Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.     

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost‐effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost‐effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.     

Family Functioning Patterns as Predictors of Engagement: Which Families Participate in Services and Which Ones Do Not?

The present study examines the relationship between specific areas of family functioning and family engagement in prevention services. A sample of 147 families who initiated youth-centered treatment services from a non-profit agency was selected. Statistical analysis was used to test for relationships between family scores on the Family Assessment Measure (version III, General Scale) and family levels of engagement in services. Results of binary logistic regression analysis indicated that individual and family characteristics are associated with family engagement in services. In addition to demographic variables of age and race, family patterns of denial made a significant individual contribution to the evaluated model. Implications for engaging families in prevention services are discussed and suggestions are made for future research.     

BEYOND THE CLINIC: IN-HOME THERAPY WITH HEAD START FAMILIES

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.     

Effects of Substance Abuse Central Intake on Treatment and Justice Costs

ABSTRACT

The cost-benefits of a central intake intervention for substance abuse treatment referrals were demonstrated using a transaction cost analysis on two cohorts of participants during the three-year initiative. Costs for clients receiving central intake services were compared with those just prior to the intervention's implementation. In order to study the relationship between substance abuse treatment costs and avoided criminal justice costs, data from three administrative data sets were used. Results indicate that clients receiving the central intake intervention had approximately a 58 percent decrease in costs compared to clients not receiving the intervention. The initiative produced opportunity cost savings to treatment, court, and correctional systems, with completion being crucial to opportunity cost savings.     

Housing problems experienced by recipients of child welfare services

This study uses data on the experiences of families involved with child welfare services to examine the nature of housing problems and needs among these families and whether housing status affects case outcomes. First, the article describes the housing difficulties faced by two distinct child welfare service populations: families receiving voluntary in-home services and families with children in court-ordered out-of-home care. Second, the study demonstrates the relationship between housing problems and the likelihood of family reunification for children in out-of-home care. The findings have implications for the delivery of child welfare services and the provision of housing assistance to low-income families with children.     

Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.     

Social support characteristics among nonclinical African-American and Filipino-American parents with school-age children

This study is the first phase of a project to develop a culturally-appropriate, family-mediated social support intervention program. This phase consisted of in-home interviews with 26 African-American (AF) and 26 Filipino-American (FA) parents who were not receiving counseling or social services for parent-child conflict, and self-reported adequate personal and family functioning. In general, parents were college educated and employed full-time and had house-hold incomes of over $25,000. On average, AF parents were 35 years old, with 4 people in the household, including 2 children (mean AGE = 10 years). FA parents were older, averaging 45 years, and had 6 people in the household, including 3 children (mean AGE = 12 years). Mean scores on standardized measures reflected high self-esteem and positive attitudes toward their children and families. Social network size averaged 32 and 38 members for AF and FA mothers respectively, and 24 and 29 members for AF and FA fathers. Most parents reported that fewer than 50% of their network members knew each other. Data also suggested that parents reported a generally positive orientation to utilizing support resources, and favorable perceptions of and satisfaction with support form family and friends. Analyzes revealed that only functional support variables were significantly associated with parent well-being. Study limitations, service implications, and further research directions are discussed.     

Structuring Home-Based Therapy: Four Phases to Effective Treatment

ABSTRACT

Home-based services are gaining more popularity than in years past. Therapists going into the home are exposed to various treatment issues that differ from those in a clinic or office setting. One of these issues is that of structuring the therapeutic process. Much has been written about the structure and stages of clinic-based therapy; however, little is known about the process of home-based therapy. This paper will delineate four phases of home-based therapy which the in-home therapist can use as a guide to provide faster and more effective services.     

Does Affirmative Training Matter? Assessing CFT Students’ Beliefs About Sexual Orientation and Their Level of Affirmative Training

This study examined couple and family therapy (CFT) students’ beliefs about sexual orientation, their self-reported competency working with lesbian, gay, and bisexual (LGB) clients, and the level of affirmative training students received in their CFT programs. One hundred and ninety students from accredited CFT programs completed the study. While participants reported feeling only somewhat competent to work with LGB clients and less than half reported receiving any training on affirmative therapy, the majority of the participants did appear to hold positive attitudes toward LGB clients. The results support the literature arguing for CFT programs to include specific training on affirmative therapy practices, as the level of affirmative training was directly related to participants’ self-reported clinical competency working with LGB clients.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Decisions on placement and family preservation. Agreement and targeting

Vignettes presented to experts and workers in the child welfare field were used to explore the degree of agreement on decisions to place children in substitute care or to refer them to family preservation services. The design allowed for investigation of the problem of targeting in family preservation programs. Findings indicate considerable inconsistency in decisions among experts and workers, particularly in decisions to refer to family preservation and other in-home services. Contrary to the stated intentions of family preservation services, a majority of the referrals to these programs do not involve children who would have been placed in the absence of these programs.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.     

Parental views of in-home services: what predicts satisfaction with child welfare workers?

Evidence on client satisfaction deserves consideration in the design of child welfare policies, programs, and practices. Data in this study come from the National Survey of Child and Adolescent Well-Being. Clients receiving in-home services reported moderate levels of satisfaction with their child welfare workers. Caregiver reports of having less than two child welfare workers, having more recent contact, and receiving timely, responsive services were associated with higher perceived quality of relationships with child welfare workers. The child welfare workers' reports of cooperativeness by the caregiver were also associated with higher caregiver-reported relationship quality.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

Characteristics of the homeless mentally ill in case management: Differentiation using major diagnostic categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of services required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

Late-Life Depression,Social Support,Instrumental Activities of Daily Living,and Utilization of In-Home and Community-Based Services in Older Adults

This study examined the relationship between social support, depression, instrumental activities of daily living (IADLs), and utilization of in-home and community-based services. The sample included 39 adults age 65 years old and older. The data were collected by distributing a self-administered questionnaire. Depression levels significantly decreased as levels of social support increased. IADLs functioning significantly decreased as depression levels increased. The number of in-home services used significantly increased as IADLs functioning decreased. The number of community-based services used significantly increased as depression levels decreased. The number of in-home and community-based services used significantly increased as levels of support decreased.     

New Zealand Vietnam Veterans’ Family Programme,Nga Whanau a Tu (Families of War): Development and Outcome

This article reviews recent research concerned with the association between combat-related posttraumatic stress disorder (PTSD) and interpersonal functioning, before describing the development of a pilot program established to provide mental health services for Vietnam veteran family members. The results of a brief program evaluation are also presented. Sixty clients provided posttreatment and six-month follow-up data on a variety of outcome measures which were compared with independent ratings returned by 33 therapists. On average, clients reported that counselling had been beneficial and indicated satisfaction with services received. However, at posttest, therapists indicated that approximately 50% of clients were in need of continued treatment. There was a decrease in satisfaction with services over the posttest-follow-up period, but no change on most measures of psychotherapy outcome.     

Evaluation of Family Therapy: A Comparison of Therapists' and Clients' Views**

In this evaluation of therapy experience for 82 families by brief therapy at Bouverie Clinic to 1976–1977, therapists' and clients' rating of outcome were obtained. After termination of therapy both therapists and clients reported high improvement rates in the presenting problem(s) as well as in the quality of family relationships and in the family's ability to deal with further problems. High agreement was found between therapist’ and clients' ratings of outcomes. Therapists were more favorable than clients in their ratings of change in the presenting problem and in their ratings of change in the quality of family relationships, but not in assessing the change in family's further problem solving ability. At follow-up clients were predominantly satisfied with their therapy experience. In addition, therapists' ability to predict outcome accurately, after the second of therapy, was strongly supported by our finding.