Home Based Crisis Intervention (HBCI)

• The HBCI Program was first evaluated in 1993.  For those families who responded to a follow-up questionnaire, none of the children had been placed in psychiatric hospitals or other out-of-home placements (Bishop & Nally, 1993).

• Currently OMH is conducting an evaluation to assess the benefit of providing clinical feedback to HBCI clinicians. Site visits to providers are being conducted to ascertain what information is relevant to gather in follow up with families.  OMH is also looking at data to be gathered by CAIRS from the HBCI programs.

• Modeled on the Homebuilders family preservation program developed by Kinney and colleagues in 1977, HBCI provides short-term, intensive in home services to families with children who are at risk of out-of-home-placement and inpatient admission.  
• In a HBCI Program in Buffalo, New York for those families who responded to a follow-up questionnaire, none of the children had been placed in psychiatric hospitals or other out-of-home placements.  Only one-third of parents responded and thus the validity of findings is questionable as two thirds of the other inquiries to families are unknown.
• Services include intensive in-home intervention teaching problem solving skills to the family, admission diversion and linking the child and family to community resources and supports.
• The target population for the HBCI service is families with a child or adolescent up to 17 years of age, who is experiencing a psychiatric crisis so severe that unless immediate effective intervention is provided, the child will be removed from the home and admitted to a psychiatric hospital.  Families referred to the services are expected to come from psychiatric emergency services and may have had contacts with the juvenile justice system, the Office of Children and Family Services (i.e., county social services departments), and the mental health system.

Family, Youth, Cultural Perspectives

Family Perspective

The HBCI Program was studied in 1993. For those families who responded to a follow-up questionnaire, none of the children had been placed in psychiatric hospitals or other out-of-home placements (Bishop & Nally, 1993).

Youth Perspective

Preventive services should be particularly emphasized in the HBCI- particularly since it is a short-term focus. In addition, transitional services need to be ready for the young person at the end of the short-term program. The focus of HBCI should also focus on the strengths and interests of the young people in order to assist them in connecting to the most appropriate services. It may be helpful to have young people who have received mental health services staff peer crisis hotlines.

Cultural Perspective

Providing effective intensive in-home services to families in New York State requires acknowledgement of the diversity found when viewing children within the context of their families and home communities. Culture and language affect the perception, utilization, and potentially the outcomes of mental health services. Therefore, the provision of culturally and linguistically appropriate services designed to meet the needs of diverse racial and ethnic populations should include language access for persons with limited English proficiency, services provided in a manner that is congruent, rather than conflicting with cultural norms; and the capacity of the provider to convey understanding and respect for the client's worldview and experiences. (DHHS 2001)

Understanding the various cultural considerations that influence who families are, how they participate in community life and the factors that impact their views of help seeking and acceptance is essential to engagement. Due to the short-term nature of this approach it is necessary to understand and effectively address existing barriers presented by issues of culture- including but not limited to - ethnicity, gender, age, language, literacy, spirituality, sexual orientation, parenting, immigration and community roles. Providers can prepare to address some of these challenges by establishing a trusted presence in the community at large. For example, relationships with formal and informal community leaders and "cultural brokers " can assist to increase overall community knowledge and understanding of barriers to access and cultural adaptation of services.

Cultural Competence and Evidence-Based Practices Fact Sheet
Cultural Competence: Maintaining the Asking Stance within the Coordinated Children's Services Initiative

Goals and Principles of HBCI

Some critical components of family preservation services and essential elements of the OMH model include: 

• Acceptance of those families on the verge of having a child removed from their home as a result of a psychiatric crisis;
• A short-term crisis oriented intervention process that provides intense intervention which is provided as soon as possible, but no later than 24 hours of referral to the program;
• Flexible staff hours including 24 hour response capability;
• An intake and assessment process designed to ensure that no family is left in a dangerous situation;
• An approach to intervention that focuses on the family, both its strengths and its needs;
• An approach that is multi-faceted including skills building, counseling and concrete services;
• A small caseload with each staff working with only two families at any one time;
• Brief duration- usually four to six weeks;
• Linkage of family with ongoing supports (i.e. respite groups, case management, etc.);
• Follow-up with families for six months both to assess their progress and to evaluate the program's success.

Children and Adolescent Service System Principles

All OMH Children's Initiatives are based upon the principles of the Child and Adolescent Service System Principles (CASSP). View the CASSP.

Home Based Crisis Intervention Providers in New York State

This link connects you to a directory of the Home Based Crisis Intervention Providers in New York State

References