Week 11 - Working with Families

SOWK 487 Spring 2020 Planning: Class 11

Location: CBC Campus - SWL 108
Time: Wednesdays from 5:30-8:15
Week 11: 03/25/20
Topic and Content Area: Work with Families I
Reading Assignment: Chovil (2009)
Assignments Due: N/A
Other Important Information: N/A

Check-in

Follow up regarding COVID-19.

Genogram Cutout Activity

I want to have us go through and do an simple activity that you can do either with one client, with a family, or even with groups.

• Description: Have various shapes and colors cut out of construction paper. It is important to have a lot of choices for the clients to utilize. Ask the clients to take various pieces of construction paper and describe their family circumstances. Tell them they can choose shapes, colors, even the layout of their family’s to describe to the group what their family looks like. Have each of the clients describe their Genogram.
• Purpose: This is an activity that helps relate family situations to the group members. It is an activity that might go a bit deeper than some of the others, so be careful to manage how much you want to go into.

Agenda

• Strengths perspective and families
• Engagement and assessment with families

Identifying Family Strengths

National Court Appointed Special Advocate Association (2007) CASA volunteer training manual. Seattle, WA. Retrieved from http://www.casaofsantacruz.org/documents/files/assets/basic-html/page79.html

Note 12 to 15 positive aspects of the household pictured.

• In the large group
• Share your observations

[Discussion] What was difficult about this activity? [Discussion] Why would this be an important exercise?

Families & Strengths Perspective (1 of 3)

Kirst-Ashman and Hull (2015)

Using the strengths perspective is very important in working with families. The traditional problem-solving approach assumes that problems are naturally occurring part of peoples lives, misses the benefits of a strengths-based perspective.

• Traditional Problem Solving Approach
• Identify Problems
  • Often times work expend most of time identifying problems
• Find Solutions
• Possible “positive reframing” and strength Identification
  • Not a necessity
  • Not functional strengths

Families & Strengths Perspective (2 of 3)

Kirst-Ashman and Hull (2015)

A strengths based approach is different than the traditional model for problem solving.

• Strengths-based approach
• Identify problems
  • Less emphasis
  • Still important
• Identify client strengths and resources
  • “A constant focus on identifying client strengths and resources and mobilizing resources that directly or indirectly improve the problem situation.” (p. 363 citing p. 123)
  • Functional strengths vs. reframing in a positive manner
• Use resources to improve the problematic circumstances
  • Using strengths to get solutions and implement.

Families & Strengths Perspective (3 of 3)

Kirst-Ashman and Hull (2015)

There are a number of particular strategies we can use to implement strengths in our work with families.

• Build on families strengths
  • Families have an inherent desire to “meet needs and reach goals…”
  • Some strengths to look at…
    • Survivor’s pride
    • Hope for the future
    • The ability to understand another’s needs and perspectives
    • Ability to identify and make choices about individual / family goals
  • [Discussion] This goes from concrete and functional to more unsure. How can these strengths be functional?
• Work collaboratively
  • Families are experts on their own lives / strengths, resources, and capacities
  • Same as client / cultural expertDraw out what are doing already…
  • Think SFBT looking for exceptions
• Help family formulate vision
  • Think SFBT the Magic question
  • Vision (writing a vision statement) / priorities (group problem solving what’s most important) / value activities (ranking values) …
• Boost participation and involvement
  • Talking about directed family time
  • “When do you feel the closet together”
• Utilize environmental modification
  • Often times making changes to the environment can have the largest impact on a families functioning.
  • Think “you are who you hang with”
  • Think removing alcohol
• Model high expectations
  • When we have high expectations, people perform better
  • Think about grading for Heritage classes

What Families Provide (1 of 4)

Families continue to remain the foundation of most peoples lives. They can provide security, support, and intimacy people need. (Kirst-Ashman & Hull, 2015, p. 329)

As you start to work with an individual who initially appears to have an individual problem…

-> Next slide

What Families Provide (2 of 4)

but you can look at this from a family’s perspective. We really need to start to view them in a larger context.

• This means you start to view the problem as not just the individuals but rather the whole family’s.

-> Next slide

What Families Provide (3 of 4)

The following are the general described functions of families:

• Procreation: Families ensure the evolutionary survival of the human species.
• Provide for physical needs: Families obtain and distribute resources that are instrumental for physical health and economic survival.
• Provide secure attachment bonds: Families provide members with a sense of psychological security and safety.
• Primary socialization of children: Families teach and reinforce social norms and rules necessary for successful performance in the social world.
• Regulate sexuality: Family structure establishes boundaries that limit sexual relationships among its members (e.g., incest).
• Satisfy emotional needs: Families provide members with affection, companion- ship, and a sense of belonging.

What Families Provide (4 of 4)

Chovil, N. (2009, April) Engaging families in child & youth mental health: A review of best, emerging and promising practices. Retrieved from http://www.forcesociety.com/sites/default/files/Engaging%20Families%20in%20Child%20&%20Youth%20Mental%20Health.pdf

Chavil’s (2009) paper lays out three types of family engagement that could be laid out on a sort of a continuum.

• Family focused: more than working with just child, but whole family.

• Family-centered

“Family-centered treatment is not simply a new technique that can be learned by frontline clinicians. Family-centered treatment involves the program’s philosophy, organization, financing, staffing, and many other policies and procedures.” (Ooms & Snyder, 2007)

• Family-driven

“Family-driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation” (Chavil, 2009).

Barriers to Engagement

Kruzich, Jivanjee, Robinson, Friesen (2003) reported the following barriers were identified by families as impeding involvement in their child’s care:

• Distance from service providers
• Caregiver’s work schedule
• Cost of transportation
• Lack of access to transportation
• Child care arrangements
• Cost of child care
• Lack of communication between staff from different programs or agencies
• Lack of open communication
• Lack of opportunity or encouragement to participate in the child’s treatment
• Inflexible visiting and meeting schedules
• Lack of clarity about whom to contact with questions and concerns
• Negative staff attitudes about the family
• Restrictive policies
• Lack of consideration for cultural values

Supports to Engagement

Kruzich et al. (2003) described the following as identified by families as supports to their participation:

• Provision of a contact person
• Notification of caregiver when something was wrong or if there were health or other concerns about the child
• Flexible scheduling of meetings
• Information about rights and grievance procedures
• Comfortable and private space for meetings
• Prompt return of phone calls
• Inclusion of caregiver’s comments in the child’s records
• Support for transitions into or out of services or programs
• Communication with all relevant family members
• Help with transportation costs
• Help with telephone costs
• Assistance with child care costs
• Caregiver treated with dignity and respect
• Caregiver made to feel that his or her participation was important
• Caregiver made to feel welcome
• All family members encouraged to participate
• Responsiveness to the family’s cultural values

Different Families, Same Love

“There are various ways to define families. One definition is ‘A primary group whose members assume certain obligations for each other and generally share common residences.’” (Kirst-Ashman & Hull, 2015, p. 331)

• Individuals in a family can be related by ancestry, marriage, adoption, or choice.
• A family can include two or more people who assume responsibility for each others well being over time.
• Families could have…
  • A female head of household
  • Parents with various sexual orientations
  • Family relationships that are not based of blood or the necessity of marriage

Once the family has been identified as your client there are different dimensions in which to assess the family.

Dimensions of a Family Systems Framework Assessment

• Homeostasis
• Boundaries and Boundary Maintenance
• Family Decision Making, Hierarchy, and Power
• Family Roles
• Communication Styles of Family Members
• Family Life Cycle
• Family Rules
• Social Environment
• Family Adaptive Capacity (Stressors and Strengths)

Homeostasis

“Homeostasis is a systems concept that describes the tendency of a system to maintain or preserve equilibrium or balance. In essence, homeostasis is a conservative property of family systems that strives to maintain the status quo” (p. 255)

Homeostasis operates through a pattern of feedback loops to reinforce the status quo and to preserve the family structure.

• Feedback loops are cycles of interactions, or expected interactions, that are used to exert influence over families and family members.
• Balance: With these feedback loops, families are always trying to get back to their homeostasis or balance..

Boundaries and Boundary Maintenance

“Boundaries, a central concept in family systems theories, can be likened to abstract dividers that function (1) between and among other systems or subsystems within the family and (2) between the family and the environment” (p. 256)

• Internal vs. External: ^^
• Unique: Think about families unique style, cultural preferences, strengths, and needs
• Families include coexisting subsystems that can be formed on the basis of gender, interest, generation, or functions that must be performed for the family’s survival
• They are also a continuum between —> Disengagement (diffused boundaries) or Enmeshment (inappropriately rigid)

Family Decision Making, Hierarchy, and Power

Family decision making power, hierarchy and power are important aspects for a social worker to be assessing and to be cognizant of. When we think abut these parts, the following are some ways that we think about them:

[Whole Class Activity] Discuss each topical area, and types of questions that you might ask?

• Historic / Context: How power has been distributed in the family in the past and whether changing conditions of the family are threatening the established power base (McGoldrick, 1998; Okun, Fried, & Okun, 1999)
• Reason for distribution: Whether the distribution of power is gender specific out of necessity for the family to survive in a hostile environment (Okun, Fried, & Okun, 1999)
• Covert power: To what extent power is covertly held by members who have aligned to form a power bloc, and to what extent covert power accrues to individual members who are manifesting extreme symptoms
• Power flexibility: The extent to which the family system allows power to be flexibly reallocated and permits roles to be adjusted to meet the demands of changing circumstances
• Family perspective: How members view the distribution of power in the family (even though the distribution is unequal, family members may be satisfied with the arrangement) The role of a family’s culture in determining the distribution of power (Congress & Kung, 2005)

Family Roles

“Roles are generally understood patterns of behavior that are accepted by family members as part of their individual identities.” (p. 259)

• Enacted: In an enacted role, the family member engages in the actual behavior relative to her status or position (example mother).
• Prescribed: members are influenced by the expectations that others hold with regard to a social position.
• Perceived: A perceived role involves the expectations of self relative to one’s social position.

Family Roles

[Small Group Activity] With a partner, ask find out information about the members of their families, what types of roles people have, what are some of the values and norms. Remember to work on your interviewing skills as you are doing this fact finding.

• Members
• Roles
• Norms
• Rules
• Values

Communication Styles of Family Members

Looking for patterns and styles of communication with in families is another important area to consider. This frequently means examining…

Congruence and Clarity of Communication, which includes verbal, non-verbal and contextual.

[Whole Class Activity - Discussion] What are some of the types of things that we are looking for verbally and non verbally (as discussed in micro skills last semester)?

Especially in working with families, we are on the look out for patterns

• Watching for patterns
  • Verbal communication patterns…
    • Who talks a lot
    • Who talks rarely
    • What tone of voice does mom use with son… etc
  • Nonverbal communication can involve facial expressions, eye contact, and posture
    • Where do they all sit?
    • How close do they sit
    • [Story] Working for the CRC, and watching the seating for while doing family sessions.
• Using techniques
  • Being warm, empathic, and genuine
  • Using interviewing techniques.
• Family interaction and communication are more complicated because more individuals are involved.

Looking for patterns and styles of communication with in families is another important area to consider. This frequently means examining…

Insoo Kim Berg Solution-Focused Family Therapy Video

Insoo Kim Berg Solution-Focused Family Therapy Video. (2009, June 29). Insoo Kim Berg Solution-Focused Family Therapy Video. Retrieved from https://www.youtube.com/watch?v=6Fe8D0hAQh0

We are going to watch a short video clip of Insoo Kim Berg doing family therapy. We are not watching necessary for techniques, but what do you observe about the verbal / nonverbal communication of the family.

• [Discussion] Does anybody know who Insoo Kim Berg is? Solution focused brief therapy
• [Discussion] What do you observe?

Family Life Cycle

One way of looking at a families stage in their own life cycle

1. Unattached young adult
2. New couple
3. Family with young children
4. Family with adolescents
5. Family that is launching children
6. Family in later life

Family Rules

The explicit and implicit rules found in a family system may be either flexible or rigid, depending on con- text and time.

[Whole Class Activity] What are some rules that families might have?

Social Environment

Social environment is also an important aspect to look at.

Think about all of the different contexts and applying ecological perspective to a family.

Talk about client communities (Iraqi, Cuban, etc.) that I’ve worked with

Family Adaptive Capacity (Stressors and Strengths)

“The adaptive capacity of any given family refers to the extent to which the family can achieve its functioning goals, given the demands of family and social life. As the family faces demands from its environment and challenges from its members, its capacity to adapt is a central property of the ability to maintain itself as a cohesive unit.” (p. 267)

• These stressors can be categorized by
  • Family Cycle: Normative (normal) vs nonnormative (not expected)
  • Frequency and Duration: Acute, Chronic, Episodic
  • Magnitude and Number: Stressful life event vs daily hassles

Family Strengths and Resilience

1. Social support, from the community as well as from kinship bonds. Families who have active and vital social support networks have ready access to coping resources.
2. Internal cohesion and commitment. Families are able to adapt to adversity when family members have a strong sense of dedication to each other and when their patterns of communication lend themselves to mutual understanding of family members’ thoughts, ideas, and feelings regarding adversity.
3. Creativity and flexibility. Families that strive for creative solutions to problems, including especially demonstrating flexibility in role assignments, enable families to find solutions to stressful situations.
4. Appraisal, insight, and meaning. When families strive to understand their difficulties and to find affirmative meaning in them, they have an increasing ability to sustain their problem-solving efforts under stress. Very often appraisal and insight are linked to family spirituality and belief systems.
5. Initiative and achievement. Families who are action oriented tend to approach problem solving using positive coping strategies such as cognitive coping, problem solving, and constructive emotional regulation strategies.
6. Boundary setting. Families with a strong sense of family structure will seek to shield its members from unhelpful, unhealthy, and destructive influences.