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FAMILY THERAPY MODELS.
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Compares theories & practical applications of Family Preservation & Behavioral approaches to treatment of abuse & neglect.... More...
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Paper Abstract:
Compares theories & practical applications of Family Preservation & Behavioral approaches to treatment of abuse & neglect.
Paper Introduction:
ISSUES OF ABUSE AND NEGLECT: FAMILY PRESERVATION MODEL
CONTRASTED WITH THE FAMILY THERAPY BEHAVIORAL MODEL
Introduction
The purpose of this paper is to compare and contrast the family preservation and family behavioral models of therapy for the treatment of issues of abuse and neglect. To this end, the paper reviews similarities and dissimilarities in components, elements, and postulates of both models. A brief look at the effectiveness of the two models is also presented.
Family Preservation Versus Behavioral Model
The Behavioral and Family Preservation models of family therapy for family systems dealing with issues of abuse and neglect have both commonalities and differences. Regarding commonalities, family preservation or the notion of keeping
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For example, Bosch (1996) conducted a study of a 14 year-old femalewhose history of abuse and diagnosis of conduct disorder had resulted in ahistory of failing multiple placements. There does, however, appear to be some differences in response totreatment depending upon the nature of the abuse. & Fraser, M. These were thetherapeutic practice approaches of: Rogerian relationship-buildingtechniques; behavioral interventions (including parent skill-building,behavioral modification, and cognitive treatment); and the provision ofconcrete social services. Severalcommonalities were noted between the two models. The approach, which is essentially behavioral, with influencesfrom certain cognitive therapies and from systematic family therapy, wassaid to have the main aim of constructing a permanent plan for the childrenwho have been abused or neglected. References Berry, M. Regarding the difference in the efficacy of the behavioral model andthe family preservation model, it should be pointed out that there arefactors which can contribute to differences in terms of how effective thefamily preservation model is for any given situation. Utilization-focused evaluation of a familypreservation program. (199 ). Families in Society, 76(1), 11-19. & Kurtz, P.D. Emotional and BehavioralProblems, 4(4), 13-17. (1996). (1994). Thisfact was illustrated by review of a behavioral model study in which thefamily was defined as the members of a residential care facility takingcare of an abused child with conduct disorder. Behavioral treatment of the victims of childabuse and neglect. & Authier, K.J. Statistics from the Homebuilders project were said toindicate impressive results; specifically, analyses revealed that 95percent of children remained at home at least three months after servicesterminated while between 8 and 9 percent of families were intact 12months after termination. Child and Youth Services Review, 13(1-2), 77-99.----------------------- 6 Peterson, J.L., Kohrt, P.E., Shadoin, L.M. In thisregard, it was found that interventions, regardless of their type, are mostlikely to be successful when they are provided for at least six to eighteenmonths. Social Work, 37(4), 314-321. (199 ). Intensive home-based family preservation services: An update from the FIT Project. & Kelly, S.A. The correlates of success/failure inbrief and intensive family treatment: Implications for family preservationservices. Application and adaptation of intensive familypreservation services to use for the reunification of foster children withtheir biological parents. Child and Youth Services Review, 16(5-6), 339-361. An evaluation of family preservation services:Fitting agency services to family needs. Behavioral family therapy with abused childrenwho have failed placement multiple times. (Microfilm Order No. However, Hall (1988) notes that the model attempted to learn aboutand incorporate into service delivery concerns salient to different ethnicand/or cultural values. Special Issue: Child abuse and neglect. In this regard, it was pointed out that theexisting literature on family therapy for abusive families indicates thatoutcomes are more successful for the family preservation model than for thebehavioral family treatment model. Community Alternatives, 1(2), 41-51. Social Work, 34(4), 33 -338. Mccarthy, B.W. A brief look at the effectiveness of the two models is also presented. & Haapala, D.A. (1993). (1991). The final difference between the models that was addressed in thestudy was that the behavioral model utilizes a far broader definition ofwhat constitutes a family than does the family preservation model. Educational Psychology in Practice, 4(3), 131-14 . In other words, what Howing andassociates' (1989) research demonstrates is that at least some of thedifferences between the family preservation model and the behavior modelare important in that they produce differences in outcome with the familypreservation model being the most likely to produce maximal outcomes. The practical nature of the foregoing differences between the twomodels were also discussed. To this end, the paper reviews similaritiesand dissimilarities in components, elements, and postulates of both models. Family preservation practice based upon amultisystems approach. Bosch, J.A. Physically abusiveparents tend to respond best to individual behavior therapy and toparenting classes when these were supplemented by in-home behavioralcoaching. Spaid, W.M. On the other hand, the behavioral model of family therapy is far morefocused on proving behaviorally-oriented services. Foster carepractitioners and family preservation services: Service delivery andpractice orientation. One point that needs to be made here concerns the relevance of thejust discussed differences between the behavioral and family preservationmodels. (1992). 6557. Specifically, Howing, Wodarski, Gaudin and Kurtz (1989) reported thatphysically abusive, neglecting, and sexually abusive families havebenefitted from the provision of family therapy provided in conjunctionwith concrete family preservation support services, such as homemakers,health care, and emergency shelter services. (1992). Another difference between the behavioral and family preservationsystems model is that the behavioral model utilizes a far broaderdefinition of what constitutes a family. However, Howing, Wodarski, Gaudin andKurtz (1989) conducted a comprehensive review of the literature oneffective interventions for abusive families and reported a number oftangible differences in outcome between various models. Some therapeutic work, alsobehaviorally focused, is conducted to revitalize the marital bond. While the foregoing objectivesare important, it should readily be seen that the family preservationapproach, in addition to offering standard therapeutic services, providesfar more services related to everyday family needs and cares than does thebehavioral family model. Blythe, B.J. However, although the girl was designated as having received "family-based treatment," since the girl was currently residing in a residentialfacility, Bosch (1996) defined the girl's family as the members of thestaff in the facility that assisted in her care. Robert, E. Journal of Emotional and Behavioral Problems, 1(4), 23-26. With respect to the foregoing, it was noted that the eclectictherapeutic approach as well as the provision of concrete family enablingand empowering services that are characteristic of the family preservationapproach are supported in the literature as the best approach to treatmentin families where parents are abusive and or neglectful of their children. Fantuzzo, J.W. Special Issue: Childabuse. behavioral, cognitive, humanistic, etc.) is providedto a family. Another similarity between the family preservation model and thebehavioral model of treatment is that both models are concerned with ethnicand cultural diversity issues. Family Preservation Versus Behavioral Model The Behavioral and Family Preservation models of family therapy forfamily systems dealing with issues of abuse and neglect have bothcommonalities and differences. Neglecting parents, on the other hand, showed maximalimprovement when individual-problem solving counseling and family therapywere provided. (1992). ISSUES OF ABUSE AND NEGLECT: FAMILY PRESERVATION MODEL CONTRASTED WITH THE FAMILY THERAPY BEHAVIORAL MODEL Introduction The purpose of this paper is to compare and contrast the familypreservation and family behavioral models of therapy for the treatment ofissues of abuse and neglect. (Doctoral Dissertation, UnitedStates International University) Dissertation Abstracts International,57(1 -B), p. It was further noted thatfamily therapy interventions appear most successful when more than one typeof intervention (e.g. Further, Blythe and Kelly (1993) report that time-limited and goal-oriented objectives concentrate support for the whole family, rather thanjust individuals. In thestudy, data were drawn from the service delivery reports of workers for agroup of 581 children in the FIT treatment sample and a group of 57children receiving IFPS services. Accordingly, in additionto providing the girl with behavioral treatment, Bosch also met with"family members" (consisting of residential staff) two to three times perweek. Differences between the models were said to be the fact that whilethe behavioral model restricts treatment strategies to cognitive-behavioralmethods, the family preservation model utilizes a variety of differentinterventions including non-behavioral strategies. Working with parents who abuse their children: Aninterdisciplinary approach in a multi ethnic society. Smith, M.K. Almost no work was done with the child's actual parents---whoessentially were viewed as a lost cause. AAD97-1 294) Cimmarusti, R.A. Journal of Sex Education and Therapy, 16(2), 1 1-114. Also, it was noted thatthe behavioral model restricts service delivery to essentially the deliveryof therapy services, while the family preservation model not only providestherapy services but also services aimed at meeting the everyday needs ofthe family, i.e. For example, in a study performed by Pecora, Fraser and Haapala(1992), which was conducted to evaluate an intensive home-based familypreservation project providing services in Utah, the authors noted that thepretest-posttest case outcome data of 453 families who received intensivefamily preservation services indicated that maximal therapy effectsoccurred when a variety of services were provided to families, includingbehaviorally oriented educational training and/or cognitive-behavioralfamily therapy. For example, McCarthy(199 ), in his discussion of the use of the cognitive-behavioral model offamily therapy for abusive families, points out that while the goal of themodel is to keep the family together, the services provided by the programprimarily consist of the use of communication and behavioral strategies toensure that incest cannot reoccur. It should be noted here that this finding by Howing and associatesis important given the fact that more and more frequently familyintervention approaches are being called upon to limit the time of servicedelivery (Cole, Hammond & Tucker, 1989; Cimmarusti, 1992). (1989). In most studies of the familypreservation model, the "family" is usually defined as those family memberswho lived in the same home as the child when the abuse occurred (e.g.,biological parents living in the same home with the child, stepparentsliving in the same home, etc.) On the other hand, the behavioral modelwill often define the "family" as any caretakers currently in the role ofcaring for the child. Indeed, it is pointed out that in terms of gettingabusive parents to change their behavior, addressing issues andinterventions in terms of ethnic perspectives greatly facilitates positivetherapy outcomes. Howing, P.T., Wodarski, J.S., Gaudin, J.M. If these differences are not relevant to treatment outcomes, thenthey are of little practical concern and the selection of which model touse could be considered irrelevant. However, it was noted that researchindicates that the extent to which the outcomes differ could well dependupon the nature of the abuse. Keeping families and childrensafe. (1988). These factorsinclude: type of admissions criteria into the program (Smith, 1995); theuse of social workers well skilled in intervention who remain as the samesocial workers during follow up checks (Smith, 1995); caseload size (Cole,Hammond & Tucker, 1989); degree to which the family desires to remainunited (Cole, Hammond & Tucker, 1989); presence of developmental disabilityor mentally impaired persons in the family (Berry, 1992); and age of thechild and degree to which parents have difficulty fulfilling the caretakerrole (Spaid & Fraser, 1991). Pecora, P.J., Fraser, M.W. BehaviorModification, 14(3), 316-339. However, one of the key differences between the two approaches is thefact that the family preservation model provides far more services thansimple therapeutic treatment. (1995). al (1989) isthat length of the intervention moderates treatment outcome. These were that bothmodels shared the objective of preserving the family, concerned theethnicity or cultural background of families to be an important concern indeveloping and implementing treatment strategies, and utilized behavioralinterventions. Cole, B.S., Hammond, J.A. Hall, N. & Tucker, K.W. Summary This paper compared and contrasted the family preservation model andbehavioral model of family therapy in work with abusive families. Bosch stated that, "Behavioralfamily therapy in conjunction with intensive individual behavioral therapywas the mode of treatment." The teenager was seen over a three month periodin which she was seen two to three times weekly. In other words, while behavioral family therapyalmost exclusively limits its therapeutic strategies to behavioraltechniques such as reinforcement, modeling, parent training workshops orseminars, and so forth, the family preservation model offers a variety ofother interventions. Similarly, McCarthy (199 ) reports that one goal of thecognitive-behavioral model of the treatment of physically abusive and/orincestuous families is to keep the family together. Treatment of incest families: A cognitive-behavioral model. Hall (1988), for example, discusses abehavioral family model of assessment/intervention in which amultidisciplinary team of workers attempt to understand and change abusiveparenting. ChildWelfare, 71(2), 177-188. (1989).Effective interventions to ameliorate the incidence of child maltreatment:The empirical base. In their discussion it is noted that the Homebuilders program and theFamilies First program---two family preservation projects with the largestand most successful programs in the United States---provide a mix ofcounseling, parenting skills training, and concrete services (e.g.,transportation, domestic support, clothing); the programs also offerintensive services focusing on behavioral changes that can help familiesachieve positive and long-lasting results. Data showed that diverse kinds of therapy were utilized as part ofthe services provided by the family preservation model with three types oftherapeutic services being the ones most often used. This can be seen in an Blythe and Kelly's(1993) discussion of family preservation systems, which the authors defineas a system of services aimed at removing the risk of harm to the childinstead of removing the child from the family. Child Welfare, 71(3), 241-256. One important point that is also discussed by Howing et. Regarding commonalities, familypreservation or the notion of keeping existing families together as atherapeutic objective is a treatment goal shared by both the familypreservation model (see: Peterson, Kohrt, Shadoin & Authier, 1996) and thebehavioral model of family therapy (see: Fantuzzo, 199 ). The fact that the family preservation model combines a number oftreatment strategies and techniques is illustrated in Robert's (1994)comparative study of the application and services of the Family-BasedIntensive Treatment (FIT) Project, (designed to prevent the out-of-homeplacement of children) with the Family Reunification Project, whichutilized intensive family preservation services (IFPS) to reunify childrenin out-of-home care placement with their biological families. clothing needs, transportation needs, etc. The ultimate therapeutic goals of the cognitive-behavioral model offamily therapy, according to McCarthy (199 ), include changing the abusivebehavior and getting each family member to see herself or himself as asurvivor rather than as a victim of incest. For maltreated children, successful outcomes were observed whenchildren participated in both individual and family counseling, and weresent to therapeutic day care centers. Another difference between the behavioral model and the familypreservation model is that the family preservation model is more eclecticin its treatment approach. (1996).Building relationships with high-risk families. In addition,therapists and counselors using both approaches often use at least somebehavioral, cognitive-behavioral strategies and techniques (Pecora, Fraser& Haapala, 1992).
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