Academic journal article Journal of Marital and Family Therapy

In-Home Family Therapy: Indicators of Success

Academic journal article Journal of Marital and Family Therapy

In-Home Family Therapy: Indicators of Success

Article excerpt

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.

Providing in-home family therapy is a growing phenomenon in the mental health field (Zarski, SandPringle, Greenbank, & Cibik, 1991) and is a relatively new area for the field of marriage and family therapy (MFT; Thomas, McCollum, & Snyder, 1999). Woodford (1999) asserts that the philosophical rationale for in-home therapy is to provide services to clients who have not responded to traditional forms therapy. In-home family therapy services are typically provided by public sector programs designed to assist with problems such as juvenile delinquency, families in which abuse or neglect has occurred, or families where at least one of the children suffers from psychiatric or emotional disorders that have the potential to "jeopardize the family's cohesion" (Mosier et al., 2001, p. 52). In-home family therapy services are typically short term and intensive.

It has been demonstrated that in-home family therapy is an effective way of working with some of "the toughest cases" (Woodford, 1999, p. 268). Mosier et al. (2001) found that in-home clients presented more severe emotional and behavioral problems compared with clients receiving outpatient services and found that the severity of the problems likened the sample to that of an in-patient sample. Specific populations with which in-home family therapy have been effective include adolescent mothers (Cherniss & Herzog, 1996) and substance-abusing adolescents and their families (Henggeler, Pickrel, Brondino, & Crouch, 1996). Furthermore, research indicates that in-home therapy programs successfully lessen the number of out-of-home placements of children (Henggeler, Melton, & Smith, 1992; Szykula & Fleishman, 1985; Wallon, Fraser, Lewis, Pecora, & Walton, 1993), lowers the risk of hospitalizations, and reduces symptoms associated with the presenting problems in the clients served (Frazer, Nelson, & Rivard, 1997).

The experiences of therapists providing in-home family therapy has also been the focus of a number of studies (Thomas et al., 1999; Zarski, Greenbank, Sand-Pringle, & Cibik, 1991). Conducting therapy in the client's home presents unique issues for therapists compared with experiences of therapists providing therapy in more traditional contexts (Adams & Maynard, 2000; Christensen, 1995; Thomas et al., 1999; Zarski et al., 1991). In-home family therapists have struggled with feelings of inadequacy associated with helping multiproblem families, boundary issues associated with conducting therapy in the clients' homes, and timing and pacing of therapy (Thomas et al., 1999). How to supervise therapists providing in-home services is another potential challenge (Adams & Maynard, 2000; Zarski et al., 1991). Zarski et al. proposed a four-stage model of supervision for those providing in-home family therapy services. The model was developed to address specific aspects of working in this context including things, such as crisis stabilization and therapist alignment.

Thomas et al. (1999) assert that there is something about in-home therapy that makes therapists act "as if they have lost what they know" (p. 188). But what do we know about families in need of in-home family therapy? …

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