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(BQ) Part 2 book “Case studies in child, adolescent , and family treatment” has contents: Case studies in family treatment and parent training, case studies in child we lf are and adoption, case studies in school and community settings.
3 Case Studies in Family Treatment and Parent Training So many different versions of family exist today A family is increasingly less likely to consist of a mother, father, and 2.2 children Instead, a family may be blended, extended, common law, or single parent Even a single‐parent family may defy our stereotypes, being made up of a single father and his son, as in one of the case studies in this section Families may be part of a majority culture, or they may have roots in a different culture that influences their dynamics and actions Regardless of their structure, families consist of human beings who coexist and interact Just as there are a plethora of family models, there are myriad ways of approaching family treatment Thompson and Rudolph (2011) point out the similarities within the various models of family treatment First, they note that within most schools of family treatment, the entire family system may need to change in order for lasting behavioral change to occur Second, family therapy encompasses the goal of finding a more comfortable balance of power and roles within the system Third, in order to achieve new balance, the current dysfunctional patterns may need to be disturbed The practitioner 182 Case Studies in Family Treatment and Parent Training 183 must ensure that this process is safe for all family members Finally, family therapy borrows from all other approaches to mental health treatment Family treatment is particularly crucial in the resolution of problems with children and adolescents, as this population is practically completely dependent on their families for physical, emotional, and social support In fact, on reflection, almost every case study in this book contains some aspect of working with the client’s family, in the many different guises that family takes There are three case studies in this chapter In the first, Gladow, Pecora, and Booth offer a moving portrait of the great strides made by a family composed of a single father and his son The family presents with a history of conflict and is referred to the HOMEBUILDERS program, which is designed to prevent unnecessary out‐of‐home placement for children from multiproblem families In the next case study, Magen relates the development and evaluation of a parent training program designed for families who have been referred to a social service agency by Child Protective Services The author describes and demonstrates the challenges in forming a group of parents, keeping group members engaged, and using parent partners (“buddies”) for mutual support among parents struggling with similar issues of raising children In the final case study, Jones Harden and colleagues describe the parent’s role in intervening with very young children using an infant mental health approach that targets the caregiver‐infant dyad The Attachment and Biobehavioral Catch‐up treatment delivered in the home by a parenting coach connects with the daily life stressors and risks faced by a Latino mother of three children These studies of family treatment, each so different, all share elements of the importance of the family bond in children’s lives REFERENCE Thompson, C., & Rudolph, L (2011) Counseling children (8th ed.) Pacific Grove, CA: Brooks/Cole 184 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT CASE STUDY 3‐1 HOMEBUILDERS®: HELPING FAMILIES STAY TOGETHER Nancy Wells Gladow Peter J Pecora Charlotte Booth Intensive in‐home services are a powerful social work tool for helping families This case study illustrates the use of goal setting and relationship building, which are critical in the HOMEBUILDERS model of home‐based treatment Questions for Discussion What are some examples of relationship building used in this case? How did the social worker intervene to reduce conflicts between the father and son? What is a teachable moment, and how was this incorporated into the treatment? What are some of the advantages and disadvantages of a home‐based treatment model? The following case involves conflict between a single‐parent father and his 13‐year‐old son The treatment agency is the HOMEBUILDERS® Program of the Institute for Family Development (IFD), headquartered in Federal Way, Washington HOMEBUILDERS is an intensive, home‐ based family preservation services program Through child welfare and children’s mental health system contracts, IFD provides HOMEBUILDERS to families who are at imminent risk of having one or more children placed outside of the home in foster, group, or institutional care Home‐based family preservation programs now exist in many states and other countries Although theoretical approaches, clinical techniques, caseloads, and length of treatment vary from program to program, the goal of these programs is the same: to prevent unnecessary removal of children from their home and to help multiproblem families cope with their situations more effectively (Allen & Tracy, 2009; Nelson, Walters, Schweitzer, Blythe, & Pecora, 2008; Walton, Sandau‐Beckler, & Mannes, 2001) Although some models of family Case Studies in Family Treatment and Parent Training 185 preservation have not been tested, research evidence suggests that programs with high fidelity to the HOMEBUILDERS model can result in a cost savings to the state (Miller, 2006) HOMEBUILDERS is an intensive model, with a time frame of four to six weeks per family and a caseload of two families per therapist Therapists provide an average of 38 hours of face‐to‐face and phone contact to each family The program is a skills‐oriented model that is grounded in Rogerian, ecological, and social learning theories The intervention involves defusing the immediate crisis that led to the referral, building a relationship with the family, assessing the situation and developing treatment goals in partnership with the family, and teaching specific skills to help family members function more effectively and achieve these goals Evaluations of HOMEBUILDERS indicate that the program is highly effective in reducing out‐of‐home placements and increasing the coping abilities of family members (Fraser, Pecora, & Haapala, 1988; Haapala & Kinney, 1988; Kinney, Madsen, Fleming, & Haapala, 1977) Evidence also shows that the model can decrease racial disproportionality in the child welfare system (Kirk & Griffith, 2008) In Washington State, referrals are made to HOMEBUILDERS primarily through Child Protective Services (CPS) and Family Reconciliation Services (FRS), which are two subunits of the public child welfare agency In CPS cases, the state worker determines that placement of one or more of the children outside of the home will occur if the family does not make immediate changes to ensure the safety of their children In FRS cases, either parents or children have requested out‐of‐home placement for the child because of severe family conflict or child behavior problems In one region of the state, referrals are also made through the mental health system, with the goal of preventing psychiatric hospitalization CASE OVERVIEW The following case study highlights some of the HOMEBUILDERS treatment philosophy and techniques with an atypical, but increasing, type of case situation: a single‐parent father and his son However, this case was similar to most cases in that the family had a history of family problems and conflict In this case, the child had no previous out‐of‐home placements, but 49 percent of HOMEBUILDERS clients have already experienced previous placement Selected client sessions are described for each of the four weeks of 1866 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT service All of the names and identifying information have been changed to protect the family’s privacy Because of space considerations, the three contacts and work with the boy’s mother are omitted, along with the contacts made with the school psychologist and other school personnel In addition, a considerable amount of time was spent working with the father regarding his use of marijuana, which was not interfering with his job performance but was a concern to his son Interventions such as working with a local church and Narcotics Anonymous were attempted (with some success) but will not be discussed in order to focus on the therapist interventions regarding client relationship building, chore completion, school behavior, and anger management INTERVENTION Week One: Gathering Information, Relationship Building, and Setting Treatment Goals It was 7:30 p.m as I drove up for the first time to the Barretts’ small three‐ bedroom house located in a working‐class neighborhood The referral sheet from the FRS caseworker said Dick Barrett had been a technician for a large manufacturer in Seattle for 10 years and that his 13‐year‐old son, Mike, was in seventh grade FRS became involved after Mike had told his school counselor that his father had been smoking marijuana for 15 years (This was the first time that the state had come into contact with his family.) Mike said he hated drugs, was tired of his father’s constant yelling, and wanted to be placed outside of the home He also said he was afraid of his uncle, who had been living with the family for two months The school counselor had already been concerned about Mike, a seventh grader for the second year, who frequently neglected to turn in his homework and disrupted class by swearing at both students and teachers Mike had already been suspended twice that semester The referral sheet said that Dick voluntarily agreed to have the uncle move out and to quit using drugs, although he was unwilling to begin a drug treatment program It also said the family had tried counseling several months ago through a local agency, but Mike had disliked the counselor and refused to continue Dick, a tall man around 50 years old, opened the door soon after I rang the bell Dick invited me to sit at the kitchen table and called for Mike to join us The family cat jumped on my lap Dick and I began chatting about Case Studies in Family Treatment and Parent Training 187 cats as Mike slowly walked into the kitchen, looking at the ground and making grumbling sounds Mike smiled when he saw Tiger sitting on my lap and being scratched under the chin Mike began to tell me stories about Tiger, and I responded with interest and a funny story about my own cat I felt no pressure to hurry the counseling session along, as taking time for small talk and showing interest in what was important to family members was a key element of relationship building that would be the foundation of any later success in confronting clients and teaching new behaviors Dick began to discuss the difficulties his family had been experiencing He said he was upset about Mike’s behavior problems and lack of motivation in school Dick said he had tried everything he knew to get Mike to improve but with no success As Dick talked, I listened reflectively, paraphrasing parts of the content and feelings that Dick was expressing For example, when Dick said, “Mike does not even try to improve his behavior in school,” I responded with, “It is frustrating for you that Mike does not seem to want to improve.” After Dick spoke about Mike’s abilities being much higher than his actual achievement, I said, “So it seems pretty clear that Mike has a lot more potential than he is using.” Reflective or active listening serves several purposes First, it helps family members deescalate their emotions As they tell their stories and begin to feel that someone understands, they calm down and are more likely to be able to take constructive steps to improve their situation Second, by conveying understanding, active listening helps build up a positive client‐ therapist relationship Third, active listening helps the therapist gain more information about the family without having to ask a lot of questions People frequently expand on their stories when the therapist is listening reflectively Asking many questions seems to limit what people say, and it creates the impression that the counselor is the expert who will “do something to” the family With HOMEBUILDERS clients, it works better to recognize and treat clients as partners in the counseling process Clients have more information about their lives than does the therapist, and their active participation in the change process is crucial However, sometimes asking a few key questions at the right time is the most efficient way to gain behaviorally specific information For example, in this situation, I wanted to know just what Mike’s grades were (He was in three special education classes and was earning one B and two Cs in those In his other classes he was earning two Fs and a D.) 1888 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT As Dick talked, Mike remained silent, although his facial expressions and body movements frequently suggested anger toward his father “You not look too pleased, Mike,” I said “What you think about all this?” Again I listened reflectively as Mike began to talk about how he hated school and his father’s frequent yelling Mike told stories about several arguments he and his father had that resulted in both of them swearing and saying things calculated to hurt each other Dick agreed that this was true I summarized, “So learning how to fight less and deal with your anger constructively is something both of you might like?” They both nodded Dick went on to say, “Mike makes me so angry If he would not say some of the things he does, I would not get so mad.” (I thought to myself that Dick could benefit from learning a basic principle about anger: No one can makee you angry; you are responsible for your own anger I did not mention my thought at this point, however, because pointing out errors in thinking and teaching too soon before there has been time for sufficient information gathering and relationship building is often ineffective.) “You have mentioned that you argue a lot more than either of you would like Tell me what kinds of things you argue about,” I requested Dick described frustration about trying to get Mike to chores around the house, saying if Mike was not willing to help, he would prefer Mike find somewhere else to live Mike complained that his Dad was always ordering him around Dick had been working especially hard lately to fix up the house so that it could be sold in a few months and finances between him and Mike’s mother could be resolved Dick and his ex‐wife had gone through a difficult divorce years ago after 28 years of marriage and four children, the older three being over 18 years of age and currently living on their own Through mutual agreement, Dick had received custody of Mike “I get the picture from the caseworker that drugs have been a big issue in your family,” I commented Dick described how he had been smoking marijuana for about 15 years He said he had also gotten into “some other things” during the time his brother‐in‐law, Mike’s uncle, had been living there Dick said once the school and the caseworker became involved, he realized it was important to have his brother‐in‐law move out, which he had done Dick said he had stopped using other drugs and had also voluntarily stopped using marijuana a few days ago Dick stated that he respected Mike’s right to live in a drug‐free home and that he thought it would benefit himself as well to stop his drug use “I can’t afford to get fired if my work finds out about this,” Dick commented Case Studies in Family Treatment and Parent Training 189 “What you think about this, Mike?” I asked Mike remained silent “If I were you, I might be a little worried that my Dad was not really going to quit using drugs,” I said “Is that anything like you are feeling, or am I way off base?” Mike opened up a little to say that his Dad had said he would quit before and had never stuck with it Mike talked about how his siblings all use drugs and how he had been scared when, three years ago, some “bikers” had come to the house to get his oldest sister to “pay up” on some drugs Mike said he also worried about having his father’s health go downhill from drug use I could tell from Dick’s expression that this was probably the first time he had heard Mike express these concerns openly Soon it appeared that Mike was getting tired, and it was time to end this 2½‐hour initial session (about the average amount of time for a first‐session HOMEBUILDERS program) I explained more of the specifics of the HOMEBUILDERS program and gave them my home phone number as well as the backup phone numbers of my supervisor and our beeper All of this is an effort to be available to clients 24 hours a day, days a week I then summarized the session in terms of treatment goals “It sounds like what you two most want help on is (1) working out a way to build in more cooperation on household chores; (2) learning how to fight less and to deal with anger more constructively; (3) Dick, you’re receiving support in your efforts to be drug‐free; and (4) improving your school performance, Mike Is that how you see it?” They both nodded Summarizing in this way checks my perception of the family’s priorities for change and also gives direction for future counseling sessions In this intake session with the Barretts, it was easier to establish goals than it is with many families There is really no rush to determine all four treatment goals (a typical number for a four‐week intervention) at the intake session, although HOMEBUILDERS therapists generally try to have one or two goals established by the end of the first week The last thing I did during the first visit was to set up individual appointments with Dick and Mike Unless family members are opposed to them, individual meetings can be helpful initially to gather additional information and continue building relationships Later, one‐on‐one sessions can facilitate work on each person’s goals I gave Mike a sentence‐completion sheet to fill out for our next session and checked to make sure he understood how to it When I came back two days later to pick up Mike for our individual session, he was listening to his stereo I listened to a few songs with him As we drove to McDonald’s, we talked about various musical groups and 190 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT our favorite TV shows He seemed to be feeling much more comfortable with me by the time we sat down with our Cokes and French fries I looked over the sentence completion sheet, which included sentences such as “My favorite subject in school is _,” “In my spare time I like to _,” and “I feel angry when _.” Instead of asking Mike a lot of questions, which teenagers frequently dislike, I read some of his answers in a tone of voice that encouraged him to expand on the topic When he did, I listened reflectively to his responses, and he frequently elaborated even further I learned that he was especially upset about his father yelling at him on a daily basis When his father yelled, Mike found himself quickly feeling angry and sometimes yelling back I reflected Mike’s feelings of worry, embarrassment, fear, and anger about his father’s use of drugs I also checked out with him what kind of system they used at home regarding who did what household chores and if Mike earned an allowance (I was thinking that coming up with a mutually‐agreed‐on chore system might be the first goal we would tackle because it was so important to Dick and was a goal with which we were likely to make concrete progress.) Mike said there was no system—his dad just gave orders and Mike either complied or didn’t I suggested a system whereby he earn an allowance for doing certain agreed‐on chores, and I asked what he thought a fair allowance would be, assuming his father would approve of this plan He said the plan sounded agreeable and suggested $15 per week I gave Mike an assignment to complete before the next meeting He was to write down (1) two things he’d like to be different in his family; (2) two things he could to help get along better with his dad; and (3) two things his dad could to help them get along together better My appointment with Dick alone began with his showing me the work he had done around the house to get it ready to sell This led him to talk about his past marriage with Rita, his feelings about the marriage ending, and how Mike had gone back and forth between their homes for almost two years up until about a year ago Dick thought some of Mike’s troubles were related to his going from home to home, plus the pressure of Dick and Rita’s continual fighting After an hour of active listening to these subjects, I felt pleased that Dick was opening up, warming up to me, and appearing relieved to get some of these things off his chest When he brought up his older children’s drug involvement, I saw it as an opportunity to gently begin talking about his own drug use (This is an example of a teachable moment—a time when clients may be particularly receptive to learning because they can Case Studies in Family Treatment and Parent Training 191 see the relevance of it in their lives.) We then spent some time discussing this issue and developing a plan of action Before ending the session, I introduced the idea of having Mike’s chores be based on allowance Dick’s reaction was positive, saying he thought more structure would be helpful I noted two benefits to such a system: (1) Mike would experience the consequences of his actions, and (2) it would reduce the number of times Dick would need to tell Mike what to Mike had developed a tendency to blame much of his behavior on others rather than taking responsibility for his actions In addition, like most teenagers, Mike hated to be told what to do, yet their previous system was based completely on Dick giving daily instructions We briefly discussed what he thought a reasonable allowance would be We agreed to negotiate this new system with Mike at the next session I also gave Dick the same homework assignment I had given Mike Week Two: Active Work on Goals As Mike, Dick, and I sat down together in the living room, I asked how things were going Meetings often start in this way, as events may have recently occurred that need to be discussed or worked out before clients will be able to concentrate on the current agenda When I asked if they had done their homework, Dick had and Mike hadn’t Dick agreed to something else for a few minutes while I helped Mike complete the questions Then both of them told what they would like to be different in their family Dick said he would like anger to play less of a role and for the home to be drug free Mike said he would like less arguing and to go places together more In discussing what each person thought he could differently, Dick said he could try not to get angry when he was frustrated, and he could also be more consistent with Mike Mike said he could help more around the house and try not to get angry so much On the subject of what the other person could do, Dick said Mike could be more responsible with housework and schoolwork Mike said his dad could stay off drugs and yell less I took this opportunity to talk about how problems in a family are almost never one person’s fault and how each family member can things that can help the other family members I also noted the similarities in the changes they wanted and stated that I had some ideas that might help them with some of these changes 374 SUBJECT INDEX Child welfare (continued ) case studies in, 236–294 Child Protective Services role in, 183, 185, 203–205, 224, 227, 237, 278, 350 discussion about, 239, 251, 252– 253, 254, 256, 257, 258, 263, 277, 289 family reunification in, 263, 267– 276, 279 family treatment addressing, 184–185, 203–205, 224, 227, 250–259, 260, 268–276 financial support for, 248–249 foster care as permanent placement in, 277–288 goal setting for, 256–257, 268, 272–273 homeless youth involvement in, 348, 350–351 individual treatment addressing, 256–257, 259, 260, 267, 274 juvenile justice overlap with, 249, 264, 275, 287 NTU psychotherapy addressing, 239, 240–262 residential treatment in, 263–274, 287 school/academic issues related to, 249, 259, 260, 261, 267, 274, 283 substance abuse issues impacting, 246, 249, 261, 265, 273 suicide attempts and ideation considered in, 265, 278 wrap-around services in, 237, 282 Cochrane Library, 206 Cognitive-behavioral therapy (CBT): assessment prior to, 75–78 brief, 64–71 cognitive restructuring as, 121–123 conduct disorders addressed using, 110, 111, 119–124, 126–127 motivational interviewing integration with, 72, 79–80 reattribution in, 121 relapse prevention as, 82 residential treatment including, 110, 111, 119–124, 126–127 sexually abusive youth in, 88, 100– 102 substance abuse addressed using, 72, 80–83 testing the evidence skills in, 121 thinking error patterns in, 121–122 trauma-focused, 101, 127 Community settings Seee School and community settings Complimenting, 38–39 Concerta, 90 Conduct disorders Seee Behavior and conduct problems CRAFFT, 75 Crisis intervention: assessment in, 47–54, 55–56 client’s responses and transference in, 57 cultural issues considered in, 47–48, 51–54, 56, 58–59 depression addressed using, 45–61 development issues considered in, 46, 47, 49–51 discussion about, 45 goal setting in, 58–59 hypothesis testing in, 55–56 intervention planning for, 59–60 parental role in, 58, 59–60 pretherapy intervention in, 54–55 strengths focus in, 53, 55 therapist-client interactions in, 56–57 Cruz, Rubin (case study), 30–43 Subject Index Cultural diversity: acculturation, 147 assessment of cultural impacts, 47–48, 51–54 cultural assimilation, 300, 302 cultural identity, 156, 158–159 cultural intelligence, 239–240 culturally grounded empowerment groups, 131, 145–159 culturally sensitive NTU psychotherapy, 239, 240–262 gender and, 147, 155, 156–157, 159, 300 Hmong culture, 299–310 language and, 146–147, 221–222, 224 minority youth and (seee Minority youth) religious and spiritual, 52, 53, 56, 58–59, 174, 176, 177, 239, 240– 262, 309 school and community-based interventions addressing, 297, 299–310, 328–344 socioeconomic, 27, 146, 153–154, 179, 221–223, 298, 328–344, 346–362 therapist’s cultural competence with, 127, 237, 302, 304–310, 347–362 Culturally grounded empowerment groups: case study of, 131, 148–159 clinical considerations of culture in, 146–148 cultural identity discussion in, 156, 158–159 demographics of Latinos/as, 145–146 discussion about, 145, 158–159 Freirian Liberation theory as basis of, 148–149 375 gender role considerations in, 147, 155, 156–157, 159 language considerations in, 146–147 reframing in, 153 strengths focus in, 147–158 Department of Social Services, U.S., 247–249 Depression and depressive disorders: assessment of, 47–54, 55–56 bullying leading to, 320 case study on, 3, 45–61 client’s responses and transference in treating, 57 crisis intervention for, 45–61 cultural issues considered with, 47–48, 51–54, 56, 58–59 development issues impacting, 46, 47, 49–51 discussion about, 45 goal setting in treating, 58–59 hypothesis testing about, 55–56 intervention planning for, 59–60 medication for, 58 parental, 223, 224, 269, 270, 289– 290 parental role in addressing, 58, 59–60 pretherapy intervention for, 54–55 prevalence of, school/academic impacts of/on, 46, 50 therapist-client interactions in treating, 56–57 trauma and victimization as cause of, 93, 320 Developmental issues: ADHD treatment impacted by, 12–14, 15–16, 17, 19–24 behavior problem treatment impacted by, 32–33 3766 SUBJECT INDEX Developmental (continued ) brief cognitive-behavioral therapy addressing, 64–71 depression treatment impacted by, 46, 47, 49–51 developmental play groups consideration of, 131, 162–173 foster care threats to healthy development, 280–281, 283–284 individual treatment and assessment impacted by, 3, 12–14, 15–16, 17, 19–24, 32–33, 46, 47, 49–51, 64–71, 87, 91–92, 93, 98, 102 infant mental health intervention consideration of, 220 school and community-based intervention consideration of, 297, 301–302, 304, 306, 310, 330–331 sexually abusive youth treatment consideration of, 87, 91–92, 93, 98, 102 Developmental play groups: activities in, 164–165, 170 assessment of participants in, 167– 168, 172 beginning phase of, 166–167 checkup for hurts in, 164 creation and function of, 162–163 discussion about, 162, 172–173 ending phase of, 170–171 feelings check in, 164 food share in, 165 group process in, 163–166 group treatment as, 131, 162–173 limits testing and setting in, 165– 166, 168–169, 170–171 middle phase of, 168–169 parental role in, 163 participants in, 162, 166–167 purpose of, 162 reading/storytime in, 165 Theraplay® foundations of, 163, 164 Dissociation, 90, 94 Drugs Seee Medication; Substance abuse Early Head Start, 220, 221, 223, 224–233 Earthforce, 341 Eating disorders, Educational settings Seee School and community settings Empowerment groups Seee Culturally grounded empowerment groups; Neighborhood Explorers program Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR), 97 Eyberg Child Behavior Inventory, 207–208, 217 Families and parents See also Children and adolescents bullying responses involving, 313, 315–317, 318–319 case studies involving (seee Case studies, by name; Case studies, by topic) child welfare and adoption addressing issues facing, 183, 184–185, 203–205, 224, 227, 236–294, 348, 350–351 crisis intervention role of, 58, 59–60 culturally diverse (seee Cultural diversity; Minority youth) developmental play group role of, 163 engagement strategies with, 31–33, 226–227 family treatment and parent training for, 88, 127, 182–233, 250–259, 260, 268–276 Subject Index GLBT youth relationships with, 176, 177, 178–179 individual treatment and assessment including, 7–28, 29–43, 58, 59– 60, 72–78, 88, 101, 127 low-income, 27, 146, 153–154, 179, 221–223, 298, 328–344, 346–362 mental disorders impacting (see Mental disorders) parent-child attachment, 25, 27, 183, 219–220, 225–232, 280, 290 reunification of, 263, 267–276, 279 solution-focused therapy involving, 29–43 structural family therapy for, 8–9 substance abuse among, 77, 186, 188–189, 190–191, 196, 199, 246 Family Reconciliation Services (FRS), 185 Family reunification: child welfare addressing, 263, 267– 276, 279 debate of best decisions about, 271–276 discussion about, 263 Family Service Agency (FSA), 203 Family treatment and parent training: anger management in, 186, 188, 189, 191, 193–195, 196–197, 198, 199–200, 224 Attachment and Biobehavioral Catch-up as, 183, 221, 225–232 benefits and challenges of, 182–183 case studies in, 182–233 child welfare issues leading to, 184–185, 203–205, 224, 227, 250–259, 260, 268–276 conduct disorders addressed using, 127 377 discussion about, 184, 203, 219 engagement in, 226–227 evidence-based approach to, 183, 203–217 funding sources for, 205, 225 goal setting in, 189, 191–195, 209, 272–273 HOMEBUILDERS program as, 183, 184–201 homework assignments in, 189–190, 191, 209, 211, 212–213, 216 I-messages used in, 198–199 individual meetings in, 189–191, 195, 196–197, 199, 212, 213 infant mental health intervention as, 183, 219–233 information gathering in, 187–188 manuals/materials developed for, 207, 225 NTU psychotherapy as, 250–259 parent training programs as, 183, 203–217 reflective listening in, 187–188, 190, 195, 199 reframing in, 268 relationship building in, 186–187, 189–190 role-playing in, 200, 253, 254 school/academic issues addressed in, 186, 187, 195, 196, 199–200 sexually abusive youth in, 88 substance abuse addressed in, 186, 188–189, 190–191, 196, 199 Foster care, growing up in: adoption as goal vs., 281, 285–286 aging out of, 288 child welfare leading to, 277–288 discussion about, 277 family history leading to, 278–280 family reunification vs., 279 3788 SUBJECT INDEX Foster care (continued ) group care facilities instead of, 286–287 juvenile justice overlap with, 287 multiple placements in, 281–285 residential treatment instead of, 287 school/academic impacts of, 283 threats to healthy development from, 280–281, 283–284 Freirian Liberation theory, 148–149 GLBT (gay, lesbian, bisexual, transgender) youth: assessment or screening of, 175–176 discussion about, 174 drop-in youth center for, 131–132, 174–181 environmental impacts on, 178–181 families of, 176, 177, 178–179 group work with, 175–176 homelessness among, 179 listening to, 176–178 religious issues for, 174, 176, 177 school challenges and support for, 177–178, 179 suicide attempts and ideation among, 177, 179 Goal setting: behavior problems addressed using, 41–43 brief cognitive-behavioral therapy including, 67 crisis intervention including, 58–59 depression addressed using, 58–59 family treatment and parent training including, 189, 191–195, 209, 272–273 homeless youth work including, 357–359 NTU psychotherapy including, 256–257 residential treatment including, 268, 272–273 scaling questions for, 41–43 solution-focused therapy including, 41–43 Group treatment: active pacing in, 130–131 benefits and challenges of, 130–132 case studies in, 130–181 culturally grounded empowerment through, 131, 145–159 developmental play groups as, 131, 162–173 discussion about, 133, 136–137, 145, 158–159, 162, 172–173, 174 GLBT drop-in youth center as, 131–132, 174–181 group formation for, 134–135 homework assignments in, 139–140, 143 parental role in, 163 parent training programs as, 183, 203–217 participation of members in, 131 reframing in, 153 role-playing in, 134, 137–138, 142–143 social skills training as, 131, 133– 144 HOMEBUILDERS program: anger management in, 186, 188, 189, 191, 193–195, 196–197, 198, 199–200 child welfare issues addressed through, 184–185 discussion about, 184 family treatment through, 183, 184–201 format of, 185 Subject Index goal setting and achievement in, 189, 191–195 homework assignments in, 189–190, 191 I-messages used in, 198–199 individual meetings in, 189–191, 195, 196–197, 199 information gathering in, 187–188 participants in, 185–186 reflective listening in, 187–188, 190, 195, 199 relationship building in, 186–187, 189–190 role-playing in, 200 school/academic issues addressed in, 186, 187, 195, 196, 199–200 setbacks addressed in, 199–200 substance abuse addressed in, 186, 188–189, 190–191, 196, 199 week one intervention in, 186–191 week two intervention in, 191–195 week three intervention in, 195–199 week four intervention in, 199–200 Homeless youth: background of, 346–351 boundaries when working with, 355 building relationships with, 353–354 child welfare system involvement with, 348, 350–351 community-based interventions for, 298, 346–362 compassion fatigue from working with, 352 constant learning when working with, 360–362 discussion about, 346, 351–353 GLBT youth as, 179 goal setting among/with, 357–359 helping to help selves among, 354 homelessness defined, 348 379 juvenile justice involvement of, 348, 349–350 needs addressed for, 355–358, 359 number of, 348–349 parental/familial issues for, 349–351 program decisions and consistency working with, 357–358 school/academic issues for, 349–350, 351 substance abuse among, 348, 351 survival mode for, 346–347, 347– 348, 350, 359 therapist’s cultural competence with, 347–362 How I Think Inventory (HIT), 117 I-messages, 198–199 Individual treatment and assessment: ADHD addressed in, 2, 5–28 behavior problems addressed in, 2–3, 29–43 benefits and challenges of, 1–3 brief cognitive-behavioral therapy as, 64–71 case studies in, 1–128 child welfare issues leading to, 256– 257, 259, 260, 267, 274 cognitive-behavioral therapy as, 64– 71, 72, 80–83, 88, 100–102, 110, 111, 119–124, 126–127 commitment to self and others in, 25–26, 27–28 complimenting in, 38–39 confrontational styles in, 115–116 coping questions in, 31 crisis intervention as, 45–61 depression addressed in, 3, 45–61 developmental changes impacting, 3, 12–14, 15–16, 17, 19–24, 32–33, 46, 47, 49–51, 64–71, 87, 91–92, 93, 98, 102 380 SUBJECT INDEX Individual treatment (continued ) discussion about, 5, 24–28, 29–30, 45, 64, 72, 86 engagement in, 30–35 exceptions identification in, 35–38 exceptions reinforcement techniques in, 39–43 first session in, 6–9, 65–68, 112 funding sources impacting, 110– 111, 116 goal setting in, 41–43, 58–59, 67 hypothesis testing in, 55–56 medication as element of, 12, 17, 19, 20, 21, 23, 58, 90, 118, 127 minority youth in, 3, 27, 40, 45–61, 127 miracle question in, 40–41 motivational interviewing as, 72, 79–80, 101, 110, 111, 113–115, 118–119, 123, 126 multisystemic therapy as, 100–101 normalizing in, 32–33 1-2-3 Magicc approach in, 8–9 parental/familial role in, 7–28, 29–43, 58, 59–60, 72–78, 88, 101, 127 parent-child attachment impacting, 25, 27 pretherapy intervention in, 54–55 reframing in, 32, 113–114 residential treatment as, 3, 110–128 role-playing in, 39–40, 124, 125–126 scaling questions in, 41–43 sexually abusive youth in, 3, 86–102 skill building as, 124–126 solution-focused therapy as, 29–43 strengths focus in, 20–24, 26–27, 28, 32, 43, 53, 55, 64–65, 90 structural family therapy approach in, 8–9 substance abuse addressed in, 3, 72–83 trauma-focused cognitive-behavioral therapy for, 101, 127 trauma-informed approaches to, 88, 99, 100–102, 127 treatment team for, 18 Infant mental health intervention: Attachment and Biobehavioral Catch-up as, 183, 221, 225–232 background of, 219–221 case overview for, 221–224 child-caregiver attachment addressed using, 183, 219–220, 225–232 child welfare issues leading to, 224, 227 discussion about, 219 Early Head Start including, 220, 221, 223, 224–233 engagement in, 226–227 implementation of, 227–232 positive parenting promotion through, 183, 219–233 termination of, 231–232 Institute for Family Development (IFD), 184 Inventory of Callous and Unemotional Traits (ICU), 90, 96 Jake (case study), 64–71 Joshua (case study), 88–102 Judy (case study), 346–362 Juvenile justice involvement: behavior and conduct disorders as cause of, 110–128 case studies on, 3, 72–74, 87–88, 110–128 child welfare overlap with, 249, 264, 275, 287 homelessness leading to, 348, 349–350 Subject Index mental health issues addressed through, 110–111 sexually abusive youth in, 3, 87–88 substance abuse as basis for, 3, 72–74 Juvenile Sex Offender Assessment Protocol (J-SOAP-II), 95–96, 97 Karen (case study), 277–288 Low-income youth and families: ADHD treatment among, 27 demographics of, 328–329 family treatment for, 221–223 homeless youth as, 179, 298, 346–362 minority youth as, 27, 146, 153–154, 221–223, 298, 328–344 school and community support and interventions for, 27, 298, 328–344, 346–362 Madison (case study), 312–323 Medication: ADHD, 12, 17, 19, 20, 21, 23, 90 antidepressant, 58 anxiety, 118 conduct disorder medication management, 127 Mental disorders: antisocial behavior as, 93, 100 anxiety and anxiety disorders as, 1, 93, 118, 223, 280, 289–290, 307, 309, 320 attention-deficit hyperactivity disorder as, 1–2, 5–28, 90, 95, 280 behavior and conduct problems as, 2–3, 29–43, 93, 100, 110–128, 280–281, 282–287 depression and depressive disorders as, 2, 3, 45–61, 93, 223, 224, 269, 270, 289–290, 320 381 dissociation as, 90, 94 eating disorders as, posttraumatic stress disorder as, 90, 93, 96, 101, 280 sexual abusiveness as, 3, 86–102 substance abuse as, 3, 72–83, 186, 188–189, 190–191, 196, 199, 246, 249, 261, 265, 273, 348, 351 Minnesota/Texas Adoption Research Project, 291 Minority youth See also Cultural diversity African-American, 3, 45–61, 127, 237, 246–262, 280, 328–344 anxiety in, 307, 309 Asian-American (Hmong), 297, 299–310 behavior and conduct disorders in, 40, 127 child welfare and adoption among, 237, 246–262, 280 culturally grounded empowerment groups for, 131, 145–159 depression in, 3, 45–61 family treatment for, 183, 221–233 gender roles among, 147, 155, 156–157, 159, 300 GLBT, 131–132, 174–181 group treatment for, 131–132, 145–159, 174–181 individual treatment and assessment for, 3, 27, 40, 45–61, 127 language among, 146–147, 221–222, 224 Latino/Latina, 40, 131, 145–159, 183, 221–233, 328–344 low-income, 27, 146, 153–154, 221–223, 298, 328–344 religion among, 52, 53, 56, 58–59, 174, 176, 177, 309 382 SUBJECT INDEX Minority youth (continued ) school and community-based interventions for, 297, 299–310, 328–344 suicide attempts and ideation among, 45–61, 177, 179, 302, 304–305 Mirabel (case study), 221–233 Miracle question, 40–41 Motivational interviewing: agreeing with a twist in, 114 conduct disorders addressed using, 110, 111, 113–115, 118–119, 123, 126 personal choice and control emphasis in, 114 reflective listening in, 113 reframing in, 113–114 residential treatment including, 110, 111, 113–115, 118–119, 123, 126 sexually abusive youth in, 101 shifting the focus in, 113 substance abuse addressed using, 72, 79–80 Multisystemic therapy (MST), 100–101 National Alliance on Mental Health, 110 National Institute of Mental Health, National Outdoor Leadership School (NOLS), 22 Neighborhood Explorers program: community defined and described in, 332–333 data analysis in, 337–339 demographics of youth in, 328–329 development and capacity to participate in, 330–331 evidence creation and use in, 334–337 good graffiti project in, 342–343 group formation and exploration in, 331–334 idea advocacy and agreement in, 339 neighborhood cleanups involving, 341–342 photovoice method in, 335–339 planning and action days in, 340–343 power map use in, 335 practitioner reflections on, 334, 339–340, 344 strengths and empowerment focus in, 298, 328–344 New Freedom Commission on Mental Health, Normalizing, 32–33 NTU psychotherapy: actualization in, 243, 245, 255, 258 alignment in, 242–243, 245, 253–254, 255 awareness in, 242, 244–245, 251, 253 case management update after, 259–261 child welfare addressed using, 239, 240–262 concerns and barriers to success of, 249–250 discussion about, 239, 251, 252–253, 254, 256, 257, 258 family situation leading to, 246–249 goals and tenets of, 240–241 goal setting in, 256–257 harmony in, 241, 242, 244, 250, 251 inspiration used in, 240–241 intervention needs to be addressed by, 249 phases and techniques of, 241–246 Subject Index Progressive Life Center establishment of, 240, 241, 247–249, 261–262 role-playing in, 253, 254 synthesis in, 243, 245–246, 257, 259 termination of, 258–259 therapy sessions in, 250–259 O family (case study), 246–262 Olweus Bully Prevention Program, 323 1-2-3 Magicc approach, 8–9 Parents Seee Families and parents Parents and Friends of Lesbians and Gays (PFLAG), 178 Parent training programs: assessment of participants of, 207–209, 217 child welfare referrals to, 203–205 demographics of participants in, 204, 208–209, 215 discussion about, 203 evidence-based approach to, 183, 203–217 goal setting in, 209 group design for, 205–207 group formation and process in, 209–217 homework assignments in, 209, 211, 212–213, 216 manuals/materials developed for, 207 postgroup interviews for, 217 questionnaires used in, 210, 211, 214, 215, 216 recruitment of participants for, 207 Pharmacological treatments See Medication Phoenix Youth Resource Center, 356 Photovoice method, 335–339 Play: 383 developmental play groups for, 131, 162–173 infant mental health intervention focus on, 227–232 Positive Achievement Change Tool (PACT), 117 Positive Youth Development approach, 329, 346, 347, 352, 353, 354, 357, 361–362 Posttraumatic stress disorder (PTSD): child welfare participants with, 280 sexually abusive youth with, 90, 96 trauma and victimization as cause of, 93 trauma-focused cognitive-behavioral therapy for, 101 Preschool and Kindergarten Behavior Scales (PKBS-2), 167–168, 172 Progressive Life Center, 240, 241, 247–249, 261–262 Prozac, 118 Psychopathy Check List - Youth Version (PCL:YV), 95 Racial and ethnic minorities See Minority youth Rational-emotive therapy (RET), 197 Reflective listening: family treatment including, 187– 188, 190, 195, 199 motivational interviewing including, 113 residential treatment including, 113, 266 Reframing: culturally grounded empowerment groups using, 153 family treatment using, 268 motivational interviewing using, 113–114 384 SUBJECT INDEX Reframing (continued ) school and community-based interventions using, 306, 359 solutions-focused therapy using, 32 Religion and spirituality: crisis intervention consideration of, 52, 53, 56, 58–59 GLBT youth issues related to, 174, 176, 177 school-based intervention consideration of, 309 spiritually-based NTU psychotherapy, 239, 240–262 Residential treatment: benefits and challenges of, 263–266 child welfare issues leading to, 263– 274, 287 cognitive-behavioral therapy as, 110, 111, 119–124, 126–127 conduct disorders addressed using, 3, 110–128 family reunification from, 263, 267–276 family treatment and, 127, 268–276 goal setting in, 268, 272–273 medication management as, 127 motivational interviewing as, 110, 111, 113–115, 118–119, 123, 126 as punishment, 266–270 reflective listening in, 113, 266 skill building as, 124–126 trauma-focused cognitive-behavioral therapy as, 127 Ritalin, 12 Role-playing: family treatment including, 200, 253, 254 NTU psychotherapy including, 253, 254 skill building using, 124, 125–126 social skills training including, 134, 137–138, 142–143 solution-focused therapy use of, 39–40 Scaling questions, 41–43 School and community settings: ADHD in, 12, 15, 16, 18, 20–21, 22–24, 27 behavior and conduct disorders in, 30, 33, 37–38, 42–43, 111 benefits and challenges of interventions in, 296–298 bullying in, 297, 312–323 case studies in, 296–362 child welfare issues impacting, 249, 259, 260, 261, 267, 274, 283 compassion fatigue in, 352 depression in/impacted by, 46, 50 developmental issues considered in, 297, 301–302, 304, 306, 310, 330–331 developmental play groups in, 131, 162–173 discussion about, 299, 312, 328, 346, 351–353 Early Head Start as, 220, 221, 223, 224–233 externalization of problems in, 307, 308 family treatment addressing issues in, 186, 187, 195, 196, 199–200 GLBT youth in, 177–178, 179 homeless youth engagement in, 298, 346–362 low-income family support in, 27, 298, 328–344, 346–362 minority youth in, 297, 299–310, 328–344 Subject Index parental/familial impacts in, 299–310, 313, 315–317, 318–319, 349–351 Positive Youth Development approach in, 329, 346, 347, 352, 353, 354, 357, 361–362 reframing in, 306, 359 social skills training in, 133–144 strengths and empowerment focus in, 298, 328–344, 360 substance abuse impacting, 76, 348, 351 therapist’s cultural competence in, 302, 304–310, 347–362 Second Step program, 323 Sexually abusive youth: ADHD in, 90, 95 antisocial behavior in, 100 assessment of, 88–98 callous-unemotional traits in, 90, 96 cognitive-behavioral therapy for, 88, 100–102 demographics of, 88 developmental issues among, 87, 91–92, 93, 98, 102 discussion about, 86 disinhibition in, 96 dissociation in, 90, 94 family-based interventions for, 88 family history of, 89–90 individual treatment and assessment for, 3, 86–102 juvenile justice involvement of, 3, 87–88 mental health concerns of, 90, 95–96, 100 motivational interviewing for, 101 multisystemic therapy for, 100–101 psychosexual evaluations of, 96–98 PTSD in, 90, 96 385 risk and protective factors for, 95–96, 98 sexual offense history of, 88–89 static, stable, and dynamic factors impacting, 94–95 strengths focus with, 90 summary of considerations for working with, 98–99 trauma and victimization of, 87, 89–90, 92–94, 96, 98, 100 trauma-focused cognitive-behavioral therapy for, 101 trauma-informed approaches to, 88, 99, 100–102 treatment considerations for, 91 treatment recommendations for, 99–102 Sexual minority youth Seee GLBT (gay, lesbian, bisexual, transgender) youth Skill building: conduct disorders addressed using, 124–126 social, group treatment including, 131, 133–144 Social skills training: complex situation practice in, 138–139 discussion about, 133, 136–137 group process illustration of, 139, 140–143 group treatment including, 131, 133–144 homework assignments in, 139–140, 143 modeling skill in, 137–138 natural environment practice of, 139–140 role-playing in, 134, 137–138, 142–143 school/academic impacts of, 133–144 3866 SUBJECT INDEX Social skills (continued ) selecting skills and situations for, 135–136 teaching social skills, 134 training process for, 135–143 Solution-focused therapy: art/drawing in, 39 behavior problems addressed using, 29–43 complimenting in, 38–39 context focus of, 33, 36, 38 coping questions in, 31 developmental issues addressed in, 32–33 engagement in, 30–35 exceptions identification in, 35–38 exceptions reinforcement techniques in, 39–43 “I don’t know” response clarification in, 34–35 miracle question in, 40–41 normalizing in, 32–33 parental role in, 29–43 reframing in, 32 role-playing in, 39–40 scaling questions in, 41–43 silence used in, 35, 36 strengths focus in, 32, 43 Spirituality Seee Religion and spirituality Steps to Respect program, 323 Structural family therapy, 8–9 Structured Assessment of Violence Risk in Youth (SAVRY), 97–98 Substance abuse: assessment of, 75–78 CBT and motivational interviewing addressing, 72, 78–83 child welfare issues related to, 246, 249, 261, 265, 273 client’s ambivalence toward, 78–80 homeless youth experiencing, 348, 351 juvenile justice involvement due to, 3, 72–74 parental, 77, 186, 188–189, 190– 191, 196, 199, 246 parental role in addressing, 72–78 relapse prevention for, 82 school/academic impacts of, 76 Substance Abuse and Mental Health Services Administration National Registry of Evidence-Based Programs and Practices, 207 Substance Abuse Subtle Screening Inventory (SASSI), Adolescent Version, 75 Suicide attempts and ideation: bullying leading to, 317 child welfare consideration of, 265, 278 crisis intervention for, 45–61 GLBT youth with, 177, 179 minority youth cultural pressure leading to, 302, 304–305 SuperCamp, 22 Tanya (case study), 45–61 Taylor, Suzie (case study), 264–276 Theraplay®, 163, 164 Transtheoretical Model of Change (TTM), 80 Trauma-informed approaches: conduct behavior addressed using, 127 sexually abusive youth in, 88, 99, 100–102 Subject Index trauma-focused cognitive-behavioral therapy as, 101, 127 Trauma Symptom Checklist for Children (TSCC-A), 118 Tumbleweed Center for Youth Development, 351, 356, 359, 361 Urban Gardens, 341, 342 Youth Seee Children and adolescents Zack (case study), 174–181 Zai (case study), 299–310 387 WILEY END USER LICENSE AGREEMENT Go to www.wiley.com/go/eula to access Wiley’s ebook EULA ... Tracy, 20 09; Nelson, Walters, Schweitzer, Blythe, & Pecora, 20 08; Walton, Sandau‐Beckler, & Mannes, 20 01) Although some models of family Case Studies in Family Treatment and Parent Training 185... health, child conduct, and parenting skills (Barlow, Smailagic, Huband, Roloff, & Bennett, 20 12; Barlow et al ., 20 11; Furlong et al ., 20 12) The results were equivocal in addressing physical abuse and. .. placement of 20 2 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT children of color in one state’s child welfare system Child Welfare, e 877(5 ), 87–105 Miller, M (20 06) Intensive family preservation