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Home > Crisis Intervention in Child Abuse and Neglect > Crisis Intervention in Child Abuse and Neglect : Family-Centered Crisis Response Models
Crisis Intervention in Child Abuse and Neglect
User Manual Series (1994)
Author(s): U.S. Department of Health and Human Services
Gentry |
| Year Published: 1994 |
Family-Centered Crisis Response Models
Introduction
In response to the growing number of children in foster care, the emotional and social disconnectedness or rootlessness of large numbers of these youth, and growing recognition of the value of the family, family-centered or home-based services have developed. Some of the family intervention models that may be available in a particular community are presented in this section. Several of the therapeutic strategies require that the crisis workers receive extensive training before they implement the strategies.
Three examples of successful, family-centered services programs are the Homebuilders crisis intervention model, the FAMILIES, Inc. home-based model, and the Intensive Family Services (IFS) family treatment model.
Homebuilders
This model assumes that most children who are in imminent danger of removal from their homes can best be served through interventions which keep the family intact.101 Homebuilders subscribes to the following seven principles:
- Children Need Families – The Homebuilders' intervention philosophy emphasizes that one's beginning and ancestry are overwhelmingly important to the development of self-identity. Bonding with parents is critical to the cognitive and emotional development of youth. Behaviorally disordered youth clearly demonstrate their need for consistent family life.
- The Safety of the Child Comes First – Through its low case loads, no more than two cases per crisis worker at any time, and training of crisis workers to defuse dangerous situations, Homebuilders designs its program to provide safety for children. Rapid response, within 24 hours, and frequent visits to the home help to curb the escalation of family stress and danger to the child. Parent and crisis worker safety are also important program components.
- Crises Present Opportunities for Change – Homebuilders is designed to capitalize on crises, when families are under great stress and looking for new directions because old ways of coping are not working. Cognitive-behavioral approaches, concrete services, a multidisciplinary team, and active listening are used to help stabilize the family. The family determines short-term goals, with crisis workers keeping the family focused on what can be accomplished in a 4-week period. After a relationship is established, most families are open to learning parenting and communication skills, anger management, and more effective coping strategies.
- Limit the Issues To Be Addressed – After carefully assessing the stress in the family, Homebuilders concentrates on what the family needs in order to stabilize. Crisis workers focus only on critical issues in the present. For instance, utility or rental payments may need to be made to prevent the family's eviction. Family members may be taught to listen to each other, instead of yelling and accusing. Parents may be assisted in finding job training or mental health counseling. Children may be placed in day-care.
- Family Members Probably Care About Each Other – Even though family members argue, abuse, or neglect each other, Homebuilders stresses that most families have strong caring feelings. Because of insecurities and emotional needs, it may appear that individual members are too self-centered to care about others. Their actions may seem to say that there is no caring. However, in-home observation usually indicates that there are caring moments and that family members love each other.
- Family Members Are Doing The Best They Can – Whatever the crisis, Homebuilders believes that families are doing the best they know how under the circumstances.
- The Power for Change Lies Within the Family – Through an attitude of respect for the family's strengths, Homebuilders empowers family members by helping them determine what they need and how they wish to proceed. Crisis workers become energized, as well, when they realize that families want to change, can set their own goals, and can follow through with their action strategies. Just as all children need encouragement, so do adults who are in a crisis. Encouragement and professional support help families use their strengths for positive change.
Families, Inc.
This model, using Nathan Ackerman and Virginia Satir's family treatment methods, was developed as an alternative to foster care for adolescents. Drawing on family systems theory, it provides home-based services to achieve more accurate family assessments, to model behaviors in the home environment, and to facilitate empowerment of the family.102 Frequently, it assigns an experienced crisis worker and a new crisis worker to a family, allowing for flexibility in schedules and for planning cases together.103 It provides intervention for 3 to 7 months. Caseloads vary from 5 to 11 per crisis worker.104
Families, Inc., uses a variety of approaches from family systems theory such as genograms, reframing, and structural techniques.105 Other intervention techniques include assigned homework regarding communication skills, paradox, parent training, fair fighting, and provision of concrete services. These approaches are described below.
- Genograms – Genograms are diagrams of the family tree through three generations. These diagrams can become large and complicated in families of many marriages and children, but can be used to pinpoint specific times and types of stress in the family. Repetitive patterns and recent occurrences which led to the crisis may be identified, as well as how various family members relate to each other and to the world outside the family.
- Reframing – Individuals and families have thoughts, feelings, symptoms, and behaviors which they or other people perceive as undesirable. Reframing attempts to emphasize the positive aspects of the "undesirable." For instance, a parent who physically harms a child might be positively recognized for wanting the child to behave, thereby opening the door to teach anger control and appropriate discipline. Reframing is used in both paradoxical and nonparadoxical therapies.
- Structural Techniques – Much like task-centered techniques, structural family therapists assign tasks for clients to accomplish between sessions.106 The therapists may try to create new alliances among the family members while also establishing new and different alliances from time to time between therapists and various family members.107 All this is done in an attempt to create a more functional family. The structural approach is concerned with behavioral and affective themes related to boundaries and role enactment.108
- Communication Homework Assignments – The past, the present, and the environment affect how one receives and processes information. In families, patterns of communication develop over time. Verbal and non-verbal communication may not be congruent.109 Families may not know how to get assistance about jobs, housing, controlling anger, or child discipline. Couples may not understand each other's style of communication.110 Likewise, some authors caution that professionals' and clients' racial or cultural differences may create misunderstandings in communication.111
Paradox – Many therapists find it helpful to side with individual and family resistances to change, often requesting or "prescribing" families to engage in the very behavior which therapy is attempting to eliminate.112 Paradox may be a client's intuitive response as well as planned response. Clients may be encouraged to pretend that they have even more symptoms, such as anxiety and embarrassment, or they may be urged to yell more than usual.
- Before using paradoxical instructions, therapists must study appropriate application of this technique. For instance, one would never "prescribe" hitting or abusing a child, using alcohol or other drugs, or breaking the law!113 - Parent Training – Numerous authors contend that adults who were unloved and uncared for as children may never become nurturing.114 With parenting education and other interventions, such as role modeling, role playing, and resolution of childhood trauma, they may, however, learn to parent appropriately.
- Fair Fighting – Many abusive parents feel frightened and inadequate. Their poor self-esteem is expressed through overly submissive or overly aggressive behaviors. They need to learn appropriate assertiveness, how to negotiate for what they want, how to compromise, or how to persuade without yelling and hitting. Having had poor role models in the past, they must be taught how to fight civilly by clearly expressing their feelings about what is bothering them, by asking for reasonable change, by clearly stating the consequences, and by using "I" messages, such as, "I feel like a child and get scared when I'm not in control."
- Concrete Services and Coordination of Services – Typical of good casework services, Families, Inc. crisis workers advocate for their clients to receive more adequate support services.115 This includes coordination with other community providers to assure quality living conditions and services both during and after the intervention. Concrete services are an important part of the intervention and include arranging for necessities such as food, clothing, housing, health care, and financial assistance. Transportation, day-care, job training, and other services also contribute to the families' success.
Intensive Family Service
Relying on family systems theory with less emphasis on concrete services and support services than the two previously described models, this program provides approximately 3 months of service either in an office or home setting.116 Other community services such as respite services and parent training supplement the work of IFS. Using this model requires crisis workers to maintain a caseload no more than 11 cases. Approaches to treatment include structural, strategic, brief, and communication-based family therapy, as described below.
- Structural Family Therapy – Founded by Dr. Salvador Minuchin, structural family therapy aims to establish clear relationships and role boundaries, to develop functional alliances within the family, to normalize the role of the child who functions as a parental surrogate, and to develop tasks which improve family functioning.117
Strategic Family Therapy – In strategic family therapy, the therapist assumes control of the treatment and designs an approach to each problem. With complex families, the therapist may involve a co-therapist or a team of consultants to assist in dealing with the multiple family dynamics.118
- Strategic therapy calculates the strength of the "anti-change" forces of the family and attempts to work through resistance through indirect means. Sometimes the expression "joining the resistance" is used to reflect how the therapy capitalizes on and exaggerates the resistance or homeostatic behavior as a means to eliminating it.119 Brief Therapy – In 1958, Leo Bellak began a 24-hour psychiatric emergency clinic based on psychodynamic therapy, but limited to five therapy sessions.120 Since that time, many therapists have asserted that brief casework may be more efficient than long-term interventions. Brief therapy practitioners use highly focused, task-oriented approaches and homework assignments to help clients develop their own problem-solving strategies. Written contracts explicitly state the acknowledged problem, the clients' goals, and tasks for alleviation of the problem.121
- Some practitioners emphasize the positive in clients' lives, always empowering the clients and constructing questions or statements in such a way that the clients feel there is an imminent solution to their problems.122 - Communication-Based Therapy – Communication-based therapy is based on the belief that what people perceive within themselves and their environment is more critical than what is real. How clients receive information and how they process it determine its ultimate effect on their functioning.123 If clients are not responding to communication as the professional expected, then he or she needs to communicate in a different way. Body language, tone of voice, or timing may require change. It is the professional's job to communicate in ways that help clients accomplish their goals.
The Family Crisis Program
In Boston, the Family Crisis Program (FCP) for sexually abused children is based on classic crisis theory and applies a comprehensive approach involving investigative, clinical, judicial, and advocacy agencies.124 The program assumes that a report of sexual abuse precipitates crisis in the family in which usual coping patterns are overwhelmed. Responding immediately to the family's crisis workers, program staff seek to restore equilibrium and more adaptive coping mechanisms. Families are helped in obtaining emergency social services or in seeking a restraining order against the perpetrator. About three-fourths of the families require treatment beyond crisis intervention.
The Interagency Sexual Abuse Council
Designed to provide crisis intervention during the chaos of incest disclosure, the Riverside Interagency Sexual Abuse Council (RISAC) in California is a joint effort of public social services, mental health, probation, and several other agencies. Self-help groups such as Parents United and Daughters and Sons United, as well as individual, couple, and family therapy, are adjuncts to the crisis intervention. The program is both supportive and confrontive with perpetrators, while encouraging behaviors that minimize family stress. Victims are supported and believed. Nonoffending mothers are confronted if they deny knowledge about the sex abuse. All interventions, however, are compassionately supportive and humanistic.125
Summary
In Child Protective Services, family-centered models are most effective for crisis intervention. Three national models of family preservation and two community programs utilize approaches and techniques that can be easily adapted to Child Protective Services crisis cases. Two models draw heavily on concrete and community support services, while another provides approximately 3 months or more of intervention.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.
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