- Email: [email protected]
Working with multiproblem families
Book Reviews and rich research literature from several disciplines, and does not suffer from the uneven and often repetitious coverage of edited texts. In addition to being appropriate for courses on child and family development, it is uniquely suited to courses on family social policy. As mentioned, the research findings on social contexts that facilitate child development offer justifications for social welfare policy goals and social welfare programs. If social workers are to offer a scientific alternative to the economic perspective that dominates social welfare policy debate, they will need to consult this text. William C. Horner Eastern Washington University
Working with Multiproblem By Lisa Kaplan Lexington, MA: Lexington
Families Books,
1986, 153 + xvi pp., $15.00
(softcover).
In Working with Multiproblem Families, Lisa Kaplan attempts to draw practical strategies for serving multiproblem families from the broader family therapy literature. This publication is perhaps best described as a monograph. Kaplan’s brief presentation of the clinical and administrative issues involved in working with multiproblem families is supplemented by de-’ scriptions of exemplary family-preservation programs and an extensive annotated bibliography. It is difficult to place this book in the context of other books on the multiproblem family because relatively little has appeared since the 1970s. It poses no challenge to Families of the Slums (Minuchin, Montalvo, Guerney, Rosman, 8c Schumer, 1967) as the classic work. It is probably best considered a basic introduction to the subject. Kaplan is a family therapist who is also involved in training, consultation, and program development. She ably sets the stage by discussing how the organization of our social service delivery systems tends to fragment families by focusing on the classification and treatment of individuals, without reference to their social contexts. She advocates for the creation of comprehensive federal and state policies dedicated to the principle of family preservation. She argues that, “our main problem is not our lack of knowledge about how to help families; it is the need for commitment to the provision of high-quality family services” (p. xv). Her appraisal of the need for family-centered services does not offer any new insights, but is fundamentally correct and sets the stage for the remainder of the book, which is aimed at “providing a framework for working with multiproblem families” (p. xi). In the first chapter Kaplan defines multiproblem families as those
Book Reviews with more than one problem, both internal and external. The families are characterized as chronic, in terms of their problems, and as crisis prone, in terms of their attempted solutions. Kaplan stresses the need to view the often nonproductive relationships between social agencies and these families as an interactional issue, requiring exploration of the agency’s contribution and the family’s contribution. The conceptual framework presented in chapter 2 is termed a growth and development model and is contrasted with the medical model. Although this section alludes to the futility of practice orientations that focus on pathology and adequately summarizes Barnhill’s (1979) review of healthy family functioning, the author’s case examples are often redundant or confusing. Rather than demonstrating how these orientations lead to very different analyses of a single family‘s functioning, she presents brief narratives of two different families. One is a multiproblem family, and the other is a functional family. Kaplan suggests that they are distinguished by the functional family’s ability to cope with its problems. Despite her avowed rejection of the medical model, Kaplan characterizes the and possessing the attributes of healthy functional family as “healthy” family functioning, implying that the multiproblem family is unhealthy. At best, this is a difficult distinction, especially for the uninitiated. At worst, Kaplan is suggesting the application of middle class values as a standard for all families. Chapter 3 introduces the notion of the family system as the primary unit of concern and briefly (four pages} summarizes the elements of family structure and organization as presented by ~inuchin (1974). Chapters 4 to 10 touch on issues relevant to both workers and administrators of family preservation programs. Some important issues are identified, but, in most cases, the presentation is far too cursory. Kaplan suggests that programs must develop specific criteria for referrals that are based on family systems, rather than symptoms, and provides examples of families whose characteristics suggest that they would benefit from a family approach. This is a difficult approach to describe, and it has been the subject of considerable research. Unfortunately, Kaplan offers little that could apply to any population beyond brief descriptions of family problems. She stresses that intake procedures should be simple, nonbureaucratic, and clear. Effective assessments are described as ecological and leading to realistic treatment alternatives. Considerable emphasis is given to the need for communicating a sense of hope and optimism to families. The section on intervention strategies is essentially a glossary, rather than a description of practical strategies, and is primarily dedicated to elaborating on what have become buzzwords in the family therapy literature. Accordingly, treatment is portrayed as a collaborative process. Such principles as “putting the parents in charge, emphasizing strengths,” and using action-oriented, present-focused interventions are mentioned. The importance of termination as a planned process is highlighted. Chapter 9 discusses the advantages and disadvantages of using paraprofessional staff and emphasizes the need for training and supervision as
Book Reviews well as considerable support for those who work with this demanding population. Chapter 10 speaks to the need for adequate program evaluation but provides little detail about ways to adapt program evaluation to capture changes in families rather than individuals. Chapter 11 describes nine exemplary family-based programs. Kaplan summarizes the history and organization of each program. She discusses the services offered and the criteria for eligibility. Although brief cost analyses are provided when the information is available, there is little discussion about the effectiveness of these programs. The main body of this book concludes with recommendations for a comprehensive program model. This general model emphasizes the principle of family preservation within the context of an ecological model of practice. Unfortunately, this book rarely lives up to its’promises. It is often difficult to determine the author’s intended audience. It is clear that Kaplan knows about the clinical and administrative issues involved in serving multiproblem families. Yet, the presentation is so basic that it will be of little interest to any but the complete novice. The book’s breadth and generality fail to convey the complexity of working with multiproblem families and often oversimplify very complicated concepts and issues. This reviewer sensed that several potential books have been collapsed into one presentation that is not likely to satisfy the reader, regardless of his or her job or level of experience. The strength of this book lies in its supplemental material. Almost half of the pages are devoted to descriptions of exemplary programs, a resource directory, and an excellent annotated bibliography. Although most of this material is available elsewhere, the convenience of this relatively comprehensive compilation could well make this book worthy of purchase. References Barnhill, L. R. (1979). Healthy family systems. The Family Coordinafor, 28, 94-100. Minuchin, S., Montalvo, B., Guerney, B. G., Rosman, B. L., & Schumer, F. (1967). Families of the slums: An exploration of their structure and treatment, New York: Basic Books. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.
Hamy Frankel University of California, Berkeley
Working with Multiproblem By Lisa Kaplan Lexington, MA: Lexington
Families Books,
1986, 153 + xvi pp., $15.00
(softcover).
In Working with Multiproblem Families, Lisa Kaplan attempts to draw practical strategies for serving multiproblem families from the broader family therapy literature. This publication is perhaps best described as a monograph. Kaplan’s brief presentation of the clinical and administrative issues involved in working with multiproblem families is supplemented by de-’ scriptions of exemplary family-preservation programs and an extensive annotated bibliography. It is difficult to place this book in the context of other books on the multiproblem family because relatively little has appeared since the 1970s. It poses no challenge to Families of the Slums (Minuchin, Montalvo, Guerney, Rosman, 8c Schumer, 1967) as the classic work. It is probably best considered a basic introduction to the subject. Kaplan is a family therapist who is also involved in training, consultation, and program development. She ably sets the stage by discussing how the organization of our social service delivery systems tends to fragment families by focusing on the classification and treatment of individuals, without reference to their social contexts. She advocates for the creation of comprehensive federal and state policies dedicated to the principle of family preservation. She argues that, “our main problem is not our lack of knowledge about how to help families; it is the need for commitment to the provision of high-quality family services” (p. xv). Her appraisal of the need for family-centered services does not offer any new insights, but is fundamentally correct and sets the stage for the remainder of the book, which is aimed at “providing a framework for working with multiproblem families” (p. xi). In the first chapter Kaplan defines multiproblem families as those
Book Reviews with more than one problem, both internal and external. The families are characterized as chronic, in terms of their problems, and as crisis prone, in terms of their attempted solutions. Kaplan stresses the need to view the often nonproductive relationships between social agencies and these families as an interactional issue, requiring exploration of the agency’s contribution and the family’s contribution. The conceptual framework presented in chapter 2 is termed a growth and development model and is contrasted with the medical model. Although this section alludes to the futility of practice orientations that focus on pathology and adequately summarizes Barnhill’s (1979) review of healthy family functioning, the author’s case examples are often redundant or confusing. Rather than demonstrating how these orientations lead to very different analyses of a single family‘s functioning, she presents brief narratives of two different families. One is a multiproblem family, and the other is a functional family. Kaplan suggests that they are distinguished by the functional family’s ability to cope with its problems. Despite her avowed rejection of the medical model, Kaplan characterizes the and possessing the attributes of healthy functional family as “healthy” family functioning, implying that the multiproblem family is unhealthy. At best, this is a difficult distinction, especially for the uninitiated. At worst, Kaplan is suggesting the application of middle class values as a standard for all families. Chapter 3 introduces the notion of the family system as the primary unit of concern and briefly (four pages} summarizes the elements of family structure and organization as presented by ~inuchin (1974). Chapters 4 to 10 touch on issues relevant to both workers and administrators of family preservation programs. Some important issues are identified, but, in most cases, the presentation is far too cursory. Kaplan suggests that programs must develop specific criteria for referrals that are based on family systems, rather than symptoms, and provides examples of families whose characteristics suggest that they would benefit from a family approach. This is a difficult approach to describe, and it has been the subject of considerable research. Unfortunately, Kaplan offers little that could apply to any population beyond brief descriptions of family problems. She stresses that intake procedures should be simple, nonbureaucratic, and clear. Effective assessments are described as ecological and leading to realistic treatment alternatives. Considerable emphasis is given to the need for communicating a sense of hope and optimism to families. The section on intervention strategies is essentially a glossary, rather than a description of practical strategies, and is primarily dedicated to elaborating on what have become buzzwords in the family therapy literature. Accordingly, treatment is portrayed as a collaborative process. Such principles as “putting the parents in charge, emphasizing strengths,” and using action-oriented, present-focused interventions are mentioned. The importance of termination as a planned process is highlighted. Chapter 9 discusses the advantages and disadvantages of using paraprofessional staff and emphasizes the need for training and supervision as
Book Reviews well as considerable support for those who work with this demanding population. Chapter 10 speaks to the need for adequate program evaluation but provides little detail about ways to adapt program evaluation to capture changes in families rather than individuals. Chapter 11 describes nine exemplary family-based programs. Kaplan summarizes the history and organization of each program. She discusses the services offered and the criteria for eligibility. Although brief cost analyses are provided when the information is available, there is little discussion about the effectiveness of these programs. The main body of this book concludes with recommendations for a comprehensive program model. This general model emphasizes the principle of family preservation within the context of an ecological model of practice. Unfortunately, this book rarely lives up to its’promises. It is often difficult to determine the author’s intended audience. It is clear that Kaplan knows about the clinical and administrative issues involved in serving multiproblem families. Yet, the presentation is so basic that it will be of little interest to any but the complete novice. The book’s breadth and generality fail to convey the complexity of working with multiproblem families and often oversimplify very complicated concepts and issues. This reviewer sensed that several potential books have been collapsed into one presentation that is not likely to satisfy the reader, regardless of his or her job or level of experience. The strength of this book lies in its supplemental material. Almost half of the pages are devoted to descriptions of exemplary programs, a resource directory, and an excellent annotated bibliography. Although most of this material is available elsewhere, the convenience of this relatively comprehensive compilation could well make this book worthy of purchase. References Barnhill, L. R. (1979). Healthy family systems. The Family Coordinafor, 28, 94-100. Minuchin, S., Montalvo, B., Guerney, B. G., Rosman, B. L., & Schumer, F. (1967). Families of the slums: An exploration of their structure and treatment, New York: Basic Books. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.
Hamy Frankel University of California, Berkeley