Family Intervention

09/28/2018  |  By Mary Jane Weiss, Karen Parenti and Jennie Labowitz
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For individuals with disabilities, the success of intervention depends on many variables. Providing evidence-based effective treatment, ongoing staff training and feedback, and identifying appropriate goals, for example, all influence the extent to which meaningful progress might occur. 

In addition to those elements of treatment, success is also influenced by the extent to which members of teams effectively collaborate with one another. Intervention is a complex enterprise and requires the ability to discuss alternate points of view, navigate differences of opinion, and resolve interpersonal difficulties. The success of intervention and the individuals’ subjective impressions of the team’s health may be determined, in part, by the degree to which team members are able to demonstrate mutual respect, communicate effectively and exude compassion.

One of the most crucial foundations of effective collaboration between parents and professionals is compassion, or the capacity to truly understand the unique challenges and extraordinary stress experienced by families or loved ones. Most clinicians have a general understanding of the ways in which having a family member with a disability might pose emotional and logistical challenges. However, they may not recall that information in everyday clinical interactions. They may feel frustrated when a family is not following a behavior plan, taking requested data, or writing back in the communication book. Such frustration may be conveyed in direct or subtle ways, leaving family members feeling that they are being evaluated negatively or falling short of expectations. Allen and Warzak (2000) emphasized the need for clinicians to assess why family members might be failing to adhere to treatment recommendations. They point out that family members may be asked to work on goals that are not highly motivating, or may be given plans that are simply too complex to implement in the natural environment. In other words, these authors suggest that a foundation of compassion might help clinicians to assess such non-adherence, to understand its persistence, and to change their own behaviors to partner more effectively with parents. The challenges encountered in a home setting and the chronicity of the stress inherent in the family context need to be considered in analyzing such problems.

It is not always the case that such skills are taught to students or to staff members. A tremendous amount of energy is spent teaching skills in instructing students, in recording data, and in summarizing progress. Comparatively little attention may be given to helping teachers and human service professionals to develop these skills. Yet, it is clear that compassion skills can be defined and can be taught (Bonvincini et al.). Even simple component skills such as learning to listen effectively and to ask questions make a difference in the extent to which the listener feels supported and understood. Being able to summarize the content that a conversational partner has offered goes a long way toward feeling valued and heard. In addition, checking in with parents to request information and clarification (e.g., “Did I miss anything?”), and offering assistance and partnership can make the difference in working effectively with families, and can reduce familial isolation and stress in some cases (e.g., Coulehan et al., 2001; Epstein et al., 1993; Hardee, 2003).

One of the goals of human service provision organizations needs to be in expanding the lens through which they view effective service delivery, by including effective partnerships with families. Staff members need to be exposed to information about family experience and family impact, and be trained in the skills that make a difference in family support. Helping to build a foundation of empathy in providers may make it more likely that parental non-adherence is interpreted as a failure to provide clinical services that match family capacity and preference, rather than as a failure on a family’s part. Teaching skills in listening and in communicating respectfully may make families feel more understood and appreciated in the context of care. 

In addition to collaboration with families, staff members also need to learn to collaborate effectively with staff members from other disciplines. The nature of intervention for those with disciplines is interdisciplinary by nature. The complex needs of learners require the expertise of many disciplines. Coordination among the disciplines is important and ultimately necessary to achieve maximum growth and progress. Each discipline comes to the table focusing on its respective goals, based on its specialized assessments. Each discipline, then, implements its own treatment interventions (either directly or through training of other staff); all of this must be coordinated throughout the treatment environments. At times, disciplines fall into doing separate work somewhat independently of other disciplines. This, in part, is a result of the logistical complexity of scheduling a number of therapies offered by a number of disciplines; finding time for discussion and observation with other professionals can be difficult to arrange. However, it is important for there to be opportunities for members of different disciplines to discuss their points of view, to share their impressions, to observe one another’s approaches, and to co-treat together. 

Broadhead (2015) urges behavior analysts (and, one could propose, those in other disciplines) to develop an understanding of the foundations and approaches of each discipline, to understand why certain recommendations may be made, to translate other procedures into one’s own worldview and framework, and to be open to procedures suggested by other professionals. Many others have noted that failures to communicate and collaborate with professionals from other disciplines may lead to misunderstandings. Professionals may feel devalued or marginalized in a team context, may believe that their views are less valuable, and may feel unable to influence team decisions. When this occurs, these professionals may remain silent and hesitate to prescribe a necessary treatment intervention.

This is another area where little is done to train professionals in the soft skills of collaboration. In behavior analysis, for instance, more attention is given to ensuring that clinicians understand the ethical obligations to offer science-based intervention than to dialog with teams about intervention choices. Yet, inadvertently, behavior analysts emphasizing evidence-based intervention may offend clinicians from other perspectives when they point out a lack of evidence for a proposed procedure. While all of these topics are part of the necessary discussion, gaps exist in training and practice in this crucial area.

It is helpful to consider how organizations might help instill a culture of collaboration to aid all staff in developing effective alliances with families and successful teams. It may be that training and supervision around these essential skills will enhance the ability of staff members to exude skills that make other members of the team feel heard, valued, respected, and understood. This should ultimately lead to more effective learner outcomes and higher satisfaction from consumers and employees. 

In sum, collaboration across disciplines and with families has great influence on the success of treatment. Good collaboration ‘sets the table’ for maximizing the success of the student/client. However, successful collaboration also means that all professionals need to have and maintain open minds, be willing to be flexible and share their time, and believe that all learners can succeed. Faulty collaboration may interfere with treatment delivery and adherence. All professionals need to step back, reflect on how each can contribute, and strive to behave in ways that not only maximize their individual effectiveness, but also elevate the team with whom they provide services to the client. To that end, these steps can be considered as a basic roadmap to enhancing collaboration and effectiveness:

  1. Train staff members in the realities of family stress and family experience; actively contextualize problems in plan adherence in this context.
  2. Encourage functional assessments of parental non-adherence, and develop plans to alter staff behavior and clinical interventions to address these concerns.
  3. Target soft skills that will increase parental comfort. Teach staff members basic active listening skills and effective communication skills.
  4. Obtain information from parents about the extent to which they feel valued, respected, supported, and understood. For example, this can be done through regular family satisfaction surveys.
  5. Actively seek to develop true interdisciplinary teams. Work against a silo approach. Foster true communication among disciplines. Create regular interdisciplinary team meetings. 
  6. Remember that true collaboration takes time, flexibility and response effort. Allow for as much planning time and flexibility as possible.
  7. Encourage observation of sessions by other professionals and seek opportunities for co-treating.
  8. Disseminate information from all disciplines.  In professional development contexts, bring in speakers from multiple professions. Share articles from many fields of study.
  9. Ensure that respect is conveyed to all professions, and that professional disagreements are resolved with respect.
  10. Emphasize collaboration skills in staff training.
  11. Evaluate the extent to which professionals feel respected within the organization. Embed questions on this issue within the annual employee surveys.
Mary Jane Weiss, Ph.D., BCBA-D serves as Melmark’s Senior Director of Research, Karen Parenti, M.S., Ph.D. is the Executive Director of Melmark Pennsylvania, and Jennie Labowitz, M.S., NCSP, BCBA, is Director of Educational Services, The Melmark School (PA).
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