Home-Based Services for Troubled Children
223
Home-Based Services for Troubled Children
223eBook
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| ISBN-13: | 9780803295285 |
|---|---|
| Publisher: | Nebraska |
| Publication date: | 02/01/2016 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 223 |
| Lexile: | 1450L (what's this?) |
| File size: | 949 KB |
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Home-Based Services for Troubled Children
By Ira M. Schwartz, Philip AuClaire
UNIVERSITY OF NEBRASKA PRESS
Copyright © 1995 University of Nebraska PressAll rights reserved.
ISBN: 978-0-8032-9528-5
CHAPTER 1
Family Preservation Services in Context: Origins, Practices, and Current Issues
Kathleen Wells
This chapter is an overview of family preservation services: their origins and practices as well as some of the policy, ethical, and research issues they raise. The focus here is upon intensive family preservation services, as opposed to family-based services in general or other services designed to preserve or to reunify families. This restriction allows the discussion to be tied to one treatment model; it is not intended to equate family preservation efforts with one approach.
As employed here, family preservation services refer to services designed to prevent the out-of-home placement of children — that is, the placement of children in foster care, group homes, residential treatment centers, psychiatric hospitals, and correctional institutions. Although prevention of child placement is a primary goal of these services, the focus of treatment is the child's family. Relying upon a wide range of interventions, services are delivered in families' homes, for as many hours as are needed, over a relatively brief period of time.
The earliest family preservation services programs were launched in the early 1970s (Bryce, 1988) in part due to concern over the high number of children in out-of-home placement (Shyne & Schroeder, 1978), the negative effects of placement on children and families, and the high cost of out-of-home care. These concerns, coupled with the presumed success of early family preservation services programs (Kinney, Madsen, Fleming, & Haapala, 1977), spurred the development of family preservation services. In addition, the federal government and many state governments passed legislation during this time to allow public monies to pay for such services. Thus, it is not surprising that the number of family preservation services programs has increased over the last 15 years. Although the current number of such programs is unknown, their expansion has no doubt mirrored that of family-based programs in general: For example, the National Resource Center on Family-Based Services listed 20 programs in their 1982 program directory and 269 in their 1988 directory, the most recent available directory (National Resource Center on Family-Based Services, 1988).
This expansion has been due to several factors, including the following: (1) Family preservation services are grounded in unassailable values — the importance of having children grow up with their own parents and of child and family self-sufficiency; (2) providers have actively promoted the use of these services; (3) the family preservation concept has been aided and developed by prominent American foundations, most notably the Edna McConnell Clark Foundation (Nelson, 1988b); and (4) preservation services are compatible with the emergent emphasis in public policy upon permanency planning, treatment of children in the least restrictive environment possible, and provision of community-based treatment programs in the child welfare, mental health, and juvenile justice systems, respectively.
Therefore, it is not surprising that there is widespread agreement that family preservation services have an important role to play in systems serving children. However, at this point of service expansion and empirical knowledge, a critical evaluation of the issues relevant to their implementation and further expansion is clearly needed. Their expansion poses serious policy dilemmas, and their implementation raises ethical issues. Also, the accumulating evidence that family preservation services are not equally effective or appropriate for all families with children at risk of out-of-home placement suggests programmatic and research questions. My assumption here is not that family preservation services should be eliminated but rather that they should not be expanded without attention to some of the dilemmas, issues, and questions raised in this chapter.
This chapter begins this evaluation by first defining family preservation services and then tracing their historical antecedents, theoretical underpinnings, and the impetus for their development. Then, based upon all of the above, some of the salient issues raised by this analysis are delineated.
Definition of Family Preservation Services
There is no consensus as to the exact nature of family preservation services (Whittaker & Tracy, 1988). However, two service models are well known and have been replicated widely: the learning theory — based Homebuilders model and the family systems theory — based Iowa model (Nelson, 1988a). Chapter 2 presents a description of the Homebuilders model and clarifies the kinds of services under discussion.
Not all programs adhere to the Homebuilders model or, for that matter, to the Iowa model, which emphasizes a family systems approach to treatment. Indeed, family preservation services vary with respect to their goals, organization and structure, and role in a community. Nelson (1988a) has identified a set of dimensions, drawn from the program evaluation literature, that could be used to describe this variability. These include: the developmental stage of the program (e.g., the number of years the program has been in operation), the organizational structure of the program (e.g., its location in a public or private agency), the duration of the program (e.g., the average length of time families spend in the program), the staffing pattern of the program (e.g., the number of workers assigned to a family), and the mechanisms in place for assessment and case planning.
In spite of the diversity in programs, family preservation services share some underlying assumptions: that enhanced family functioning is the vehicle through which individual problems and needs should be addressed; that services provided at home and as needed enhance workers' understanding of families and increase the likelihood that they can help families change; that an integrated response to both the concrete (e.g., housing) and social-psychological (e.g., marital difficulty) problems of families is necessary to family preservation; and that a time-limited service conveys to families a belief in their own capabilities (Nelson, 1988b).
Additionally, family preservation services share some common features. Pecora and his colleagues (Pecora, Fraser, Haapala, & Barlome, 1987) have identified a set of 14 attributes of these services. The most central of these features are that services last no more than 90 days; services are provided two to three times a week for one to four hours at a time; services are routinely provided in the home; workers are available 24 hours a day for emergency visits or calls; families are provided with "concrete" services; and service providers encourage family empowerment and believe that most children are better off in their own homes.
These shared assumptions and common features of family preservation services render them a unique and new service delivery model. Yet several key concepts pertinent to family preservation services were anticipated by child welfare practices and trends emerging at the turn of the century (McGowan, 1988).
Historical Antecedents of Family Preservation Services
The earliest and most direct precursor of family preservation services was the use of "friendly visitors" by charity organizations in the last century (McGowan, 1988). The Charity Organization Movement, begun in 1869 in London, sought to rationalize philanthropy. The purpose of the charity organization societies — which soon sprang up in American cities — was to coordinate philanthropic resources so that worthy cases would be provided with relief. Originally, the intent was to promote more efficient administration of private charities; however, they eventually came to provide relief with their own funds. In this effort, they used volunteers "to visit, counsel, and instruct the poor; ... [these] friendly visitors were expected to be combination detectives and moral influences. They were to ascertain the reason for the applicants' need and to help them overcome it" (Bremner, 1971, p. 52). Anticipating contemporary reactions to family preservation services, Boston's Irish-American poet John Boyle O'Reilly "wrote scathingly of 'The organized charity scrimped and iced / In the name of a cautious, statistical Christ'" (Bremner, 1971, p. 53).
In the early part of the century, some methods employed by friendly visitors became part of the newly developing social work practice. Frankel (1988) noted that "The first generation of professional caseworkers, like their voluntary predecessors, operated almost exclusively through home visits. They were primarily concerned with the provision of concrete services and recognized the advantages of home visits for both accurate observation and putting the family at ease. Considerable time and energy were also spent in mobilizing natural helping networks and coordinating services" (p. 139). Thus some of the features of family preservation services have been a part of social work practice for a long time.
About the same time that social work was emerging as a profession, several broad concepts pertinent to the development of family preservation services were emerging as well (McGowan, 1988). For example, the development of Societies for the Prevention of Cruelty to Children in the 1870s helped establish the concepts of "state intervention in family life" and "minimal acceptable standards of parenting." Other pertinent concepts included the establishment of the juvenile court in 1899, the concept of differential treatment of child and adult offenders, the Child Guidance Clinic Movement, which started around 1910, and the concept of treating children within the context of their "natural environments" (Glasscote, Fishman, & Sonis, 1972).
However, it was not until the Family Centered Project of St. Paul (Geismar, 1957; Stinson & Associates, 1955), which was launched in the early 1950s, that the basic approach taken by family preservation services providers today emerged. This project was one of several in the United States at that time concerned with treatment of multiproblem families — families who were "overwhelmed by multiple problems, and ... were unlikely to respond favorably to requests for introspection," the technique required for psychodynamic treatment approaches in use at the time (Wood & Ludwig, 1989, p. 65).
This project developed in St. Paul partly in response to a community survey that revealed that 6% of St. Paul's recipients of social welfare services used about half of such services in the community. Community leaders believed that an effort had to be made to reduce the disproportionate use of services by such families. The project that evolved focused upon families with children who were in clear and present danger and depended upon what was called a family-centered approach. In this approach, the focus of treatment was the family, considered as a unit, and services were delivered at home. Workers took responsibility for all of a family's psychosocial needs. Although this approach was conceptualized as long-term treatment, grounded in the traditional casework principles of the time, project staff used a range of intervention techniques distinguished by their directness (e.g., "expressing to the families matters of community concern" and "sharing diagnostic impressions with clients"), experimental nature (e.g., "we realized we did not know enough about ... what goes on in the total family interaction"), and emphasis upon the families as partners in the helping process. The project also attempted to develop mechanisms to coordinate the community resources available for such families.
The results of the St. Paul project were encouraging (Geismar, 1957); Bryce (1988) observed that the project's in-house evaluations revealed that about two thirds of their families improved. Bryce further noted that "These rather impressive results encouraged the public sector to field several projects with multi-problem families in ensuing years. However, these programs differed significantly from the St. Paul project and therefore the results were not encouraging" (p. 183).
It is not clear why the St. Paul project was not widely replicated with precision, though the staff's own characterization of the project hints at one reason: "We are trying to narrow down the numbers of families we cannot successfully treat. Maybe the essential newness [of the project] is in the optimism. Maybe the essential opposition to saying there's anything new comes from a sense of not having arrived anywhere" (Stinson & Associates, 1955, P. 15).
Indeed, the project and the interventions tried were not only new but were rather radical within the context of the child welfare system of the time and the individually oriented treatment approaches that dominated agency practice in the 1950s. Their effort was also bold, for in the absence of well-developed models of family treatment and behavioral change, they groped to develop concepts pertaining to family systems and parent-child relationships that are taken for granted today. It is probably not an accident that family preservation services did not emerge until the 1970s, after such models had been developed.
Theoretical Underpinnings of Family Preservation Services
In fact, family preservation services draw upon several theoretical perspectives that gained prominence between 1950 and 1970. Barth (1988) identified social learning theory, family systems theory, crisis intervention theory, and ecological perspectives on child development as providing the major theoretical underpinnings of family preservation services. The following section relies upon his analysis.
Prior to elucidating how each of these perspectives is reflected in family preservation services, it is important to note that even well-articulated family preservation services models such as Homebuilders are not developed fully so that the connections made between theory and practice are an evolving rather than to a finished practice approach. Programs also vary in the extent to which they draw upon each theory.
SOCIAL LEARNING THEORY
Social learning theory (e.g., Bandura, 1977) treats behavior as a function of the reciprocal interaction between individual and environmental determinants. These determinants are not considered fixed but rather are viewed as potentials. An individual's behavior will partly determine which environmental potential will be activated and vice versa. In this theory, "symbolic, vicarious, and self-regulatory processes assume a prominent role" (Bandura, 1977, p. 12) as codeterminants of behavior. A common method for understanding behavior is the analysis of dyadic exchanges. This approach allows one to identify the ways in which the behavior of one member triggers a particular behavioral response in the other that, in turn, offers a counteraction "that mutually shapes the social milieu in a predictable direction" (Bandura, 1977, p. 198).
Barth (1988) identifies the two major contributions of social learning to practice as the rejection of "the belief that changes in thinking and feeling necessarily antecede changes in behavior ... [and] their grasp of the way that family members learn from each other" (p. 97). Working within this perspective, practitioners have devised a number of strategies (e.g., use of "time-out," development of contracts, practicing cognitive restructuring, training in self-management skills) (Barth, 1988) that have been applied to families in conflict by family preservation services providers (Kinney et al., 1977).
FAMILY SYSTEMS THEORY
Family systems theory (e.g., Satir, 1967) is linked to various forms of family therapy and cannot be considered apart from therapeutic approaches that have developed within this tradition (Barth, 1988). Structural family therapy (Minuchin, 1974) is an approach widely used by providers of family preservation services. In this approach, the individual is understood within his or her social context, particularly the context of the family. Minuchin identified the underlying assumptions of this treatment: An individual's psychic life is not entirely an internal process; changes in family structure (i.e., position) contribute to changes in the behavior and the inner psychic processes of the members of the family system; and when a therapist works with a family, he or she enters the family system.
(Continues...)
Excerpted from Home-Based Services for Troubled Children by Ira M. Schwartz, Philip AuClaire. Copyright © 1995 University of Nebraska Press. Excerpted by permission of UNIVERSITY OF NEBRASKA PRESS.
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Table of Contents
Contents
Foreword,Acknowledgments,
l. Family Preservation Services in Context: Origins, Practices, and Current Issues Kathleen Wells,
2. Homebuilders: Helping Families Help Themselves Jill Kinney and Kelly Dittmar,
3. Network Interventions with High-Risk Youth and Families Throughout the Continuum of Care Elizabeth M. Tracy, ]ames K. Whittaker, Francis Boylan, Paul Neitman, and Edward Overstreet,
4. Parent Support and Education Programs: Their Role in the Continuum of Child and Family Services Robert Halpern,
5. Multisystemic Treatment of Serious Juvenile Offenders and Their Families Scott W. Henggeler and Charles M. Borduin,
6. In-Home Programs for Juvenile Delinquents Jeffrey A. Butts and William H. Barton,
7. The Systemic Impact of Family Preservation Services: A Case Study Ira M. Schwartz,
8. Issues in Government Purchase of Family-Based Services Sandra O'Donnell and Ronald D. Davidson,
9. Concluding Remarks Ira M. Schwartz,
List of Contributors,
Author Index,
Subject Index,