Integrating a Family-Centered Approach into Social Work Practice with Families of Children and Adolescents with Disabilities

Abstract

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Challenges of Interdisciplinary Collaboration

Abstract

The realities of the 1990s, which include reduced funding and resources, the public's impatience with bureaucratic rigidity, and the empowerment of families who want timely and appropriate services, have created a favorable climate for collaborative, interdisciplinary practice. Collaborative, family-centered practice models are being promoted by family/child advocates and professionals. Yet child and family services, for the most part, continue to be provided in traditional ways using individual treatment and categorical services. However, federal child mental health funding is supporting community-wide, collaborative practice in twenty-one sites scattered across the United States. One site, in rural northeastern North Carolina, is unique as it includes a graduate-level, interdisciplinary academic component [East Carolina University's (ECU) Social Sciences Training Consortium (SSTC)] to train and support service providers and families, and to prepare master's level graduates to work in such innovative programs. Called PEN-PAL [an acronym for Pitt-Edgecombe-Nash (three NC counties) Public Academic Liaison] this university/interagency collaborative effort works in partnership with families to coordinate public and community services into a seamless system of care for children with severe emotional disturbances. This article is based upon a qualitative study of SSTC faculty members, and it chronicles the successes and difficulties encountered by faculty in the first year of a five-year collaborative process.     

Integrating a family-centered approach into social work practice with families of children and adolescents with disabilities

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Bespoke program design for school-aged therapy disability service delivery

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.     

Outcomes of family centered meetings for families referred to Child Protective Services

In order to address the number of children entering the foster care system each year and to promote the family's participation in the decision-making process, family-centered meetings have been widely adopted throughout the United States as well as in other countries. Since 1989, Family Group Conferencing, Family Group Decision Making, and Family Team Meetings have all been introduced into public child welfare systems. This paper will refer to all three approaches as family-centered meetings. However, little empirical research has been done to test the impact of these meetings on families referred to Child Protective Services (CPS). This paper examines literature on the impact of family-centered meetings with families referred to CPS on child and family functioning outcomes. The results suggest that more research is needed to examine fidelity models and specific types of interventions being implemented. However, all of these three appear to increase kinship care placements. More research is needed, specifically regarding the contexts where family-centered interventions could be appropriate. Implications for practice are also discussed, with special consideration of integrating family-centered interventions with other interventions to promote both family participation and child safety.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

A study of home-based services for families of adolescents

Adolescents and their families present some of the most difficult challenges for family-centered, home-based service providers. A study of 51 families of adolescents, who received services from one rural home-based program was conducted in order to describe the characteristics distinguishing families in which placement was averted from families in which placement was not. Content analysis of case records indicated group differences on severity and type of adolescent behavior, family functioning, and families' follow-up with discharge recommendations. Gender differences in placement rates were also noted. Implications for the provision of family-centered, home-based services to families of adolescents were discussed.     

The Impact of Racism on Social Work Education

One of the most difficult problems in teaching social services has to do with the development of an analytic framework for an understanding of the delivery of social services within the community. This paper examines a particular systems framework that allows the student to conceptualize and evaluate what services are being delivered, what specific inputs and connections of agency with community act to produce this service, and what changes in the system may be possible. The model allows ready connection with practice, policy, and research components of the curriculum.     

The child in family services: expanding child abuse prevention

Child welfare concerns have drifted to an inappropriate focus on crisis intervention and a punitive approach to child protection intervention at the expense of community-based preventive child welfare programs. Recent attempts to divert cases from the child protection system through differentiated response mechanisms have been criticised for failing to provide access to relevant services or preventing vulnerable families from re-entering the child protection process. A tension inherent in providing both child protection and family support within the one agency is also identified as a barrier to effective service delivery. This paper discusses the value of the UK Children in Need approach as a model for enhancing support to children and families outside the statutory child protection system. Information from an evaluation of a trial implementation of the UK Children in Need approach in Victoria is used to discuss the implications for policy and practice of placing responsibility for coordinating a response based on the needs of children and their families within family support services.     

How Do They Fit?

Abstract

Despite public policies that promote an increased role for faith-based organizations in the delivery of publicly supported services, insufficient attention has been paid to assessing how service delivery by faith-based and secular providers might differ. This study considers the issues involved in evaluating the role of faith-based organizations within the broad context of a community's social service offerings. Criteria are developed for assessing role differences by comparing the types of services, delivery approaches, and service locations offered by different types of providers. The approach is then illustrated using a large sample of social service providers in Los Angeles County. Important role differences are revealed. Faith-based organizations offer fewer and different types of services than their secular counterparts. The results suggest a modest and focused role for faith-based organizations in social service delivery, but one that is complementary to the efforts of secular providers. The methodological issues raised by such analyses are highlighted.     

National consistency and provincial diversity in delivery of long-term care in Canada

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Fostering families' and children's rights to family connections

Recent federal legislation strengthens children's and families' rights to family-centered practice by increasing the responsibility of child welfare agencies to identify and engage extended family members in providing care and support to children placed out of the home. Preliminary results from an experimental study of a federally funded family finding project found greater involvement of family, kin, and informal supports and a higher likelihood of reunification or relative placement compared with standard child welfare services.     

An Aging Workforce in an Increasingly Global World

Summary

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

Adolescent Violence—Strategies,Outcomes and Dilemmas in Working with Young People and their Families

MATTERS is a program of Berry Street, and has been in existence since 1990. The service is funded to address parent/adolescent conflict and the service delivery model has developed over time in a direction which incorporates family therapy and conflict resolution techniques. Many families come to the service seeking assistance for problems regarding violence, and increasingly around a young person's violence to parents and other family members. In some instances, violence has been present over a long period and has become normalised within the family's experience. When working with families who present with problems of adolescent violence, the service aims to find a pathway for the young person/family to confront violent behaviour and move to a different position about the meaning of violence in their lives. This paper describes the team's approach to working with adolescent violence, utilising ideas from narrative family therapy and psychodynamic theory, and incorporating issues of power in society, culture and gender. Outcomes, dilemmas and future directions are also discussed.     

Early Intervention in Portugal: Study of Professionals’ Perceptions

Early intervention (EI) has been characterized by considerable advances in its domain, which has had great repercussions in the implementation of the family-centered approach. These changes have had implications in the practices and in the adoption and learning of new values that should be implemented in EI. This study evaluates the professional perspectives regarding family-centered practices in EI programs in Portugal. The results highlight the importance of effective collaboration and coordination between health, education, and social services and the importance of providing child and family support in a natural context. These results reinforce the need to invest in professional training to improve the quality of services offered to families in EI.     

Social Work Practice with Older Soviet Immigrants

ABSTRACT

With the recent sociopolitical changes in the Former Soviet Union, significant numbers of older Soviets have arrived in the U.S. with their families. Soviet immigrants who enter the U.S. are no longer automatically considered political refugees, which has limited their entitlement to services. Recent changes in public welfare and immigration policy place the responsibility for care of elderly members solely on the family. While caring for older adults is stressful for any family, new immigrants may be especially burdened since they have limited knowledge of services, few coping resources to provide adequate care, and little experience resolving cultural conflicts with their older parent. By using a practice model designed to evaluate late-life caregiving situations, two case scenarios are presented to examine practice and service delivery issues of older Soviet immigrants and their families.     

Community Based Rural Health Care in India

SUMMARY

India is a large country, geographically as well as popula-tionwise. The majority of its population lives in rural areas, i.e., villages. Again, most of the villages are in remote areas. The State has been making sincere efforts to make the basic social services accessible to all in the rural area. Health being one of the vital services, it has been a challenging task before the State to extend it to the remote rural areas, many of which are not yet connected by motorable roads. As a result of various experiments carried out over the last five decades, the State has developed a fairly well-designed primary health care service, and it is in operation in rural areas. However, there appears to be a striking gap between the delivery of health services in rural areas and utilization of the services by the people. Attempts have been made in this article to apprise the readers of the health service system in India, and it discusses the issue of health service delivery at the village level. The discussion is based on a small study carried out in a rural area in the State of West Bengal (India) where students of social work of the University to which the author belongs are placed for field work. Following the inputs received through supervision of the students' work, the study was initiated and conducted.

This article based on the study seeks to focus on peoples' perception of the health services as provided by the State in rural areas, which in turn gets reflected in the extent to which they utilize the services. Social workers being an integral part of the health set up, their role bears special significance. Discussion, therefore, centres on scope for social work intervention at the community level as well as in institutional level of the health service delivery system to make the services meaningful and effective in rural areas. In fact, it has to take the leadership role in reforming the service delivery system when required.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.