Collaboration on Critical Questions in Child Psychotherapy: A Model Linking Referral, Assessment, Intervention, and Evaluation

Article excerpt

SOCIAL WORKERS HAVE ALWAYS BEEN interested in helping clients change. The evolution of new modes of intervention has facilitated rapid outcomes on the one hand (Marks, 1987; Ost, Salkovskis, & Hellstrom, 1991) and an increase in emphasis on valuative and comparative studies of treatment efficacy on the other hand (Garfield, 1983; Kazdin, 1982, 1986). The issues of the client's right to effective treatment and the therapist's responsibility to provide that treatment have gained crucial attention in psychotherapy in general and in social work in particular (Alford & Beck, 1997; Bergin & Garfield, 1994; Bloom, Fischer, & Orme, 1995; Chambless et al., 1996; Curtis, 1996; Giles, 1993; Klerman, 1990).

Myers and Thyer (1997) identify several ways for clinicians to facilitate effective treatment. Among them are: using criteria from the Task Force on Promotion and Dissemination of Psychological Procedures (1995), employing stages to categorize empirical validation (Curtis, 1996), basing treatments on outcome studies (Chambless et al., 1996; MacDonald, Sheldon, & Gillespie, 1992), or learning from meta-analyses (Gorey, 1996; Kazdin, 1988).

Schools of social work have contributed to the dialogue and research on effective treatment strategies in a number of ways: (1) achieving a clearer and more concrete definition of target problems (Stein & Gambrill, 1977); (2) demonstrating a greater willingness to pursue goals of a modest scope (Reid, 1978); (3) instituting baseline and outcome measures (Kazdin, 1988); and (4) the inclusion of all of the above in social work studies and professional training (MacDonald et al., 1992; Tutty, 1990).

One of the largest populations with whom social workers are involved are children, who encompass more than 50% of referrals to social welfare services. Recent epidemiological studies indicate that from 17% to 22% of children and young people under 18 years of age suffer from developmental, emotional, or behavioral problems (Kazdin, 1994).

Children are a population at high risk for developing behavioral and emotional problems for several reasons:

1. The normal basis of most childhood disorders. The majority of childhood disorders begin as developmentally normal problems and become deviant when they persist longer than expected (e.g., bed-wetting becomes enuresis) or when they increase instead of decrease in frequency (e.g., sleep problems become sleep terror disorder) (Mash & Terdal, 1988; Ronen, 1997).

2. Spontaneous developmental changes. Children undergo constant and rapid changes in motoric, emotional, and cognitive skills. This instability can be at the root of children's behavioral and emotional disturbances (e.g., mood shifts and anger in adolescence).

3. Children's dependence on and vulnerability to caregivers. In addition to the development of independent childhood disorders, many children are in need of intervention due to difficulties in their interactions and relationships with others, usually adults, in their environment. This situation is exacerbated when those same adults who should be protecting children are the ones responsible for their distress (e.g., by neglecting and abusing them).

In view of the fact that one of the critical predictors of adult mental health problems is childhood disorders (Kazdin, 1988), the issue of applying effective intervention in childhood and adolescence becomes crucial. Kazdin's review of over 230 different techniques for child and adolescent therapy revealed that the great majority of these techniques have never been studied and, therefore, have never been shown to be effective.

Throughout their growing years, children encounter many professional figures (e.g., nurses, teachers, counselors, educators, pediatricians), but social workers in social welfare agencies are the only figures who assist children with personal or familial difficulties throughout all their life circles--family, school, peers--and at all stages of their development--infancy, childhood, adolescence, and adulthood (Ronen, 1995b, 1998; Rose & Edelson, 1988). …