was developed by Prevent Child Abuse America. The overall goals of the program are to cultivate and strengthen nurturing parent-child relationships, promote healthy childhood growth and development and enhance family functioning by reducing risk and building protective factors. HFA includes screening and assessments to identify families most in need of services, offering intensive, long-term, and culturally responsive services to both parent(s) and children and linking families to a medical provider and other community services as needed. Title IV-E enrolls infants from birth through 3 months.

Brief Strategic Family Therapy (BSFT) uses a structured family systems approach to treat families with children or adolescents 6 to 17 years old who display or are at risk for developing problem behaviors including substance abuse, conduct problems and delinquency. There are three interventions components:

1. Establish relationships with family members to better understand and join the family system.

2. Counselors observe how family members behave with one another to identify interactional patterns that are associated with problematic youth behavior.

3. Counselors work in the present, using reframes, assigning tasks and coaching family members to try new ways of relating to one another to promote more effective and adaptive family interactions. 

BSFT is delivered by trained therapists and are required to participate in four phases of training and are expected to have training and/or experience with basic clinical skills common to many behavioral intervention and family systems theory. BSFT is typically delivered in 12 to 16 weekly sessions in community centers, clinics, health agencies or homes.

Parent-Child Interaction Therapy (PCIT) is a program for 2 to 7 year old children and their parents or caregivers that aims to decrease externalizing child behavior problems, increase positive parenting behaviors and improve the quality of the parent-child relationship. During weekly sessions, therapists coach parents and caregivers in skills such as child-centered play, communication, increasing child compliance and problem-solving. Therapists use “bug-in-the-ear” technology to provide live coaching to parents and caregivers from behind a one-way mirror or with same-room coaching. Parents and caregivers progress through treatment as they master specific competencies, thus, there is no fixed length of treatment. Most families can achieve mastery of the program content in 12 to 20 one-hour sessions. Master’s level therapists who have received specialized training provide PCIT services to children and their parents or caregivers.

The Family Check-Up® (FCU) model is a brief, strengths-based intervention for families with children ages 2 through 17. The intervention aims to promote positive family management and address child and adolescent adjustment problems. 

The FCU model has two phases:
1. An initial assessment and feedback
2. Parent management training

Phase one includes three main components: 
1. An initial interview that involves rapport building and motivational interviewing to explore parental strengths and challenges related to parenting and the family context
2. An ecological family assessment that includes parent and child questionnaires, a teacher questionnaire for children who are in school, and a videotaped observation of family interactions
3. Tailored feedback that involves reviewing assessment results and discussing follow-up service options for the family

Phase two is parent management training. North Dakota will require Everyday Parenting as its designated parent management training. Everyday Parenting is a skills-based curriculum designed to support the development of positive parenting skills. The curriculum is modular, and sessions can be tailored to the family’s specific needs and readiness based on the FCU assessment. 

The FCU model can be delivered in a variety of settings, including in the home, schools, community mental health settings, health centers, hospitals, primary care, and Native American tribal communities.

Multisystemic Therapy (MST) is an intensive family and community-based treatment program for youth 12 to 17 years old delivered in multiple settings. This program aims to promote pro-social behavior and reduce criminal activity, mental health symptomology, out-of-home placements and substance use in youth. The MST program addresses the core causes of delinquent and antisocial conduct by identifying key drivers of the behaviors through an ecological assessment of the youth, his or her family and school and community. The intervention strategies are personalized to address the identified drivers. The program is delivered for an average of three to five months, and services are available 24/7, which enables timely crisis management and allows families to choose which times will work best for them. Master’s level therapists from licensed MST providers take on only a small caseload at any given time so that they can be available to meet their clients’ needs.

Nurse-Family Partnership (NFP) is a home-visiting program that allows specially trained nurses to regularly visit first-time moms-to-be, who are 28 weeks or less and meet income requirements, and continue through the child’s second birthday. Title IV-E enrollment of infants begins at birth and continues through 2 years of age. The primary outcomes of NFP are to improve the health, relationships and economic well-being of mothers and their children. The content of the program can vary based on the needs and requests of the mother. Mothers, babies, families and communities all benefit. Through the partnership, the nurse provides new moms with the confidence and the tools they need to ensure a healthy start for their babies and to envision a life of stability and opportunities for success for both mom and child.

Functional Family Therapy (FFT) is a short-term prevention program for at-risk youth and their families. FFT aims to address risk and protective factors that impact the adaptive development of 11 to 17 year old youth who have been referred for behavioral or emotional problems. The program is organized in five phases that consist of: 

1. Developing a positive relationship between therapist/program and family 
2. Increasing hope for change and decrease blame/conflict 
3. Identifying specific needs and characteristics of the family 
4. Supporting individual skill-building of youth and family 
5. Generalizing changes to a broader context

Typically, therapists will meet with the family face-to-face for at least 90 minutes per week and for 30 minutes over the phone over an average of three to five months. Master’s level therapists who provide FFT are part of an FFT-supervised unit and receive ongoing support from their local unit and FFT LLC.

Homebuilders provides intensive, in-home counseling and support services for families who have a child 0 to 17 years old at imminent risk of out-of-home placement or who is in placement and cannot be reunified without intensive in-home services. Homebuilders uses behavioral assessments to determine outcome-based goals and help families identify strengths and problems associated with child safety and intervention maintenance of change. It aims to support families during crises using tailored intervention strategies and a diverse range of services, such as support with basic needs, service navigation and psychotherapy. Providers use cognitive and behavioral practices to teach family members new skills and facilitate behavior change. 

Homebuilders services are concentrated during a period of four to six weeks with the goal of preventing out-of-home placements. Homebuilders therapists typically have small caseloads of two families at a time. Families typically receive 40 or more hours of direct face-to-face services. The family’s therapist is available to family members 24 hours per day, 7 days per week. Treatment services primarily take place in the client's home. Providers are required to have a master’s degree in social work, psychology, counseling or a closely related field, or a bachelor’s degree in social work, psychology, counseling, or a closely related field with at least 2 years of related experience.

Parents as Teachers (PAT) is a home-visiting parent education program that teaches new and expectant parents skills intended to promote positive child development and prevent child maltreatment. Title IV-E enrollment begins at birth and continues through 5 years of age. PAT aims to increase parent knowledge of early childhood development, improve parenting practices, promote early detection of developmental delays and health issues, prevent child abuse and neglect and increase school readiness and success. The PAT model includes four core components: 

• Personal home visits
• Supportive group connection events
• Child health and developmental screenings
• Community resource networks

PAT is designed to be delivered to diverse families with diverse needs, although PAT sites typically target families with specific risk factors. Families can begin the program prenatally and continue through when their child enters kindergarten. Services are offered on a biweekly or monthly basis, depending on family needs. Sessions are typically held for one hour in the family’s home, but can also be delivered in schools, child-care centers, or other community spaces. Each participant is assigned a parent educator who must have a high school degree or GED with two or more years of experience working with children and parents. Parent educators must also attend five days of PAT training.