Home-Based Services for High-Risk Youth: Assessment, Wraparound Planning, and Service Delivery

To say that parents and caregivers possess the greatest ability to effect true change in at-risk youth is axiomatic. Although clinicians working in traditional office-based settings may assist caregivers by offering their expertise, clinicians who work in home-based programs are perhaps uniquely suited to assist in this process. Being able to go into the home allows one to observe subtle dynamics that families either cannot express verbally or may not consciously be aware of. Support can be offered in real time as struggles occur, instead of after the fact as events are recounted. Stacey M. Cornett has extensive experience in the development of intensive services for children and presents an in-depth guide to the field of home-based care.

The book opens with historical background and principles. The concept of providing care to individuals in their homes originated with religious and charity groups, including the Settlement House movement, in which practitioners “settled” among urban poor, sharing their lives “in order to truly understand and impact the needs of the community.” Another important paradigm shift, occurring in the 1960s and coinciding with deinstitutionalization, was the concept that families had a responsibility to care for their special needs children. The term “wraparound” was subsequently coined in the 1980s and is defined as a mix of tailored modalities, emphasizing “family and youth being heard and represented throughout all phases of service delivery,” according to Ms. Cornett.

Practical workforce issues highlight the next set of chapters. We are told that when hiring, one should look for employees who are open to new challenges, a trait prioritized over knowledge and experience. Safety tips are offered; for example, workers are advised to first make phone contact before visiting a home for the first time to let the household know the purpose of the visit. The nature of interdisciplinary teams is described, yet if families are inclined toward distrust, limiting the number of practitioners with whom the family must interact may be best. A chapter on supervision emphasizes parallel processes, whereby a supervisor helps a supervisee to feel understood, and “empowers the supervisee to support this same experience with the family.”

The third section, on assessment, constitutes the core of the book and includes chapters on infancy, school age, and adolescence and transition age, plus overview chapters on caregivers and family. Presented are an array of topics, including normal development (motor, cognitive, social, and so on) and behavioral patterns (such as attachment issues and aggression), and a primer on mental illnesses. Depression, we are told succinctly, is often “not expressed in words but rather in behaviors.” Oppositional behavior can be “a reflection of an unmet need,” with recognition of the bidirectional nature of problems between youths and parents. Resiliency is underscored; for instance, Cornett points out that siblings can enable youths to “develop and practice an emotional language” and that recreational activities can promote cooperation and negotiation skills. A recurrent theme is that deficits and disorders can be overcome and that strengths and talents should not be overlooked.

The final set of chapters is on interventions and includes useful advice, such as coaching caregivers on ways to temper discipline with empathy. For example, Cornett advises that because children with trauma histories are prone to feeling deserted, discipline is best managed not by time-outs but by having the child remain with the caregiver. Crisis plans, also described in a separate chapter, should rely on a network of voluntary, natural supports, with paid practitioners used solely as a last resort.

This is a highly readable and well-researched text. Administrators will find material and sample documents to assist in designing and implementing a program. Clinicians who venture out into the field will benefit most from the book’s practical features, including numerous tables providing a wide range of sample interview questions for quick reference. Despite some redundancy, the central point of home-based care resonates—that for youths and families with the greatest needs, often what is needed is a first-hand understanding of the natural environment, where a picture is truly worth a thousand words.