A review of project ‘12-ways’: An ecobehavioral approach to the treatment and prevention of child abuse and neglect

Adr. Bchaa. Res. Thu. Vol. 6. pp 63-73. 1984 Printed in Great Britain. All rights reserved.

Copyright

0

014ti4ll2184 $O.llO + .50 19X4 Pergamon Press Ltd

A REVIEW OF PROJECT ‘12-WAYS’: AN ECOBEHAVIORAL APPROACH TO THE TREATMENT AND PREVENTION OF CHILD ABUSE AND NEGLECT John R. Lutzker,*

David Wesch* and James M. Rice**

‘5outhern Illinois University at Carbondale, IL, U.S.A. **St. Cloud State University, MN, U.S.A.

INTRODUCTION It has been estimated that the incidence of child abuse and neglect in the United States is between 1-lj% of all children (Helfer, 1982). This means an approximate rate of lo-15/1,000 children per year. Treating child abuse and neglect is especially difficult for several reasons. Many parents who are investigated for child abuse and neglect may not admit to it. Thus, trying to provide counseling or other services to these families can be especially difficult when clients essentially refuse that there is a problem. Further, as Kelly (1983) has pointed out, child abuse is a private act that under most circumstances cannot be directly assessed. This also creates a oroblem for the researcher or service orovider. Other factors making treatment bifficult include cultural and sociolo$ical variables (Kellv. 1983; Vasta. 1982). For examole. the ma.ioritv of child abuse and neglect case; represent parents'from lower ;ocioeconom;c groups. Thus, the problems of low SES such as unemployment may make providinq services esoeciallv problematic. Finally, evaluations of skrvices'provided to families'under ;hild protective service for abuse and neglect has not been accomplished in sufficient numbers or detail to know what kinds of services may or may not be useful in further prevention of the problem (Helfer, 1982). To date, three models have been articulated to try to explain and treat child abuse and neglect. These have been psychodynamic (Merrill, 1962), sociological (Garbarino, 1976), and social learning (Kelly, 1983). The psychodynamic model views child abuse and neglect as stemming from personality conflicts of the parents. This view holds the child abusing parent as "sick" and having personality problems such as poor impulse control, low frustration tolerance, low selfesteem, and emotional insufficiency. The sociological model sees the problem of child abuse and neglect as stemming from problems in the families' environment such as unemployment, marital discord, family size, and poor housing. Finally, the social learning model views the problem as learned coercion among family members. That is, each family member learns to rely on aversive control techniques This coercion then escalates into abusive incidents. In lookinq at the problem of child abuse and neqlect. and treatment, it would seem that all three models have something to offer. -Sureiy, there must be parental personality characteristics that influence child abuse and neglect. For example, it has been suggested that abusive parents have more difficulty handling stress than do nonabusive parents (Green, Gaines, & Sandgrund, 1974). Thus, for many of these parents learning stress reduction techniques would seem to be one logical

63

64

J. R. Lutzker,

D. Wesch and J. M. Rice

therapeutic technique among others that might be offered. If unemployment and marital discord seem to be factors associated with child abuse and neglect, then assisting parents in job-finding, or offering marital counseling would seem to be additional treatment options. Finally, if the family relies on coersive interactions, then teaching new child management techniques based upon social learning principles should enable the family to get along in the absence, or at least reduction of, aversive control strategies. Considering all three models, Lutzker (1984) has proposed an ecobehavioral approach to the treatment and prevention of child abuse and neglect. By ecobehavioral it is meant that child abuse and neglect is seen as a multifaceted problem in need of multifaceted treatment services. Parental inadequacies, child behavior problems, sociological and social learning variables are all seen as contributors to child abuse and neglect. Born out of this view was Project 12Ways, an effort to assess and treat as many contributing variables as possible when serving families under state child protective service because of indicated child abuse or neglect. Thus, the purpose of this review is to provide an overview of the structure of Project 12-Ways, to discuss four strategies for assessing its effectiveness, and to speculate on what components may produce its effectiveness. STRUCTURE Project 12-Ways is funded through federal Title XX money allocated by the State of Illinois to the Illinois Department of Public Aid (DPA). DPA then contracts with the Illinois Department of Children and Family Services (DCFS), the state's child protective service agency, which in turn contracts with Southern Illinois University at Carbondale (SIUC) for Project 12-Ways' services. Under a program known as the Governor's Donated Funds Initiative, SIUC provides 25% of the annual ($500,000+) funding for Project 12-Ways. Project 12-Ways is housed in the Rehabilitation Institute BATP offers separately coded program in behavior analysis the basics of applied behavior therapy, behavioral medicine, and community behavior analysis.

the Behavior Analysis and Therapy Program (BATP) in of the College of Human Resources at SIUC. The M.A. and M.S. degrees in a 45-credit hour graduate and therapy. In addition to a strong background in students can take coursework in behavior analysis, biofeedback, mental retardation, child behavior,

The Fiscal Officer/Principal Investigator of Project 12-Ways is also the Coordinator of the BATP. He provides direct supervision to the three clinical supervisors on the Project; they are the Program Manager and two Chief Rehabilitation Counselors. The Program Manager handles the majority of the administrative functions of the Project and devotes 25% time to clinical supervision. The Chief Rehabilitation Counselors devote the majority of their time to clinical The Program Manager and Chief Rehabilitation Counselors (CRC's) supervision. hold masters degrees with strong emphases in behavior analysis and therapy. Under the supervision of the Program Manager and the CRC's are Counselors. The Counselors provide the majority of direct service to the clients. Most Counselors are advanced students in the BATP and have 50% appointments. Some hold masters degrees and are students in the Doctor of Rehabilitation Program. Counselors provide supervision to teams of three or four graduate assistants who are less experienced students in the BATP. Essentially, these graduate assistants serve apprenticeships with the Counselors. Referrals All referrals neglect, or

come from DCFS. a family considered

These represent at high risk

for

cases of indicated abuse or neglect.

child abuse Self-referrals

or

A Review of Project are accepted to Project

if they 12-Ways

first

refer

themselves

‘ll-Ways’ to

the

6.5

DCFS which

in

turn

refers

them

Clients Clients are served in 10 rural southern Illinois counties. As can be seen in Table 1, the average client is a single female head of household, about 30-yearsold, with two children in the home, and the reason for referral being high risk for abuse or neglect. Most clients served by Project 12-Ways can be characterized as what Wahler (1980) has labeled as insular. That is, they have few community contacts or friends, and most of their social interactions are with family members or agency personnel. Most clients live in rural settings. Many live in public housing projects in small rural communities. The average Project 12-Ways client is easily characterized as low SES. Services The services offered to clients is, they are provided directly settings, and day care settings. management. TABLE

1 Available

by Project 12-Ways are delivered in the clients' homes, in schools, This has been called multiple

Demographic Data on Project Fiscal Year, 1980 - 1983

12-Ways

Clients

1981

1982

156 97 (62%) 14 (9%) 45 (29%)

153 (52%) (4%) (44%)

1980 Served: Total Heads of Household Female Heads of Household Served: Male Heads of Household Served: Female and Male Heads of Household

169 129 (76%) 23 (14%) 17 (10%)

Served: Marital

Average Number of Range of Children

Children per per Household:

1981

28% 21% 9% 34% 4% 5%

1982

1983

NA NA NA NA NA NA

NA NA NA NA NA NA

1980 ----

1981

1982

1983

2.79 l-6

2.42 l-6

2.36 l-6

2.02 l-6

37% 19% 9% 32% 3% 0%

Household: 1980

Average Age of Primary Range of Age of Primary Referral

Clients Clients

for:

Abuse Cases Neglect Cases Prevention Cases Other *This list

information themself

may certainly as single even

1983

Status

1980 ---Married: Divorced: Separated: *Single: Widowed: Status Unknown:

That --in situ. foster care setting behavior

=

1981____

28.5 yrs = 13-65 yrs

1980 ---15% 40% 45% ---

1981 22% 53% 25% ---

30.7 lo-66

1982 35% 24% 27% 14%

be artifactual, though they were

yrs yrs

1982 1983 NA NA

NA NA

1983 27% 22% 42% 9% in that previously

someone may married.

66

J. R. Lutzker,

D. Wesch and J. M. Rice

Most families referred to Project IE-Ways have difficulties *~$&?c~~tionships. Thus, over 90% of the families served receive parent-child training. Each family's individual make-up and assessment results determines what kind of training they receive. Thos most structured training closely resembles the training described by Forehand and McMahon (1981). In carefully structured sessions this training involves teaching parents to use clear, concise commands to their children, to attend to and reward their children at higher rates, and to use timeout for noncompliance. The Forehand and McMahon (1981) model was chosen over other similar behavioral parent-child trainin models because of its focus on antecedents (commands) as well as on consequences 4 rewards and time out), and because parents must meet specified performance criteria before advancing through training. As Lutzker, McGimsey, McRae, and Campbell (1983) have suggested, however, to be durable, parent-child training should include more than compliance training. Thus, in addition to the structured compliance training there may be other strategies employed such as token economies for chores or to reduce tantrums (Dachman, Halasz, & Bickett, 1984), or planned activities in order to facilitate other training and to enhance family relationships. Finally, with some families didactic materials are used as adjuncts to direct training, whereas in other families only verbal rationales are used along with the direct training. Basic skill training. Many abused or neglected children lag behind their agemates in reaching developmental milestones. Children who are developmentally delayed are at higher risk for abuse than normal children. Thus, if some of their delays can be remediated the risk of abuse might be reduced. In this light Project 12Wavs staff orovide direct trainina of basic skills such as raoid toilet trainina (A&-in & Foxx, 1974), dry-bed training for nighttime enuresis'(Azrin, Sneed, & " Foxx, 1974), or basic hygiene such as bathing (Rosenfield-Schlichter, Sarber, Bueno, Greene, & Lutzker, 1983). An example of this was described by RosenfieldSchlichter, et al. (1983). Their clients were a 38-vear-old mother and her four children, I5-year-old, 13-year-old, and 5-year-old males, and a g-year-old female. Teachers reported that the 5-year-old and the g-year-old had such poor personal hygiene that they smelled so badly that other children would not associate with The teachers also reported that the children seldom, if ever, wore clean them. clothes. A program was then instituted wherin the teachers provided daily ratings of the children's hygiene and appearance. Baseline data substantiated the teacher's opinions about these children's poor hygiene. Because the mother had repeatedly failed to comply with Project 12-Ways and other agencies' efforts at setting up home management programs, the counselors enlisted the help of the 13-year-old son. With the mother's permission, a portion of her public aid payment was legally withheld to be used as a contingent allowance for the 13year-old boy's efforts at managing a bathing routine of his younger sister and brother. That is, based upon the teachers' ratings of improved hygiene in the target children, the 13-year-old brother received the allowance. In addition, the counselors arranged for a state homemaker service to do the laundry for this family, something the mother could not be relied upon to do. Considerable improvement in the children's hygiene and wearing of clean clothes was produced and maintained for over 13 weeks. The teachers also reported greatly improved peer relationships for both children. Thus, several sources were pooled together in this case to remediate a personal hygiene problem with two neglected children. Health maintenance and nutrition. Many clients seen by Project 12-Ways are heloed‘7 in manaaina medical reaimens for the oarents or children. Also. if nutrition asse;sm&ts indicate that the family does not maintain nutritious eating habits, attempts are made to teach nutritious meal planning, shopping, For example, Sarber, Halasz, Messmer, Bickett, and Lutzker (1983) and serving. taught nutritious meal planning and shopping skills to an illiterate moderately The woman's four-year-old daughter had been removed mentally retarded mother. from the home because of neglect based upon the mother's inability to provide a Using match-to-sample along with reinforcement and properly balanced diet. imitation procedures, the counselors first taught the mother to plan three meals ..-

A Review of Project

‘12-Ways’

61

a day per week, choosing food from the four basic food groups. Pictures of foods were placed on color coded cards according to food groups. The mother learned to match the cards to colors on a large planning board that contained library pocket envelopes in which the cards were placed. She then created a "shopping list" by matching pictures on her planning board and placing them in separate plastic pages of a two-ringed binder which she took on shopping trips. A multiple baseline design across food groups showed that the training procedures were responsible fcr criterion performances in the mother's ability to shop for nutritious meals. After the mother showed maintenance of her planning and shopping skills and generalization to a new store, the daughter was returned to the home. Approx imately 25-30% of clients served by Project 12-Ways receive health maintenance and nutrition training. Unsafe homes are commonly found among child abuse and neglect Welles. 1982). These unsafe conditions can contribute to a charae of neglect and can lead to abuse in two ways. First, if a child receives a serious iniurv from a home accident and becomes handicaooed. the risk of abuse becomes greater because the risk of abuse is greater for'handicapped children than for nonhandicapped children (Friedrich & Boriskin, 1980). Second, a parent may physically abuse a child in trying to prevent the child from injury in a potentially life threatening situation such as the child attempting to stick a metal object into an electrical outlet. Thus, clients served by Project 12-Ways whose homes are unsafe receive a comprehensive home safety training program. They are provided with a slide-tape program describing common household hazards, a manual describinq how to correct hazardous situations, feedback on where hazards exist in their home, instructions to correct hazardous situations, and safety devices such as "kindersards" (child-oroof cabinet locks). A formal assessment tool, the Home Accident Prevention Inventory (HAPI) has been developed and validated for use in these families' homes (Tertinger, Greene, & Lutzker, in press). Marital provided

(1973))

counselin g. Couples who seek help from with reciprocity counseling as described and contracting as described by Tearnan

Stress reduction. Clients who in-home stress reduction training & Lazarus, 1966) or behavioral Assertiveness training may also

have

difficulty handling stress utilizing progressive muscle relaxation training (Schilling be provided.

Money management. An individualized to live within their means (usually economically. Leisure families.

time

counseling,

Job-finding. an individualized is used. Self-control. tive coping weight, stop Alcoholism Wavs client co;nselors self-monitor

For

Clients

clients who modification

strategies smoking,

Project 12-Ways in by Azrin, Naster, and Lutzker (1980).

training protocol is public aid), to handle are

are of

taught

inexpensive

interested in the "Job-Club"

Individual are developed and so on.

this and

are provided with relaxation (Wolpe & Poppen, 1983).

used to creditors,

teach

activities

seeking approach

or

to

Young Thus,

unwed this

mothers group

programs of behavioral self-control to help parents control their

is

are at served

high risk by Project

for

clients and to shop do

as

upgrading employment, (Azrin & Besalel, 1980)

treatment referral. When alcohol abuse is a problem for referrals are made to local communitv aaencies. Proiect may supplement community treatment approaches by helpjng drinking or comply to an antabuse regimen.

Unwed mothers. (Taylor, 1973).

area are Jones

child 12-Ways

abuse with

and temper,

cognilose

a Project 12-Wavs the client and neglect services

12-

68

J.

R.

Lutzker,

D.

Wesch

and

J. M.

Rice

including prenatal and postnatal training in preparation for childbirth, nutrition for mothers and infants, selection of physicians for mothers and infants, health care education, home safety, family planning, and mother-infant stimulation. Other Project 12-Ways services are also available to these young unwed mothers. Table fiscal

2 lists years,

TABLE

the percent 1980-1983.

2 The

Percent Percent

of of

of

families

Families Families

receiving

each

Receiving Receiving

Treatment Each

1.

Parent-Child Training Basic Skill Training :: Stress Reduction-Assertiveness Training 4. Unwed Mothers Multiple Setting Behavior Management 65: Self-Control Training 7. Job-Finding 8. Money Management 9. Leisure Time Counseling Social Support :7: Alcoholism Treatment or Referral Home Safety K: Health Maintenance and Nutrition Counseling 14. Marital 15. Assertiveness Training the of

majority service,

EVALUATION Lutzker and Ways. These evaluation.

Rice are:

of these

the families percentages

78% --16% 16% 20% 19% 13% 11% 10% 9% 5% ----8% 14% served do not

received sum to

service

Services

Treatment

Fy’80

*Since type

treatment

in

in

four

FY'80-FY'83*

Service

FYI81

FYI82

FYI83

93% --23% 30% 45% 30% 19% 25% 30% 24% 4% 20% 20% 10% 23%

92% 30% 18% 21% 36% 18% 13% 15% 19% 18% 10% 18% 30% 14% 15%

91% 26% 15% 22% 43% 9% 11% 14% 14% 12% 3% 20% 26% 16% 7%

more 100%.

than

one

STRATEGIES

(in 1)

press) have described clinical; 2) single-case

four

levels of experiments;

assessment of 3) research;

Project 12, 4)program

Clinical. The most frequent form of assessment is the collection of clinical data on cases. Relvino so heavilv on behavior analvsis and theraov treatment orocedures, staff-naturally collect a good deal 07 baseline and'"treatment data. Most of these data are not publishable because of lack of experimental designs and reliability. Nonetheless, these data are valuable to clients and staff alike. Frequently, the clients take an active role in recording their own behavior, or their children's behavior. These data help the clients learn to target and track behavior, and they provide feedback on treatment progress. These data also allow counselors to share empirical information with their supervisors (c.f. Rice & Lutzker, 1983). Single-case experiments. Behavior change in individual families umented by single-case experiments in which publishable desiqns with reliably collected data. These efforts‘provide evidence techniques used on Project 12-Ways are indeed effective with for child abuse and neglect. Whereas there is limited external be claimed from these efforts, they nonetheless contribute to child abuse and neglect in that they document that change can they invite replication. Examples of single-case experiments al. (1983) study teaching nutritious meal planning and shopping

can also be docare used alone that some of the families indicated validity that can the literature in be produced, and are the Sarber, et skills to the

A Review of Project

‘UWays

69

retarded neglectful mother and the Rosenfield-Schlichter, et al. (1983 study which improved the personal hygiene of two grade-school children. Ano 1 her example of the ecobehavioral approach documented through a single-case experiment was provided by Campbell, O'Brien, Bickett, and Lutzker (1983). They described a case in which the mother was a self-referral because of an expressed fear that she was going to kill her 4-year-old daughter if she did not receive help in managing the Assessment by the counselors determined that the mother suffered child's behavior. from debilitating migraine headaches and was experiencing some marital difficulties Despite the clear need to teach child management skills to this mother, the counselors decided that doing so would be difficult at best if the client was still experiencing her headaches. Thus, after a medical examination ruled out any identifiable organic cause for the headaches, the counselors began an in-home stress reduction program with the client. By the fourth treatment session, headaches were greatly reduced in frequency and duration, and were ultimately eliminated. Once headache frequency had been reduced, the counselors began teaching the mother to use compliance training procedures with her daughter. The client quickly learned these behavior management techniques which qreatly improved her relationship with Subsequent to the stress reduction and compliance training, the her daughter. client was provided with marital counseling. Marital Happiness Inventory data showed posttreatment improvements in the marriage as a function of the counseling. This case was a clinical success and one in which publishable data were generated. Research. In addition to clinical data and single-case experiments, research with clientsis also conducted. The Tertinger, et al. (in press) home safety program provides a good example. The use of the Home Accident Prevention Inventory and education/training program was evaluated with six client families. A multiple baseline design across categories of hazards in each home demonstrated that the program was responsible for considerable improvements in each family's home. Using a group design, Campbell, Lutzker, and Cuvo (1982) compared affection responses, parent training, and tasks across low SES families indicated for abuse, neglect, and a comparison nonabuse, nonneglect group. They found that different kinds of tasks affected the frequencies of affection responses in mother-child dyads. Also, parent training enhanced affectionate responding. Use of these results has utility in assessing and treating child abuse and neglect families. Research efforts on Project 12-Ways, make contributions beyond the scope of singlecase experiments. They provide information on the behavioral characteristics of families involved in child abuse and neglect, and provide a more sophisticated analysis of components of this ecobehavioral approach. In work such as Tertinger, et al. (in press), external validity is provided of a treatment program across families served by Project 12-Ways. Program evaluation. The fourth level of assessment is program evaluation. Current efforts in this area involve trying to examine recidivism rates of abuse and neglect. Participants in the first effort were 51 families referred by the DCFS to Project IE-Ways during Fiscal Year, 1980 (FY'SO). These families were referred because of a history of child abuse or neglect or because they were considered "high-risk" for abuse or neglect. They had the option to terminate their participation with Project 12-Ways at any time; however, under the Illinois Child Protection laws, they were required to receive services from DCFS. In order to provide a comparison group to compare Project 12-Ways services with the conventional services provided by DCFS, 46 families were randomly selected from regional office records. The comparison group families were also served during the same fiscal year, and were selected from the same geographic areas as the Project 12-Ways families. The only differences between these groups were the discreoencv in samole (51 vs. 46) and-more information was available on the Project 12-Ways"families. For example, 12-Ways families had additional information on the date of service termination, the number of treatment goals, and the length of time services had been

70

J. R. Lutzker.

D. Wesch and J. M. Rice

received. Of particular interest was the rate of recidivism that is, the number of families who abused or neqlected their children after termjnation of child abuse services. In order to determine this, information on the 51 Project 12-Ways families and the 46 comparison group families was submitted to the Illinois State Central Registry (SCR). The SCR is responsible for keeping records on all indicated instances of abuse and neglect. The SCR not only collected data on child abuse/neglect perpetrators, but also on the victims of abuse, the individual reporting the abuse, and other codes. In recidivism was defined as abuse order to simplify data collection ambiguities, and neglect following termination of services in which a family member was designated as a perpetrator. The same procedures received Project number of families

were used in examining treatment and comparison 12-Ways and DCFS services in FYI81 and FY'82. in each group was 85 and in FYI82 it was 54.

The results are shown are presented cumulatively cidence results whereas is. incidences reoorted Ways group repeat'rate For FYI81 the 12-Ways For FYI82 the Project 31.4%. For FYI83 the parison group rate was For was

groups

who

In FYI81 the

in

Fig. 1. For the FYI80 groups recidivism and repeat data across years 1980-1983. The 1980 data are repeat inthe '81, '82, and '83 data reflect recidivism data, that FYI80 the Project 12after the termination of services. of abuse and neglect was 3.9%; the comparison group was 26%. recidivism rate was 11.7%; the comparison group was 28.2%. 12-Ways group rate was 21.6%; the comparison group rate was Project 12-Ways qroup recidivism rate was 25.5%; the com34.5%.

the 8%;

FYI81 groups the FYI82 rate of recidivism for the Project 12-Ways The FYI83 rate was 19% for the the comparison group rate was 5%. The one-year follow-up on 12-Ways group and 17% for the comparison group. ivism for the FYI82 groups showed a 21% rate for the Project 12-Ways group 31% rate for the comparison group.

group Project recidand a

Some caution should be used when comparing the groups described here. Because Project 12-Ways data were available on the date of service termination, the actual recidivism data can be calculated for this group. Since the actual termination date for the control group was not obtained, it is unknown what proportion of these incidences occurred before, during, or after delivery of child abuse/ Therefore, these data are not truly equivalent. neglect services. The data are suggestive that there are generally lower recidivism clients served by Project 12-Ways. The exceptions to this are sons during FYI82 and FY'83. NO explanation for this discrepancy other than speculation that those data are somehow artifactual.

the

rates among FYI81 comparican be offered

Future program evaluation efforts will examine the relationshio between services delivered and results obtained. To do this, a more precise format for identifying and tracking an appropriate comparison group will be used. Rather than relying on the SCR to supply information on-the'possible occurrence of abuse or neglect, matched comparison group client files kept by DCFS will be examined. This will allow for the precise identification of the comparison group, for exact knowledge of service frequency and dates, for the level of success achieved during contact with DCFS, and a host of demographics. Access to treatment information for both Project 12-Ways and comparison families will also allow for clearer knowledge of how similar or different the services were, and whether or not such features as frequency of contact is related to outcome. The families served by each could be compared on severity and frequency of abuse or neglect, rather than solely recidivism, and during treatment successes. Inclusion of demographic information on all clients may allow for the establishment of predictors of success or failure among those families served.

FISCAL 1982 % RECIDIVISM

FISCAL 1980 % RECIDIVISM

72

J. R. Lutzker,

D. Wesch and J. M. Rice

Restrictions exist on a complete experimental verification of Project 12-Ways' impact. The formation of a true experiment using an appropriate level of randomization and a more closely observed comparison group is not feasible. Assessing clients' skill levels across time, rather than just looking at recidivism data, cannot currently be completed. The four levels of evaluation mentioned here can be combined to provide a very persuasive argument in favor of the impact achieved. Each piece of evidence compiled at each level helps provide substance to details gathered at another level. It may be difficult to completely document that the results achieved came only from Project 12-Ways’ intervention, but it may be strongly suggested. DISSEMINATION If program evaluation data and the data accrued from the other three levels of assessment continue to suggest that Project 12-Ways reduces the likelihood of child abuse and neglect, then dissemination must be considered. Can the model be used outside of southern Illinois? Some components of Project 12-Ways may be close to being ready for dissemination. For example the Home Safety Program is a form that could be implemented elsewhere. Also, aspects of the staff training program are sufficiently structured and task analyzed that they could be attempted elsewhere. This includes a training program on how to teach time-out skills to parents, and how to interact with children. Many more components, however, need to become as structured and need to be formally evaluated before a whole-scale replication of Project 12-Ways should be attempted. Finally, there are variables that mav affect Project 12-Wavs effectiveness that mav be difficult to evaluate or repljcate. For example, the staff are at once students in an intensive and highly structured graduate program in behavior analysis and therapy. Would a staff in a mental health center or child protective service agency be able to deliver these ecobehavioral services in a similar manner? The workina relationship between DCFS and Project 12-Ways is unusually positive. Does this facilitate Project 12-Ways' efforts and could such a relationship be replicated? Staff members serve families by pairs. Is this an essential component? These are difficult issues to examine, but some effort should be made at exploring them if this comprehensive project is to be disseminated. REFERENCES Azrin,

Azrin,

N.

H.,

& Besalel,

Y.

York: Simon & Schuster. N. H., Naster, 8. J., learning-based procedure

11. 365-382.

B.

(1980).

Job

club counselor's Baltimore: University let training in less

& Jones, R. for marital

(1973). counseling.

Reciprocity Behav.

manual: A behavioral Park Press. than a day. New counseling: Research

A rapid and Thrpy,

H., Sneed, T. J., & Foxx, R. M. (19 ). Dry-bed training: Rapid elimiBehav. Research and Thrpy, 12, 147-156. nation of childhood enuresis. Campbell, R. V., Lutzker, J. R., & Cuvo, A. J. (1982, May). Comparison study of affection in low socioeconomic families across status of abuse, neglect, and non-abuse neglect. Paper presented at the Eighth Annual Convention of the Association for Behavior Analysis, Milwaukee, Wisconsin. J. R. (1983). In-home parentCampbell, R. V., O'Brien, S., Bickett, A., & Lutzker, trainina. treatment of miaraine headaches. and marital counselina as an ecobehavio&l approach to prevent child abuse. J. of Behav. Thrpy and Exe. Psych., 14, 147-154. Dachman, R. S., Halasz, M. M., & Bickett, A. D. (1984). The use of dot-to-dot posters and a grab-bag to reduce inappropriate child behavior. the Behav. Therapist, 7, 4-14. Forehand, R. L., & McMahon, R. J. (1981). Helping the noncompliant child: A

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A Review of Project

‘12-Ways’

73

clinician's guide to parent training. New York: Guilford Press. Friedrich, W. N., & Boriskin, J. A. (1980). The role of the child in abuse: A review of the literature. In J. V. Cook & R. T. Bowles (Eds.), Child abuse: Commission and omission (pp. 171-182). Toronto: Butterworths. Garbarino, J. A. (1976). A preliminary study of some ecological correlates of child abuse: The impact of socioeconomic stress on mothers. Child Develop., 4J, 178. Gelles, R. J. (1982). Problems in defining and labeling child abuse. In R. H. Starr (Ed.), Child abuse prediction: Policy implications (pp. l-30). Cambridge: Ballinger. Guen, A. H., Gaines, R. W., & Sandgrund, A. (1974). Child abuse: Pathological syndrome of family interaction. Am. J. of Psych., 131, 882-926. Helfer, R. E. (1982). A review of the literature on the prevention of child abuse and neglect. Child Abuse and Neglect: The Inter. J., 5, 251-261. Kelly, 3. A. (1983). Treating child-abusive families. New York: Plenum Press. Lutzker, J. R. (1984). Project 12-Ways: Treating child abuse and neglect from an ecobehavioral perspective. In R. F. Dangel & R. F. Polster (Eds.), Parent training: Foundations of research and practice. New York: Guilford Press. Lutzker, J. R., McGimsey, J. F., McRae, S., & Campbell, R. V. (1983). Behavioral parent-training: There's so much more to do. the Behav. Therapist, 6, llO-

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FOOTNOTE Reprints are available Rehabilitation Institute, Illinois 62901.

from

John R. Lutzker, Southern

Illinois

Behavior University

Analysis and at Carbondale,

Therapy Program, Carbondale,