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Introduction

Family-centered practice is an innovative approach to working with children and families who are at-risk or in crisis. It is based on a radical set of principles, values, and beliefs that recognize the critical role of family as the constant in a child's life. Emphasis is placed on the family as the unit of attention, with informed choice and participation in decision making by family members. An additional focus is placed on utilizing and building on family strengths and resources.

One of the most critical aspects of family-centered practice is an explicit set of principles and values that inform practitioners and guides all interactions with families. These principles include maintaining a strengths-based perspective, providing culturally responsive services, employing an empowerment paradigm, and developing collaborative partnerships with families. Delivering home and community-based services is also an important component of family-centered services.

This module introduces participants to the basic underlying values, theory, and goals of family-centered practice. It begins by comparing family-centered, system-centered, and child-centered services. Next, family-centered assessment and intervention roles are presented. The module ends with a brief discussion of barriers and obstacles to providing family-centered services.


Goals of the Class
  1. To define family-centered practice;
  2. To describe the core values and principles of family-centered practice:
    • Strengths-based
    • Culturally-responsive Services
    • Service Delivery in the Family's Natural Environment
    • Empowerment Oriented
    • Family Collaboration and Partnership;
  3. To define the theory base of family-centered practice;
  4. To describe the implications of core beliefs on assessment; and
  5. To describe the implications of core beliefs on intervention roles.

Suggested Readings

Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: W. W. Norton. (to Selected Annotation)

Bryce, M., & Lloyd, J. C. (1981). Treating families in the home: An alternative to placement. Springfield, IL: Charles C. Thomas.

Hartman, A., & Laird, J. (1983). Family-centered social work practice. New York: Free Press. (to Selected Annotation)

Kaplan, L., & Girard, J. (1994). Strengthening high-risk families: A handbook for practitioners. New York: Lexington Books. (to Selected Annotation)

Kinney, J., Haapala, D., & Booth, C. (1991). Keeping families together: The homebuilders model. New York: Aldine De Gruyter. (to Selected Annotation)

Nichols, M. P., & Schwartz, R. C. (1998). Family therapy: Concepts and methods (4th ed.). Allyn and Bacon: Boston, MA.

Roberts, R., Rule, S., & Innocenti, M. (1998). Strengthening the family professional partnership in services for young children. Baltimore, MD: Paul Brookes Publishing. (to Selected Annotation)

Weiss, H. B, & Jacobs, F. H. (1988). Evaluating family programs. New York: Aldine De Gruyter. (to Selected Annotation)

Williams, B. (Ed.). (1995). Family-centered services: A handbook for practitioners. Iowa City, IA: The National Resource Center for Family-centered Practice, School of Social Work, The University of Iowa. (to Selected Annotation)


Selected Annotations

Berg, I. K. (1994). Family-based services. New York: W. W. Norton & Company, Inc.
Through the use of brief, solution-focused therapy and family-centered services, Berg provides a framework for child welfare and social service workers to empower clients. Berg also details the strengths and weaknesses of a family-centered approach in treatment services. Case examples are provided to assist practitioners in illustrating different techniques that can be adapted to various service programs.

Hartman, A., & Laird, J. (1983). Family-centered social work practice. New York: The Free Press.
This book addresses the fundamental beginnings, practice, assessment, and intervention strategies used in family-centered social work services. The authors look at the changing and developing family systems of today, current policies affecting the subsistence of these systems, and how a family-centered program can serve the needs of the family unit. Through the use of the ecological perspective, Hartman and Laird lay out the groundwork for starting family-centered agencies, discuss case management issues, and look at specific direct casework interventions with family systems.

Kaplan, L., & Girard, J. (1994). Strengthening high-risk families: A handbook for practitioners. New York: Lexington Books.
The authors provide a historical overview of the family preservation/family-centered movement and its necessity in providing services to families and children. Kaplan and Girard present from the framework that children cannot be helped without addressing the needs of the entire family unit. Family-centered practice is then the cornerstone of a new philosophy of thinking that places the entire family system as the direct unit of attention.

Kinney, J., Haapala, D., & Booth, C. (1991). Keeping families together: The homebuilders model. New York: Aldine De Gruyter.
Through an analysis of the Homebuilders Program, an intensive family preservation service, the authors provide a detailed description of the family-centered context and philosophy. They outline the basic components of the family-centered approach and discuss the stages of intervention and organizational issues when dealing with possible out-of-home placement. The Homebuilders model gives unique and concrete methods of how to work with the entire family unit through prevention, intervention, and treatment services that target each individual family member.

Roberts, R., Rule, S., & Innocenti, M. (1998). Strengthening the family professional partnership in services for young children. Baltimore, MD: Paul Brookes Publishing.
Building on successes of parent/professional relationships in early intervention programs, this book outlines how to develop effective partnerships with parents. The first section of the book outlines strategies for developing partnerships in services, system development, and evaluation. The second part of the book offers nine richly detailed case studies that illustrate best practice in developing parent/professional partnerships.

Weiss, H. B., & Jacobs, F. H. (1988). Evaluating family programs. New York: Aldine De Gruyter.
This book examines family support and education programs and the challenges and opportunities they present for families and practitioners in family-centered practice. The authors provide a theoretical base (the ecological theory) behind the family-centered movement and explain its relevance to practice with individuals. With the use of case studies, measurement tools, and a discussion of current issues in theory and policy, this book is an excellent tool for family-centered program evaluators and practitioners.

Williams, B. (Ed.). (1995). Family-centered services: A handbook for practitioners. Iowa City, IA: The National Resource Center for Family-centered Practice, School of Social Work, The University of Iowa.
This resource handbook details critical issues related to family-centered practice for the practitioner. Authors cover such issues as culturally competent social work practice, intervention roles of practitioner, assessment strategies, and the solution-focused approach to working with child abuse cases. Through the use of family-centered practice, the authors present practitioners with ways to enable families to access internal and external resources needed for family well-being.

Lecture Notes
  1. Definitions
    1. Family-Centered as a principle asserts that the best way to meet the needs of children is within the context and in consideration of the entire family. This definition underscores the centrality of family involvement and participation in making decisions that impact children and consequently, the family. Adapting a family-centered approach requires a profound system-wide philosophical re-orientation that begins with re-evaluating traditionally child-focused and problem oriented practice to family-focused and strengths-based practice. Operationalizing a family-centered perspective requires both ethical and practical challenges. Ethically, practitioners must honor parental rights and authority to make decisions concerning their children. Practitioners must support and encourage parents to exercise these rights while at the same time create a climate among other professionals that engages parents appropriately. If providers believe in parental rights and authority, it is incumbent upon them to assure that parents have the opportunity to participate by scheduling meetings at times when and in locations where parents can easily participate (Kaplan & Girard, 1994, p.11; Roberts, Rule, & Innocenti, 1998, p.56).
    2. Comparing Family-Centered, System-Centered, and Child-Centered Services
      1. Family-Centered: The family is the unit of attention rather than the parents or children as individuals with problems. The priorities and choices of the family drive service delivery. The emphasis is on enhancing family functioning and developing and strengthening natural supports and resources.
      2. System-Centered: An individual or family can be the unit of attention. The emphasis is on the strengths and needs of the system. Professional assistance is provided within the service structure defined by the agency or program.
      3. Child-Centered: The child is considered the unit of attention. Strengths and needs of the child drive the delivery of services. Parents are involved only to the extent that they support plans developed for the child.

Family-Centered System-Centered Child-Centered
Unit of Attention Entire family unit-as defined by the family Mostly individuals, sometimes families-defined by referral source Child
Goal of Services To resolve reason for referral and to strengthen, support, and empower families To resolve reason for referral To resolve reason for child's referral
Intervention Strategies Traditional and non-traditional strategies-counseling, teaching new skills, advocacy, and formal and informal resource connection Mostly traditional-selected from services available at the agency-generally includes counseling and skill development Mostly traditional-selected from services available at the agency-generally includes play therapy and counseling
Decision Makers Family and professionals Professionals Professionals with some consultation with parents
  1. Core Values and Principles that Guide Family-Centered Practice
    1. Strengths-Based Services (Williams, 1995, p.3)
      1. Recognize and build on family strengths and competencies.
      2. Help families to develop skills, competencies, and resources that can be translated as strengths.
      3. Help practitioners in related disciplines to incorporate family strengths in their respective assessments and intervention planning.
    2. Culturally Responsive Services (Raheim, 1995, pp.24-25)
      1. Respect ethnic and cultural diversity.
      2. Be sensitive to and aware of cultural differences.
      3. Respect and honor family cultural beliefs and traditions of the family.
      4. Value and seek to strengthen ethnic resources and community supports.
    3. Family Friendly Service Environment (Kinney, Haapala, & Booth, 1991, p.25)
      1. Believe children deserve to grow up in their families.
      2. Provide services in-home and in the family's community.
      3. Strive to provide flexible services both in types of interventions and hours of availability (i.e., evenings and weekends).
    4. Empowerment Oriented (Kaplan & Girard, 1994, p.40).
      1. Support skill development and resource procurement to keep families together
      2. Encourage personal and social change.
      3. Promote self-efficacy.
      4. Develop and strengthen competencies and skills.
    5. Collaborations and Partnerships (Williams, 1995, pp.3-4)
      1. Develop mutual relationships that reflect family and professional partnerships.
      2. Share tasks and work activities to achieve goals.
      3. Create reciprocal relationships based on loyalty, trust, honesty, and full disclosure.
      4. Respect parental authority and final decision making in matters concerning their family.


Complete Assignment
Integrating Family-centered Values

  1. Theoretical Foundations of Family-Centered Practice

  1. Family systems and ecological theory inform family-centered assessment and intervention planning. Following is a brief discussion of both theories and how they relate to family-centered practice.

    Family Systems Theory - Family is more than a collection of separate individuals; it's a system, a whole whose parts function in a way that transcends their separate characters (Nichols & Schwartz, 1998, p. 6-8).

    1. Family Systems Theory informs family-centered practice in that it purports that individual clients are affected by their environments, one of which is the family unit (Kaplan & Girard, 1994, p.4).
      1. Family systems theory suggests that behavior witnessed in families is the result of many factors and influences. No single cause is to blame when family difficulties arise. Interactions among family members and with external systems impact the functioning of the entire family system (Williams, 1995, p.6-7).
      2. Types of family systems
        1. Subsystems: smaller units of the family system (e.g., parental subsystem, sibling subsystem).
        2. Suprasystem: larger units of family system (e.g., communities, cities and towns).
      3. Family system concepts:
        1. Boundaries: dictate what belongs inside and what belongs outside the family system. Family boundaries involve loyalties, rules, and emotional connections (Hartman & Laird, 1983).
        2. Hierarchy & Rules: order and organize the system (Williams, 1995, p.6-8). Rules are expressed by consistent patterns of behavior, organization, and communication among family members (Hartman & Laird, 1983).
        3. Expression of Feelings: the ability to appropriately express emotions such as love, caring, concern, and disappointment to other family members.
        4. Role: a family member's position (e.g., mother, sister) and function (e.g., caretaker, peacemaker) in the family.
        5. Communication Process: verbal and nonverbal exchange of information, instructions, commands, and feelings.
    2. Ecological theory-informs family-centered practice in that it "moves the focus from the individual to the family, subsystems within the family, and the family's interaction with the community" (Kaplan & Girard, 1994, p.4).
      1. Ecological theory works to incorporate all the systems with which the family interacts in order to best serve the family's needs.
      2. The ecological perspective suggests:
        1. Problems or difficulties with the family are deficits in the environment, dysfunction between systems, or interrupted growth and development, rather than a disease process located within the individual.
        2. Family problems are seen as outcomes of the transactions of many complex variables.
        3. Life experience is seen as the model for and primary instrument of change.
        4. A change in one part of the system has an impact on all other parts of the system (Hartman & Laird, 1983, pp. 72-73; Kaplan & Girard, 1994, p.51).

  2. Goals of Family-Centered Practice
    1. To assure the physical, psychological, and spiritual well being of the family (Williams, 1995, p.1).
    2. To ensure the safety of children, preferably in their own homes if their families receive the necessary assistance and support. (Kaplan & Girard, 1994, p.12-13).
    3. To preserve the integrity of the family unit.
    4. To work with families, not for families-to model EMPOWERMENT and enable families to meet the needs of its own members (i.e., building a natural social support network) (Williams, 1995, p.9).
    5. To increase skill levels and resources among families so that they will function better after the intervention (Kinney, Haapala & Booth, 1991, p.16).
Figure 1:
  1. Continuum of Service

  1. In addition to programs for families with children with special needs, family-centered practice has heavily influenced the field of child welfare, particularly family support and family preservation programs. Figure 1 illustrates how family-centered practice is central to both types of programs.

    1. Family Support
      1. Family Support builds on the desire of parents to do the best for their children by building strong families in supportive communities.
      2. Six defining characteristics:
        1. Ecological approach in order to promote human development by fostering child and parent growth by enhancing both the family's child-rearing capacities and the community context in which they live.
        2. Community-based and sensitive to local needs and resources.
        3. Supply information, emotional and appraisal support, and instrumental assistance.
        4. Emphasize primary and secondary prevention.
        5. Innovative and multilateral (as opposed to exclusively professional) approach to service delivery through such means as peer support, creative use of volunteers and paraprofessionals, and the promotion of informal networks.
        6. Provide formal and informal support while reinforcing and respecting the family's roles and prerogatives (Weiss & Jacobs, 1988, pp. 9-11).
      3. Family support programs focus on prevention, family-life education, home visitor programs, parent education, childcare, etc.
      4. Family support programs work with communities, schools, hospitals, businesses, and corporations.
    2. Family Preservation
      1. Family preservation services are designed for families at-risk of placing one or more children out-of-the-home in more restrictive settings such as foster care, group homes, residential treatment, and mental health hospitals.
      2. Family preservation services are intensive, time-limited, delivered in the family's home, goal oriented, responsive to family needs, and flexible.
      3. The goals of family preservation are to protect children, to strengthen family bonds, to stabilize family crises, to increase skills and competencies, to facilitate use of a variety of formal and informal helping resources and to prevent unnecessary out-of-home placement of children.
      4. Typical interventions include: assisting families to meet basic needs, active listening, engaging clients, teaching skills in problem-solving, communication, anger management, parenting, defusing and confronting irrational thoughts and behaviors, and suicide prevention.
      5. Family preservation services facilitate the development of a safe, nurturing environment for children within the context of family.
      6. Family preservation programs operate under the auspices of both public and private agencies.

  2. Assessment Domains of family functioning using family-centered criteria
    1. Safety of family members
    2. Strengths and resources-must assess strengths as well as problems, and be alert to families' potential capabilities as well as limitations (Kinney, Haapala, & Booth, 1991, p.79).
    3. Family dynamics and communication-genograms (diagram similar to family tree where practitioners record information about family members and their relationships), tangible resources to work with families (Williams, 1995, p.72).
    4. Basic needs-food, clothing, shelter, medical care, and physical, emotional, and spiritual well being (Williams, 1995, p.54).
    5. Connection to informal and formal community resources.
    6. Other needs, risks, and risk factors (financial, health, mental health, etc.).


Complete Assignment
Johnson Family Case Study, Part I

  1. Family-centered intervention roles
    1. Advocate-advocacy is generally used when families are in conflict with organizations or agencies. Advocates speak and act on behalf of and in support of families and defend the rights of families with whom providers work. "A person with more power, knowledge, or resources will 'stand up for' a person or group of persons with less power or knowledge or fewer resources" (Bryce & Lloyd, 1981, p.134). Advocates also teach families how to advocate for themselves.
    2. Broker-provides information and assists families in connecting with formal and informal services based on their needs and life-style. Referral is the primary intervention technique used in the broker role (Kinney, Haapala, & Booth, 1991, p.31; Berg, 1994, p.6).
    3. Case-Manager-worker seeks to understand the families' needs and goals. Worker identifies, organizes, coordinates, and facilitates multiple systems (services and agencies) with which a family is involved in order to combine the efforts of these systems to work together on behalf of the entire family.
    4. Teacher-utilizing modeling, rehearsal, role-play, and feedback, family members learn new, appropriate skills to replace dysfunctional or inappropriate skills. Common skills include problem solving, communication, relaxation, self-control, and parenting skills. Workers use family sessions to assess interactions between family members, to teach new skills, to set up family contracts, and to review the family's progress (Kinney, Haapala, & Booth, 1991, p.29).
    5. Mediator/arbitrator-families may be at odds with other individuals or agencies and have not been able to resolve the conflict despite their best efforts. As a mediator, family-centered social workers facilitate discussions between the opposing parties. The goal is to remove any barrier or obstacle to improving family functioning. Mediation involves remaining neutral, listening, asking questions that elicit facts and feelings, and facilitating discussion between parties.
    6. Therapist-counseling skills are used to intervene in interpersonal and intrapersonal problems. Interventions include active listening, reflection of content and feeling, paraphrasing, encouraging, summarization, confrontation, and influencing techniques.


Complete Assignment
Johnson Family Case Study, Part II

  1. Obstacles to providing family-centered services
    1. Lack of well trained work force
      1. Staff must respond immediately to needs of the family.
      2. Staff must show flexibility and a willingness to do things differently.
      3. Staff must be innovative and creative.
      4. Staff must be able to act as team members and be cooperative (Berg, 1994, p.6)
    2. Lack of system-wide support for family-centered practice in general. Issue of credibility is raised from many different agencies and organizations as to whether this is the right approach or if it is even successful (Berg, 1994, p.7).
    3. Child-focused laws, policies, and funding resources that are not family centered.
    4. Inadequate public system and agency infrastructure to address family needs.

Exercises


  • Integrating Family-Centered Values*

    TIME: 45 to 60 Minutes

    This exercise is most effective when used at the end of a lecture/discussion on family-centered values. Acceptance of family-centered values is easier for students when viewed theoretically. It becomes more challenging when attempting to apply these values to a case example that includes serious safety issues.

    LEARNING OBJECTIVES:

    • To help students integrate family preservation values by applying them to a HOMEBUILDERS case example.
    • To encourage students to examine their own values in relation to family preservation values.

    STEP-BY-STEP PROCEDURE:

    1. Divide students into small groups of three to five.
    2. Have students read the Hogan Family Case Study, Intake Information.
    3. Have small groups discuss the following questions (20 minutes):
      • Should Eric be at home? Why or why not?
      • What are the strengths of the Hogan family?
      • During the initial contact, what would you do to help make these clients your colleagues?
    4. Discuss responses to the questions in the large group. Key discussion points:
      Discussion Point A: The need to balance the safety of the younger siblings with the importance of Eric being at home with his family.
      Discussion Point B: Encourage students to include Eric's strengths if they have not already done so.
      Discussion Point C: Encourage students to be very specific about what they would say and do to engage the clients as colleagues.
    5. Share information with the class regarding the goals and outcomes of the case.

    Prepared by:

    • Peg Marckworth, MSW and Linda Jewell Morgan, MSW
    • Family Preservation Practice Project
    • School of Social Work, University of Washington

    *Used with permission. Tracy, E., Haapala, D., Kinney, J., & Pecora, P. (Eds.). (1991). Intensive Family Preservation Services: An Instructional Sourcebook. Cleveland, OH: Mandel School of Applied Social Sciences, Case Western Reserve University.

    HOGAN FAMILY CASE STUDY
    INTAKE INFORMATION

    The family consists of Mary (33), Eric (16), Robby (13), Andy (6) and Alex (6).

    One year ago Andy disclosed that Eric had sexually molested him on several occasions. An investigation concluded that Alex was also molested by Eric and that six years ago Robby had been molested by Eric.

    Eric was removed from the home. He lived with an uncle for three months, and then he was placed for six months in a Crisis Residential Center. During this time, the family participated in family counseling, and Eric attended a group for juvenile sex offenders.

    Three months ago, Eric was returned home. Mary stated that she reluctantly agreed to his return, based on her belief that the family would receive daily, in-home counseling. She stated that the service she actually received was "babysitting" while she was at work.

    She explained that the counselor arrived at 4:30 a.m. when Mary left for work and supervised the children all day so that Eric had no opportunity to be alone with them. However, in the early morning the counselor slept downstairs while the children slept upstairs. Mary felt that this was not enough protection for the twins.

    Mary expressed great fear that Eric would re-offend. She did not believe the twins were safe or that the support services the family received were adequate. She said she felt exhausted by having to transport the boys to counseling in the South County when she lives in the North County. She stated that Eric would get more help if he were placed in a group home setting. She requested that Eric again be placed outside of the home. HOMEBUILDERS was offered as an alternative.

    HOGAN FAMILY CASE STUDY
    GOALS AND OUTCOMES

    GOAL 1: Create as safe an environment as possible to reduce the likelihood of future sexual abuse within the family.

    • The HOMEBUILDER assured Mary that he would listen to her concerns about Eric's presence at home. If Mary felt it was still unsafe, he would pass these concerns onto the caseworker (at end of intervention).
    • He purchased locks for bedroom and bathroom doors, taught the twins to use them, and monitored that they were being used routinely.
    • He established "safety rules" for family members and monitored that they were understood and enforced.
    • He taught appropriate/inappropriate touch (using coloring books, Spiderman comics, and puppets) to the twins and assessed their ability to understand the information.
    • He taught the twins what to do if they were inappropriately touched (including assertive statements and telling responsible adults).

    GOAL 2: Improve communication between family members (decrease amount of verbal harassment between family members).

    • The HOMEBUILDER taught "feeling words."
    • He provided rationales for using "I" messages and helped the family to practice using them in part through homework assignments.

    GOAL 3: Develop a plan and make the appropriate referrals for services after HOMEBUILDERS.

    • The HOMEBUILDER helped Eric set up individual counseling.
    • He referred the twins to a group for 5-7-year-old victims.
  • He referred Robby to a group for teenage victims.

    In addition:

    • The HOMEBUILDER gave Mary books and a bibliography on juvenile sex offenders and treatment strategies for them.

    At termination:

    • Eric had not re-offended.
    • He was doing fine in school.
    • He had gotten his driver's permit.
    • He had gotten a fast-food job.

    THE JOHNSON FAMILY*, Part I
    Ennis Center for Children
    Detroit, Michigan

    Marilyn Johnson freely admitted her addiction to crack. It was not hard to believe-at 98 pounds, the 31-year-old mother of four was selling her food stamps to support her habit. The authorities suspected that drug trafficking was occurring in her home, and these suspicions were aggravated by the burly man monitoring admittance to her two-story house and the hovering presence of numbers of men and women on the premises. Marilyn's younger children were unkempt. Her 13-year-old daughter had not attended school for six months, was engaging in physical brawls with Marilyn, and ran in the streets with her boyfriend, a drug "roller." Marilyn was told by the police that she had 24 hours to rid her home of drug traffic, and the Children's Protective Services threatened to remove her children.

    The case was referred to Families First and the Ennis Center for Children, a new program in Detroit specializing in the treatment of high-risk families. When the Families First worker visited Marilyn the day the referral was made, Marilyn was obviously high but insisted that she wanted help in keeping her family together.

    Prior to her drug addiction, Marilyn had lived a conventional, comfortable life. She was married, worked as a restaurant manager, and owned a house and car. Her drug use began when her husband urged her to try heroin, and it became a daily habit. As her addiction progressed, she turned to crack and her marriage foundered; she lost her job and was forced to sell her home, furniture, appliances, clothing, and car to support her drug habit. She became the pawn of dealers who beat her and demanded that she sell drugs from her home.

    When Families First arrived, she had been using crack for two years and was illegally "squatting" in a house with broken windows, falling plaster, and bullet holes in the walls. Listening to her story, the caseworker offered understanding and compassion, carefully avoiding judgment or criticism.

    Case Study Discussion Questions

    Directions: Break into groups of 3-5. Answer each of the questions below.

    1. What are the safety issues for the Johnson family?
    2. What are the strengths and resources of the Johnson family?
    3. Are the basic needs of the family currently being adequately met? If not, what basic needs require immediate attention?
    4. Does the family have contact with social support resources? What other types of (formal and informal) resources would be helpful to the Johnsons?
    5. In addition to safety issues and basic needs identified above, what other unmet needs are present in the Johnson family?

    Instructor Notes:

    Safety Issues:

    1. Drug trafficking occurring in the home and in the presence of children
    2. Children frequently unsupervised
    3. Children in presence of strangers, may be at risk of physical, verbal, and sexual abuse
    4. Children's hygiene and appearance neglected
    5. Children engage in physical altercation with mother
    6. Mother at risk of physical abuse from drug dealers
    7. Mother at risk of arrest for selling food stamps
    8. Mother at risk of arrest for selling drugs
    9. Drugs may be accessible and available to the children

    Strengths of the Family

    1. Mother wants to keep the family together and has managed to do so even through her drug addiction
    2. Mother made an effort to be present for the 1st home visit
    3. Mother has marketable skills and has a history of steady employment
    4. Mother has a connection with formal supports (Social Services)
    5. Mother is resourceful in that she managed to find housing, albeit substandard, for her family

    Basic Needs

    1. Adequate food
    2. Appropriate clothing
    3. Adequate and safe shelter

    Social Support Resources

    1. Family is connected to Police, Protective Services and Social Services (receives food stamps)
    2. Mother has social support network of other drug users and dealers (maybe interpersonal skills could be transferred to appropriate peer group)
    3. Mother may have contacts and resources from her job and lifestyle before she started abusing drugs
    4. Husband may be a resource to wife and children

    Other Family Needs

    1. Drug treatment for mother
    2. Structure and routine for children
    3. Affection and discipline for children
    4. Tutoring and academic support for 13 year old
    5. Day care for younger children
    6. Job training and placement for mother
    7. Recreational activities for family
    8. Adequate income including child support
    9. Health and dental care
    10. Connection to informal support network (neighbors, friends, relatives, extended family)

    Johnson Family Case Study, Part II*
    Ennis Center for Children
    Detroit, Michigan

    When the worker explained to Marilyn that the goal of the Families First intervention was to try to keep families safe and together, Marilyn made a commitment to work with the program. She identified three goals for the intervention: to find new housing, to obtain drug treatment, and to rebuild a relationship with her 13-year-old daughter. The worker helped to alter supervision arrangements so that she was satisfied that the children would be protected without being removed from the home.

    The caseworker encouraged Marilyn to take the initiative in looking for housing; the worker provided such support services as realtor lists and transportation. While driving around looking for housing, they talked. The caseworker actively reinforced Marilyn's determination and motivation and encouraged the positive steps she was taking to regain control of her life. The Families First worker often spent all day, every day, with Marilyn, helping in the search for a new house and securing emergency goods and clothing. Because Marilyn had no money or means of transportation, the worker's provision of these concrete needs was an important part of the intervention process.

    It was impossible for Marilyn to enroll in a drug treatment program until housing and furniture were secured, so the caseworker devised alternatives to help Marilyn refrain from using drugs until her treatment could begin. They worked out several emergency tactics, such as a crisis card with substitute activities, the use of "self-talk," and the 24-hour availability of her caseworker by phone. On a few occasions, when Marilyn relapsed and smoked crack, she was very upset and called her Families First worker to discuss it. Another ongoing concern was the continued drug trafficking in her home. It was difficult for Marilyn to admit the risk to her children posed by the drug sales, but eventually she acknowledged the need to detach herself from her drug-involved friends and environment, as well as from her husband and male friends who remained on drugs.

    Dealing with Marilyn's problems was extremely frustrating for the caseworker, but she drew on the support and encouragement of the Families First program staff. Her supervisor pointed out, "In this past year, our statistics show that approximately 55% of our referrals have had substance abuse as the referral problem and approximately 82% of those cases have been related to crack."

    By the end of the six-week intervention and with the help of emergency funds from the state, Marilyn had moved to a four-bedroom house, complete with furniture, appliances, and utilities. She enrolled in a women's drug treatment facility specializing in the needs of women and their families, including a program for pre-school children to attend along with their mothers. Six months after the program's conclusion, Marilyn's improved sense of self-worth is reflected in her appearance. She has gained weight, dresses fashionably, and uses makeup. Her relationships with her children, especially her 13-year-old daughter, improved dramatically after counseling, and her daughter now attends school every day. Marilyn attends Narcotics Anonymous meetings daily, has learned money-management skills, and is looking forward to working with Vocational Rehabilitation Services and securing a job.

    Case Study Discussion Questions

    Directions: Break into groups of 3-5. Answer each of the questions below.

    1. What intervention roles were carried out with the Johnson family?
    2. Identify other intervention roles that might be appropriate for the Johnson family?
    3. What types of formal and informal social supports would be appropriate for the Johnson family after termination?

    Instructor Notes

    Intervention Roles

    1. Broker
    2. Teacher
    3. Therapist

    Additional Intervention Roles

    1. Advocate - ensuring appropriate educational services for all the children, especially the 13-year-old
    2. Case-management - to continue to identify and coordinate services for the family
    3. Teacher - to continue to teach problem solving and parenting skills, especially as the children develop and move through different developmental stages

    Formal Resources

    1. Vocational Rehabilitation and/or job training program
    2. Mental Health services if appropriate for Mother or children
    3. Social Services for continued financial assistance and food stamps
    4. Public School-to assure adequate progress of 13-year-old daughter and for younger children who will soon enter the public school system soon

    Informal Resources

    1. Establish connections with other parents in her neighborhood
    2. Re-establish and develop new connections with friends and family prior to drug addiction
    3. Connect to family resource center or local family support program with the goal of learning preventative strategies

    *Used with permission. Tracy, E., Haapala, D., Kinney, J., & Pecora, P. (Eds.). (1991). Intensive Family Preservation Services: An Instructional Sourcebook. Cleveland, OH: Mandel School of Applied Social Sciences, Case Western Reserve University


    Additional Resources

    Web Resources:

    Family-Centered Care for Children with Special Health Care Needs
    The Maternal and Child Health Bureau
    http://www.dhhs.gov/hrsa/mchb/family.htm

    What is Family-Centered Care?
    The Association for the Care of Children's Health
    http://www.acch.org/ACCH/aboutus/fcc.htm

    Family-Centered Care: Our Promise to You
    The University of Virginia
    http://www.med.virginia.edu/~smb4v/kcrc/family.htm

    • MCH Public Health - Social Work Leadership Training Program
    School of Social Work
    CB# 3550, 301 Pittsboro Street
    Chapel Hill, NC 27599-3550

    Jordan Institute for Families
    School of Social Work

    Phone: (919) 962-6429
    Fax: (919) 962-0890
    Email: mchphsw@unc.edu

    Beyond 2010 Public Health Social Work Practice This web site was partially supported by the Health Resources and Services Administration, Maternal and Child Health Bureau through grant number T19 MC 00007.