National Center for Juvenile Intervention

Behavioral House-calls? Professionals Hit the Streets to Solve Problems at the Source

by Rich Tarbox

Over the past several years, in-home solutions to child behavior have been popularized by programs such as Supernanny and Nanny 911. But are such programs really effective, and can they replace traditional therapy sessions in a counselor’s office? We spoke with one professional who has taken this notion a step further by providing quality, licensed therapeutic care into the homes of families all over the Illinois area to get some answers.

Mr. Billy Kaplan, LCSW, is the President and Clinical Director at House Calls Counseling outside of Chicago. We spoke with him to find out what makes house calls better than traditional office-based therapy.

Rich Tarbox: First of all, Billy, what made you consider doing house calls in the first place?

Billy Kaplan: I was working for a family preservation program in Illinois called Family First that provided in-home therapy to families who were indicated for abuse or neglect. The goal was to help the family make sufficient changes to keep together, or to demonstrate to the court that the family could not make such changes and recommend for removal of the children from the parents’ care.

When I decided to start my own practice, I decided to follow that in-home model because it not only eliminated the overhead cost of an office, but more importantly I found that I could provide a more comprehensive assessment in the home (see things that couldn’t be seen in an office) and more intensive and successful treatment. I figured it was easier for me to adapt to being “uncomfortable” in a new environment than the families I was working with adapting to my office.

I also thought, given our focus on treating children and youth in Foster Care, that I was more likely to see teenage clients in their homes (or nearby on the basketball court of they weren’t at home) than if their foster parent(s) had to get them to my office via public transportation (as many foster parents did not have cars or drive).

RT: When people think about house calls, there’s likely an initial sense that perhaps it’s just your niche, or just a convenience that you offer, but it’s really much more than that isn’t it? What are some of the things you find unique about this method?

BK: Things can happen in the home that cannot happen in the office. One young person I was working with who lived with her maternal grandparents was talking about being mad at her birth mother who abandoned her. She ran over to the wall, took down the one picture of her mother in the home, and “yelled” at her mother. Sure, I could have tried to set that up in an office by having the kid bring in a picture, but the natural flow of this event was priceless.

Some not-so-obvious benefits are seeing the actual home – from how clean/messy/hyperly organized is it, to who had doors on their bedrooms and who does not. One family I worked with wanted help getting their seven-year-old to stop urinating in his bedroom. As I was discussing this with the parents in the seating area just outside his bedroom, I happened to look up at the kid’s door and saw a latch at the top. Then I asked the dad, “How long do you lock him up for at a stretch?” The dad told me up to a couple of days at a time when he was “really bad.” We had the child removed from his parents’ care.

RT: So, you’re getting to see the actual environment where these behaviors and issues are taking place. What do you find to be the biggest challenge in doing these types of house calls?

BK: Helping to shape therapeutic space in the home. Sometimes I have to ask people to turn the TV off, lock the dog up, put the phone on silence, shut off the computer. Sometimes I have to ask family members to keep out of the child’s room while we meet. And, of course, in Chicago, as there are only two seasons – Winter and construction – traffic can be rough so getting to clients on time can be difficult. Most folks understand that 15 minutes late isn’t late – it’s traffic.

RT: Of course, the big question is: Do you find that your clients report better results with in-home therapy as opposed to coming in to your office?

BK: I do find better results with in-home therapy. I think I see better results because the client is in their natural environment. So they’re more comfortable and therefore act more naturally. Sometime, I think, clients “forget” I’m their therapist and really show me like it is! Also, rather than theoretical solutions to problems, I can help the family implement things immediately. For instance, one twelve-year-old I worked with had a lovely “ankle bracelet” provided by the county because of his multiple run-ins with the law. When he ran out the door one session because he got mad, and again broke his probation, the family started to run after him. I called them back, then asked what they normally do when he returns. They told me they yell at him, tell him he shouldn’t do it, etc. I encouraged them to try an experiment and do something different: this time when he returned, I asked them, give him a hug, tell him how much you love him and how glad you are that he returned. They tried my “experiment” and told me later that that intervention changed their entire family.

RT: It’s awesome to see how the smallest change based on your direct observation of their everyday ‘life’ could make such an impact. It’s often the simplest solutions that people sometimes overlook because they are so emotionally involved in the situation they can’t see what immediate changes they can make on their own. How long have you been doing these types of house calls?

BK: Over ten years.

RT: Looking back over that period of time, what one client do you consider your greatest success?

BK: By far it was my work with a teenage boy. I started working with him when he was 15. DCFS in Illinois wanted to have him placed in a locked residential program because of his aggressive behaviors, history of fire-setting, and history of sexually molesting a child. I was able to provide intensive treatment in the home – 1.5 hours twice per week – and he not only became stabilized, but is college-bound at this point in time. He went from attending therapeutic day school, and not too successfully, to honor-roll mainstreamed in a public high school.

RT: So even for families that are dealing with very serious behavioral issues, there is hope with this type of in-home solution. One of the things we noticed about behavior changes when we operated our residential program was that behavior improved while they were with us, but many deteriorated within a few weeks of returning home. When we moved to in-home intensives with the entire family, that ‘honeymoon effect’ was eliminated, in part I believe, because we were dealing with the issues where they occurred and working with the child’s environment as a whole.

Having worked now in many different settings over the last 10 years, where do you see your program going in the next five years?

BK: We’re continuing to expand. We’re also serving more children, youth and families who have been privately adopted, as we specialize in treating attachment-related disorders.

RT: That’s another hugely important and often misunderstood topic we’d like to talk with you some more in-depth about that in the future. In the meantime, where can people who are interested in your program go to find out more information about your work?

BK: They can look us up on our website at www.HouseCallsCounseling.com or call us directly at (847) 256-2000.



		© 2005-2010 National Center for Juvenile Intervention JAN/FEB 2010 Behavioral House-calls? Professionals Hit the Streets to Solve Problems at the Source by Rich Tarbox Over the past several years, in-home solutions to child behavior have been popularized by programs such as Supernanny and Nanny 911. But are such programs really effective, and can they replace traditional therapy sessions in a counselor’s office? We spoke with one professional who has taken this notion a step further by providing quality, licensed therapeutic care into the homes of families all over the Illinois area to get some answers. Mr. Billy Kaplan, LCSW, is the President and Clinical Director at House Calls Counseling outside of Chicago. We spoke with him to find out what makes house calls better than traditional office-based therapy. Rich Tarbox: First of all, Billy, what made you consider doing house calls in the first place? Billy Kaplan: I was working for a family preservation program in Illinois called Family First that provided in-home therapy to families who were indicated for abuse or neglect. The goal was to help the family make sufficient changes to keep together, or to demonstrate to the court that the family could not make such changes and recommend for removal of the children from the parents’ care. When I decided to start my own practice, I decided to follow that in-home model because it not only eliminated the overhead cost of an office, but more importantly I found that I could provide a more comprehensive assessment in the home (see things that couldn’t be seen in an office) and more intensive and successful treatment. I figured it was easier for me to adapt to being “uncomfortable” in a new environment than the families I was working with adapting to my office. I also thought, given our focus on treating children and youth in Foster Care, that I was more likely to see teenage clients in their homes (or nearby on the basketball court of they weren’t at home) than if their foster parent(s) had to get them to my office via public transportation (as many foster parents did not have cars or drive). RT: When people think about house calls, there’s likely an initial sense that perhaps it’s just your niche, or just a convenience that you offer, but it’s really much more than that isn’t it? What are some of the things you find unique about this method? BK: Things can happen in the home that cannot happen in the office. One young person I was working with who lived with her maternal grandparents was talking about being mad at her birth mother who abandoned her. She ran over to the wall, took down the one picture of her mother in the home, and “yelled” at her mother. Sure, I could have tried to set that up in an office by having the kid bring in a picture, but the natural flow of this event was priceless. Some not-so-obvious benefits are seeing the actual home – from how clean/messy/hyperly organized is it, to who had doors on their bedrooms and who does not. One family I worked with wanted help getting their seven-year-old to stop urinating in his bedroom. As I was discussing this with the parents in the seating area just outside his bedroom, I happened to look up at the kid’s door and saw a latch at the top. Then I asked the dad, “How long do you lock him up for at a stretch?” The dad told me up to a couple of days at a time when he was “really bad.” We had the child removed from his parents’ care. RT: So, you’re getting to see the actual environment where these behaviors and issues are taking place. What do you find to be the biggest challenge in doing these types of house calls? BK: Helping to shape therapeutic space in the home. Sometimes I have to ask people to turn the TV off, lock the dog up, put the phone on silence, shut off the computer. Sometimes I have to ask family members to keep out of the child’s room while we meet. And, of course, in Chicago, as there are only two seasons – Winter and construction – traffic can be rough so getting to clients on time can be difficult. Most folks understand that 15 minutes late isn’t late – it’s traffic. RT: Of course, the big question is: Do you find that your clients report better results with in-home therapy as opposed to coming in to your office? BK: I do find better results with in-home therapy. I think I see better results because the client is in their natural environment. So they’re more comfortable and therefore act more naturally. Sometime, I think, clients “forget” I’m their therapist and really show me like it is! Also, rather than theoretical solutions to problems, I can help the family implement things immediately. For instance, one twelve-year-old I worked with had a lovely “ankle bracelet” provided by the county because of his multiple run-ins with the law. When he ran out the door one session because he got mad, and again broke his probation, the family started to run after him. I called them back, then asked what they normally do when he returns. They told me they yell at him, tell him he shouldn’t do it, etc. I encouraged them to try an experiment and do something different: this time when he returned, I asked them, give him a hug, tell him how much you love him and how glad you are that he returned. They tried my “experiment” and told me later that that intervention changed their entire family. RT: It’s awesome to see how the smallest change based on your direct observation of their everyday ‘life’ could make such an impact. It’s often the simplest solutions that people sometimes overlook because they are so emotionally involved in the situation they can’t see what immediate changes they can make on their own. How long have you been doing these types of house calls? BK: Over ten years. RT: Looking back over that period of time, what one client do you consider your greatest success? BK: By far it was my work with a teenage boy. I started working with him when he was 15. DCFS in Illinois wanted to have him placed in a locked residential program because of his aggressive behaviors, history of fire-setting, and history of sexually molesting a child. I was able to provide intensive treatment in the home – 1.5 hours twice per week – and he not only became stabilized, but is college-bound at this point in time. He went from attending therapeutic day school, and not too successfully, to honor-roll mainstreamed in a public high school. RT: So even for families that are dealing with very serious behavioral issues, there is hope with this type of in-home solution. One of the things we noticed about behavior changes when we operated our residential program was that behavior improved while they were with us, but many deteriorated within a few weeks of returning home. When we moved to in-home intensives with the entire family, that ‘honeymoon effect’ was eliminated, in part I believe, because we were dealing with the issues where they occurred and working with the child’s environment as a whole. Having worked now in many different settings over the last 10 years, where do you see your program going in the next five years? BK: We’re continuing to expand. We’re also serving more children, youth and families who have been privately adopted, as we specialize in treating attachment-related disorders. RT: That’s another hugely important and often misunderstood topic we’d like to talk with you some more in-depth about that in the future. In the meantime, where can people who are interested in your program go to find out more information about your work? BK: They can look us up on our website at www.HouseCallsCounseling.com or call us directly at (847) 256-2000.