Correlates of recommended aftercare service use after intensive family preservation services

Abstract

The Andersen framework of service use was used to examine the correlates of use of the recommended aftercare services after intensive family preservation services (IFPS). Primary caregivers were interviewed at two months after termination of IFPS to ascertain use of the recommended aftercare services. Hierarchical ordinary least squares regression was used to assess the contribution of need, predisposing, and enabling variables to service use variance. Although most families had contact with at least some of the recommended aftercare services, the models explained little of the variance in service use. It is suggested that use of recommended aftercare services be conceptualized as treatment adherence and that researchers incorporate treatment process variables when studying the use of recommended services. Key words: aftercare services; child mental health; child welfare; family preservation; service use ********** Short-term, home-based intensive family preservation services (IFPS) are provided to families with children at imminent risk of placement. The goals of IFPS are to (1) protect children, (2) maintain and strengthen family bonds, (3) stabilize the crisis situation that is placing the child at risk of placement, (4) increase the family's skills and competencies, and (5) facilitate the family's use of formal and informal helping resources (Whittaker & Tracy, 1990). Families that receive IFPS often experience chronic and multiple problems that require more than a short-term crisis intervention (Besharov, 1994; Yelton & Friedman, 1991). The community context, including the availability of follow-up services, must be considered when assessing the success of IFPS (Wells & Biegel, 1990;Yelton & Friedman, 1991). Although a goal of IFPS is to link families with other services and the importance of these linkages has been noted in the literature (Adams, 1994; Pecora, Fraser, Nelson, McCroskey, & Meczan, 1995; Stroul, 1988; Yelton & Friedman, 1991), little is known about service use following IFPS. The purpose of the study reported here was to describe the extent to which families used the recommended aftercare services and to examine the correlates of service use. This knowledge is necessary to develop interventions to help families access and use services. BACKGROUND The Andersen framework of health care use was used to examine the correlates of aftercare service use. The Andersen framework was initially developed to assist in understanding the who and why of health services use and to measure whether access to health care was equitable (Andersen, 1995). It has been used to model mental health and social services use across a variety of populations (Arcia, Keyes, Gallagher, & Herrick, 1993; Bergman, 1989; Leaf et al., 1985; Padgett, Patrick, Burns, & Schlesinger, 1994; Padgett, Patrick, Burns, Schlesinger, & Cohen, 1993; Rudolph & Porter, 1986; Sommers, 1989; Wan, 1987). According to the Andersen framework, service use occurs within a social context. Social norms, characteristics and structure of the service delivery system, and individual and community characteristics are important determinants of service use (Andersen & Newman, 1973). The population characteristics that influence service use are classified as predisposing, enabling, and need variables. Predisposing variables include demographic and social structural variables. They are operationalized by characteristics such as age, gender, education, occupation, ethnicity, and beliefs and attitudes toward illness and help seeking. Enabling variables are personal and community resources that facilitate access to and use of services. These include income, health insurance, knowledge about resources, transportation to services, and travel and waiting time. Need for service is measured by an individual's perceived need for service and a professional's evaluated need for service. …