Intervention plan for a blended family managing behavioral and elder care challenges

Intervention Plan

This family consists of Xavier, a 40-year-old Hispanic-Jewish male who works as a pharmacist. His domestic partner is Samantha, a 38-year-old Brazilian female who works odd jobs in the \"gig\" economy like being an Uber driver. Samantha has one son, Michael, aged 6, from a previous marriage. Xavier has one daughter, Catherine, aged 17, also from a previous marriage. Together, Xavier and Samantha have one daughter, the youngest member of the household, named Poppy. Because she is self-employed in the gig economy, Samantha takes care of Poppy. The presenting problems of the family include Michael\'s behavioral problems. Michael has been throwing tantrums at home, and he has also been acting out in school. When Michael was sent home for biting a girl in his class, the family knew they had to take action and seek treatment. Michael\'s teachers have recommended that he see a psychologist for testing and possible attention deficit disorder. In addition to Michael\'s behavioral problems, the family contends with elder care issues in that Samantha\'s aging parents, who speak no English, might need supervised care in the near future. Samantha does not want to place her parents in a home, but their current home is too small to allow for the additional generation to live there comfortably. However, Catherine might be going to college soon, which would make Michael the new oldest child in the household and could open up a bedroom.

Issues for Intervention

The intervention will focus on family needs, while respecting client autonomy and resisting the creation of dependency patterns. The interventions need to be techniques that the family can incorporate into their daily strategies for coping and developing ongoing resilience. During the intervention assessment process, the therapist can also recognize any points of potential resistance or lack of motivation. In this case, the motivation level of the family is very high at the moment, but once the intervention process begins, the therapist might encounter resistance to specific recommendations or techniques. The resistance can be dealt with in compassionate and culturally appropriate ways, without any coercion but instead, with flexibility and open-mindedness. Ultimately, goals should be set early but they can change over time to reflect new issues or situations that arise or changing opinions of family members. Expectations should be high but realistic, agreed upon by all family members who are affected by the changes. As the therapist needs to maintain professional distance, boundaries also need to be established early in the professional relationship (Collins, Jordan, & Coleman, 2013).

Focusing both on macro issues and micro level issues will prove especially helpful in this case. The macro issues have to do with things like the relationship between the family and its community, such as Michael\'s role in the school versus his role at home. Micro issues will have more to do with the psychological issues that each family member contends with, but also how those issues compound interpersonal communications problems. Finally, the therapist reaches the stage at which problem definition occurs naturally. \"Problem definition is important because the way we define problems can open up very different directions for family work,\" (Collins, Jordan & Coleman, 2013, p. 315). How the family defines the problem may impact how the therapist defines the problem and vice-versa, which is why a collaborative and positive focus needs to be maintained throughout the therapeutic relationship. The strengths-based assessment and intervention does not focus on the problem, but instead emphasizes strengths so that the family can do the same. A strengths-based approach mirrors the tenets of positive psychology and other humanistic orientations that stress human potential and not human pathology. As Robbins, Chaterjee & Canda (2012) point out, \"the metaphor of human potential offers an optimistic, growth-oriented, strengths-based view of human behavior,\" and this is the recommended theoretical viewpoint for this family case (p. 22).

A strengths-based approach also acknowledges that change is a positive, and change is exactly what the family is seeking when they first approached the therapist. Therefore, change becomes an extension of how the family can apply their strengths to achieve future goals. In this case, the family wants to change Michael\'s behavior. The therapist can help identity exactly what changes, especially, the family would like to see. Michael is young but he may also be asked what changes he would like to see in the family or his school. Change may entail a shift in parenting styles for Samantha and/or Xavier, a consultation with the teacher regarding any unmet needs Michael has at school, or psychological counseling for Michael to help him develop strength and resiliency if his behavior is a symptom of coping with stress. The issue of change may also come into play when the family addresses how to care for Samantha\'s parents. Regarding this issue, the family can consult on issues related to Catherine\'s possibly leaving and what that might mean for the future of the family. If financial strain is eventually identified as a problem, then finding an additional source of income for the family might be a recommended change.

Aspects of the family that might be contributing to the problem also need to be identified. In this case, Michael\'s needs may not have been fully addressed yet. If Samantha, Catherine, and Xavier tend to be personally resilient people psychologically, they might expect that all people are like that, but Michael may be wired differently. His unique characteristics may make him more sensitive to stress, and less naturally capable of coping with stress in healthy ways. If this is the case, then a change in attitude towards Michael and a willingness to spend extra time with him might be necessary. In terms of what needs to be decreased, increased, modified, eliminated, or created, the family will need to explore the various options available to them. The family may need to increase the amount of attention Michael receives, modify communications and parenting styles with Michael, and create opportunities for elder care.

Interventions and Intervention Techniques

Observation and reframing are both \"useful techniques\" that can help family members collectively \"gain new insights and create change,\" (Collins, Jordan & Coleman, 2013, p. 341). Structured observation is a tool therapist can use for assessment and feedback. For example, the therapist might use structured observation to document parenting styles used with Michael, role ambiguity in the family, or ambiguous or conflicting messages delivered by Xavier vs. Samantha. As each parent will have a different parenting style, and especially as Michael is Samantha\'s biological son from a previous marriage, there are bound to be differences in the way Samantha treats Michael versus the way Xavier does. Observation permits a more objective overview of parenting style differentiation, from which the parents can be honest about what they are doing and initiate recommended changes. The observation techniques used can include self-monitoring, such as counting the number of times positive reinforcement or negative reinforcement techniques are used, even using technological tools in the observation process. Observation parallels mindfulness techniques, too, which can be incorporated into the intervention process. As Collins, Jordan & Coleman (2013) note, the social worker occupies a unique place in the therapeutic model because of the opportunity to see the family as a whole, as part of the entire ecology of the family. If the house is chaotic or unsanitary in some ways, the social worker can observe this and help the family to recognize how external environment might impact the psychological or behavioral problems currently being experienced. In this situation, sanitation was not observed in the household, but chaos was, and the specific issues have been brought to the attention of both parents, who have already recognized what may be exacerbating Michael\'s behavioral problems. More structure and more consistent disciplinary techniques have also been recommended after the observation.

Reframing \"removes a situation from an old context (set of rules) and places it in a new context (set of rules) that defines it equally well,\" (Collins, Jordan & Coleman, 2013, p. 347). Reframing sometimes involves shifting the language used when referring to problems. For example, the teachers have said that Michael should be evaluated for possibly having attention deficit hyperactivity disorder. Instead of focusing on potential pathology, the family can reframe the issue as a challenge for them to find ways to redirect Michael\'s energy on activities that he enjoys. If possible, the social worker can help the teacher and school administrators also to engage in reframing, so that Michael\'s needs are being supported in the school through programs like physical education, art, or music. Reframing is also a technique that can be used when addressing the elder care needs. Instead of framing Samantha\'s parents as a burden, their presence can be viewed as a tremendous opportunity to move the family forward. The grandparents could move into the house and watch Poppy, if they are able, while Samantha finds some external activities, whether a job or a hobby, that might help her bring in more income or expand her career opportunities for the future. If Catherine does not decide to leave home at this time, then Samantha might still be able to leave Poppy with the grandparents for short periods of time.

Of the listed interventions, the three that offer the \"best fit\" for this family include ecological intervention, solution focused intervention, and parenting skills training intervention. The ecological intervention allows the therapist to play an active role in the family\'s initial self-awareness, allowing for an objective observation of the stressors that might be impacting Michael\'s behavior. \"Ecological validity allows the worker to witness \'real- life behaviors\' in that family members often do not exhibit the same behavioral intensity in an office that usually occurs in home,\" (Collins, Jordan & Coleman, 2013, p. 13). The advantage that the therapist has when using an ecological intervention is that the family is observed in its most natural state. Technological tools can be used for self-monitoring or for therapist-initiated monitoring, to help clarify what types of behaviors need to be changed, or what strengths can be capitalized on in the future. The expected change outcomes include improvements in Michael\'s behavior and a change in parenting styles that reinforces that behavior.

A solution-focused intervention allows the therapist to stress the outcomes and goals, rather than emphasizing problems and pathology. If the goal is to improve Michael\'s resilience and help him to cope with stress, then with the help of the parents, the therapist can ask Michael what he needs. Then, the family can think about what specific things they can do to bring about the desired changes. If Michael needs more attention, more talking to, more physical affection, or more intellectual or physical stimulation, then these are specific issues that can be addressed in a solution-oriented approach. Similarly, the elder care issue can be resolved with solution-orientation rather than viewing the parents as a potential source of conflict. As a solution, the family might be able to capitalize on community resources, which would have been observed also during the ecological intervention. The expected outcomes of solution focused interventions include a more proactive approach to elder care, and also a more compassionate approach to Michael than simply labeling him as having a behavioral problem.

Finally, parenting skills training provides a tremendous opportunity for this family to thrive. By using observations to document parenting styles, both Samantha and Xavier can recognize where they differ in terms of parenting philosophy. Shifting their parenting styles to one that is more consistent might help to clarify Michael\'s role in the household. In addition to promoting role clarity and consistency, the parents can also shift their communications styles to ones that work best for Michael. A harmonious parenting style that is neither authoritarian nor laissez-faire may work best, providing Michael with additional structure to mitigate the many changes he senses in his environment. The expected outcomes of using parenting skills training are to provide long-term solutions for the family, as Michael\'s needs will change over time.

Conclusions

As a social worker, I see tremendous promise in this family. They have sought help in their time of need, showing that they recognize when they need help and are not afraid to ask for help. Having observed them at their home, the ecological perspective allows me to see that they do have some room for improvement mainly in terms of parenting styles that are sending Michael mixed messages. Because Catherine is almost an adult, she has been immune to some of the chaos in the environment, but her little brother and new little sister are not. It is predicted that if the parenting styles become more consistent, and if Michael\'s needs are addressed, that Poppy will not exhibit behavioral problems in the future. If, however, no attempt was made to change their parenting styles, then Poppy might also exhibit behavioral problems. I do believe that the family will work with the therapist, and will be willing to find solutions to their problems.