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COMMUNITY BASED FAMILY THERAPY - Michael A. Graziano, M.Ed., LMFT
The last fifteen years have seen major shifts in the clinical approaches to child
and adolescent mental and behavioral health problems. The identification and naming
of mental health disorders specific to Children and Youth, such as ADHD, Oppositional
Defiant Disorder and Conduct Disorder, have brought new and sometimes controversial
methodologies into the treatment of these conditions. Psychotropic medications, antidepressants,
and various behavior-based methodologies have taken their place alongside of traditional
types of mental health treatment, such as play therapy and psychotherapy, as commonly
considered treatments for child and adolescent problems. In severe cases, psychiatric
hospitalization and long-term residential care are well-known and still often used
interventions.
What is not commonly known or often noted in the press or magazine articles about
childhood mental health treatments of today is the establishment in Pennsylvania
and other states of comprehensive “continuums of care”, initiatives characterized
by a range of services and modalities known within the CASSP/ public Medical Assistance
system as “community-based care”. These programs are designed specifically to provide
more inclusive, flexible and family-friendly approaches to issues such as complicated
scheduling, the difficulty of getting reluctant teenagers to an office to “talk about
their problems”, and the need to include various members of children’s life domains
into their treatment. Just as importantly, these programs allow for “outreach”, that
is, an active rather than passive role for the therapist in recruiting family systems
that, for various reasons, have had very little success in connecting with and utilizing
traditional therapeutic settings. It could be argued that the shift toward bringing
these various modalities into home and community based settings is just as significant
an event in the evolution of clinical services for children and adolescents as the
introduction of new medications or therapeutic techniques.
Some of the elements of these programs are common to one another, such as:
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they are often home-based, placing the burden of traveling and outreach onto the
mental/behavioral health therapists or team, rather than the troubled child, teenager
or family. |
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they are sometimes school-based, which creates easy and more frequent “as needed”
access between child and counselor. |
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therapists are limited in their caseload numbers, insuring a certain amount of flexibility
in their schedules and more time to attend to complex and unpredicted family and
child needs. |
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they understand that the approach to child and adolescent problems must include “systems”
work, that is, inclusion of the parents, school teachers and counselors, physicians,
other community providers, and sometimes even the peer group. |
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significantly, the fiscal and organizational infrastructure of these programs promotes,
rather than hinders, these elements of outreach and time commitment. |
The names of these programs, such as Family Based Services (FBS), Multisystemic Therapy
(MST), Behavioral Health Rehabilitation Services BHRS), Extended Assessment Services
(EAS), and School-Based Services all carry indications of how they vary in approach.
FBS considers the family system as its main focal point, including outreach to all
relevant family members, even those who may live outside of the child’s home. MST
treats behavioral symptoms as being resolvable by a focused intervention at each
level of the child’s life domains. BHRS uses behavior analysis to identify the source
of the problems, and sustained staff intervention to identify and practice new and
more adaptive behaviors. The EAS program will make multiple home and school visits
to complete a “Functional Behavioral Assessment” which they will then use to make
recommendations and advocate for treatment services. School-Based Counselors maintain
ongoing, often daily contact with troubled students by setting up within the school,
and maintaining contact between the school and parents. In bringing in the common
elements described above, each distinct approach carries with it the mandate of flexing
around family limitations and financial and scheduling burdens, including the important
members of the child’s life, and identifying the tasks of all members of the child’s
service team.
It is important for PAMFT members and other Mental Health Professionals who specialize
in child and adolescent issues to be aware of the availability of these services,
how they can be accessed, and what their respective eligibility criteria are. This
knowledge is beneficial in terms of knowing the full range of options available to
practitioners, and also as referral options for families in need of specialized,
intensive approaches. Many of these programs can be found within the larger Child/Adolescent
serving agencies of each county. These agencies, sometimes known as Base Services
Units or “Anchor Providers”, have Access units that can provide consumers and referral
sources with information on eligibility criteria, insurance coverage issues and other
“system navigation” advice. Practitioners should be aware that many different levels
and disciplines of the family therapy field are utilized. Bachelors level case managers,
Masters level Family Therapists, Counselors and Social Workers and all licensed disciplines
are employed by these agency programs. All PAMFT providers are encouraged to learn
more about the network of programs within their immediate communities and keep the
information on hand as a resource for their client base and the professional community.
Mike Graziano is the Division Director of the Family First Program at Child Guidance
Resource Centers.
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