of fathers in general and of families in diverse ethnic communities in particular with home visitation interventions, and (5) the need for follow-up services once the period of home visitation has ended.
Intensive Family Preservation Services
Intensive family preservation services represent crisis-oriented, short-term, intensive case management and family support programs that have been introduced in various communities to improve family functioning and to prevent the removal of children from the home. The overall goal of the intervention is to provide flexible forms of family support to assist with the resolution of circumstances that stimulated the child placement proposal, thus keeping the family intact and reducing foster care placements.
Eight of ten evaluation studies of selected intensive family preservation service programs (including five randomized trials and five quasi-experimental studies) suggest that, although these services may delay child placement for families in the short term, they do not show an ability to resolve the underlying family dysfunction that precipitated the crisis or to improve child well-being or family functioning in most families. However, the evaluations have shortcomings, such as poorly defined assessment of child placement risk, inadequate descriptions of the interventions provided, and nonblinded determination of the assignment of clients to treatment and control groups.
Intensive family preservation services may provide important benefits to the child, family, and community in the form of emergency assistance, improved family functioning, better housing and environmental conditions, and increased collaboration among discrete service systems. Intensive family preservation services may also result in child endangerment, however, when a child remains in a family environment that threatens the health or physical safety of the child or other family members.
Recommendation 6: Intensive family preservation services represent an important part of the continuum of family support services, but they should not be required in every situation in which a child is recommended for out-of-home placement.
Measures of health, safety, and well-being should be included in evaluations of intensive family preservation services to determine their impact on children's outcomes as well as placement rates and levels of family functioning, including evidence of recurrence of abuse of the child or other family members. There is a need for enhanced screening instruments that can identify the families who are most likely to benefit from intensive short-term services focused on the resolution of crises that affect family stability and functioning.
The value of appropriate post-reunification (or placement) services to the child and family to enhance coping and the ability to make a successful transition
diagnosis of autism, even though there are strong and consistent commonalities, especially relative to social deficits.
The large constellation of behaviors that define autistic spectrum disorders—generally representing deficits in social interaction, verbal and nonverbal communication, and restricted patterns of interest or behaviors—are clearly and reliably identifiable in very young children to experienced clinicians and educators. However, distinctions among classical autism and atypical autism, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger’s disorder can be arbitrary and are often associated with the presence or severity of handicaps, such as mental retardation and severe language impairment.
Identifying narrow categories within autism is necessary for some research purposes; however, the clinical or educational benefit to subclassifying autistic spectrum disorders purely by diagnosis is debated. In contrast, individual differences in language development, verbal and nonverbal communication, sensory or motor skills, adaptive behavior, and cognitive abilities have significant effects on behavioral presentation and outcome, and, consequently, have specific implications for educational goals and strategies. Thus, the most important considerations in programming have to do with the strengths and weaknesses of the individual child, the age at diagnosis, and early intervention.
With adequate time and training, the diagnosis of autistic spectrum disorders can be made reliably in 2-year-olds by professionals experienced in the diagnostic assessment of young children with autistic spectrum disorders. Many families report becoming concerned about their children’s behavior and expressing this concern, usually to health professionals, even before this time. Research is under way to develop reliable methods of identification for even younger ages. Children with autistic spectrum disorders, like children with vision or hearing problems, require early identification and diagnosis to equip them with the skills (e.g., imitation, communication) to benefit from educational services, with some evidence that earlier initiation of specific services for autistic spectrum disorders is associated with greater response to treatment. Thus, well meaning attempts not to label children with formal diagnoses can deprive children of specialized services. There are clear reasons for early identification of children, even as young as two years of age, within the autism spectrum.
Epidemiological studies and service-based reports indicate that the prevalence of autistic spectrum disorders has increased in the last 10 years, in part due to better identification and broader categorization by educators, physicians, and other professionals. There is little doubt that more children are being identified as requiring specific educational interventions for autistic spectrum disorders. This has implications for the provision of services at many levels. Analysis of data from the Office of