Design and Development of a
Family Therapy Model
With Urban African-American Families

Melvyn C. Raider
WayneStateUniversity

     This writer conceived the notion of developing a model for social workers to practice with low-income African-American families as an outgrowth of his evaluation research on school-based mental health programs. These programs located in inner-city Detroit Schools primarily served low income African-American families. Findings of process evaluation research studies indicated that parents of the children receiving school-based services perceived that there was little communication between social workers and themselves. Further, parents did not feel sufficiently involved in their child’s treatment. Social workers in these programs perceived parents an inaccessible, difficult to engage and generally indifferent to being involved in their children’s treatment. In spite of the fact that social workers acknowledged the necessity to involve parents and, if necessary, provide family therapy, few parents visited the schools for this purpose and even fewer home visits took place. Consequently, it became obvious that social workers needed additional training to engage parents and bring them into the treatment process. The Model of Social Work Practice with low income, urban, African-American families was developed to train these social workers and ultimately to improve their effectiveness with this population.
     The task of developing such a social work practice model was indeed challenging. There has been a great deal written about African-American culture and counseling approaches. Much of this is based upon experiential and anecdotal information. What was needed was to compress this immense volume of literature into a useable format and to develop knowledge and treatment components of a concise, practical intervention model. Further, it was necessary to go beyond anecdotal and experiential sources of knowledge to validate the components of the model. In order to empirically validate the model, qualitative and quantitative research was conducted with the workers who were actually providing services to low-income African-American families.
     To provide structure to this task, Edwin Thomas’ Developmental Research approach was used as a working methodology for the process of crafting the practice model. Thomas’ approach was accepted since it provided a systematic methodology for assessing the state of existing knowledge, validating that knowledge and developing an innovative practice paradigm.

The Design & Development Model of Practice Research
     Phase one and two of the design and development model of Practice Research served as a beginning framework for the development of our Model of Social Work Practice with Low-income, Urban, African-American Families. This approach was introduced by Edwin Thomas, among others, almost twenty years ago (Thomas ’78). Unlike traditional research methods which seek to contribute to our knowledge base, Design & Development research seeks to develop new practice approaches or innovations. Thomas refers to his Design and Development approach as the Developmental Research Approach to D&D (Thomas 1992). For Thomas “the outcomes of developmental research are products that are the technical means of achieving social work and social welfare objectives” (Thomas, 1992 p. 73). The four major phases of the approach are: analysis of existing knowledge and the state of the art in the area in which the innovation is to take place; design of the intervention approach; development of the implementation plan; and evaluation of the effectiveness of the intervention (Thomas, 1992 p. 74). The analysis and design of the Developmental model involved analysis of relevant literature and the state of existing interventions. It also included empirical data gathering in order to determine the most appropriate selection of information and data sources to be included in the Model. The design phase of model construction involved exploration of new interventions based upon the analysis of relevant information and empirical data gathering.

Analysis of relevant information and the status of existing interventions
     A literature review was conducted which examined the characteristics and history of African-American families; barriers to services, and practice approaches which have been proposed to be helpful with African-American families. A later task of the analysis phase of the Developmental Research Approach was the selection of information sources and the gathering and processing of information necessary to refine the intervention model.
     In order to develop a model that was both grounded in theory as well as consistent with current social work practice, a qualitative and quantitative exploratory survey of service providers in agencies serving low-income, urban, African-American families was implemented and analyzed. A purposive sample of twenty-five respondents from ten agencies was obtained. Three agencies were residential programs which focused on child and family services, one was a school outreach program serving families, five of them were school based mental health programs, and one was a program which provided medical social work and support services to families.

Instrument Development:
     Based on the information obtained in the literature review, instruments were developed. Using these instruments, researchers sought to gather further information regarding the five potential model components selected as a result of the literature review. The instruments were also designed to empirically validate the intervention techniques postulated as helpful to low-income, urban, African-American families.
     The first instrument developed was a three-part questionnaire. The first part of the questionnaire was composed of open-ended questions. The questionnaire was constructed to determine how the families were most often referred; services most often used by African-Americans in the respondent’s program; strategies and techniques used by the participant to help the families; and the worker’s level of experience with the target population. Participants in the survey were also asked to describe a successful as well as an unsuccessful intervention with low-income, urban, African-American families.
     Information obtained from the literature review suggested that it was important for workers who serve low-income, urban, African-American families to have knowledge of African-American culture. Consequently, twenty-six Likert Scale items focused on history and culture; self-esteem; support from extended family and the community; spirituality and religion; safety issues and living conditions; gender roles; and the roles of grandparents. The same format was used to focus on practice principles. Nineteen Likert Scale items on the questionnaire gathered data regarding family workers’ perceptions and use various treatment techniques for service delivery to low-income, urban, African-American families. Techniques examined in this component of the questionnaire included: the role of extended families in services; the role of religion, spirituality and the church community in service provision; and communication techniques to overcome communication and language barriers. The entire questionnaire was reviewed by a sample of workers serving low income urban African-American families to establish face validity.
     The study sample was composed of 11 school-based mental health workers from the Detroit Compact Child and Family Program, and 14 social workers or therapists from six other programs. These included three residential programs which focused on child and family services; one school outreach program which focused on child and family services; and one program based in a medical agency which provided medical social work and support services to families. From these six outside agencies, two respondents were second year Master of Social Work students who volunteered to participate in the study after an announcement was made in their social work class regarding this study. The sample was a convenience sample, meaning that the agencies were selected for participation based on their degree of experience with the identified population and their willingness to participate in the research.

Data Collection:
     Respondents completed the three-part questionnaire in the presence of the researcher, the 20-minute face-to-face interview followed a few minutes after completion. Respondents who completed the questionnaire independently returned the questionnaire to the interviewer a few minutes before the face-to-face interview. To complete interviews, the researcher visited each respondent’s workplace. Before conducting the interview, the researcher reviewed each participant’s questionnaire, and marked areas for in depth exploration. In addition to a list of standard questions asked, the interviewer tailored each interview according to the participant’s responses. For example, if a respondent gave an answer to an open-ended question, stating that he/she had 5 years experience with the target population in a hospital setting; and five years experience in a outreach setting, the interviewer might find it useful to ask the participant differences and similarities in service delivery and how the target population responded to services in each setting. At the end of each interview, participants were asked to give the interviewer feedback regarding the use of the instrument and the study itself.

Data Analysis: Open-ended Questions
     Quantitative data gathered from the questionnaire was analyzed using SPSS for Windows, version 6.0. Data collected from the interviews and the open-ended portion of the questionnaire was qualitatively analyzed using the Hyperrsearch Program, version 2.0. The first part of the questionnaire contained eight open-ended questions formulated to obtain information regarding respondents’ experience and practice approaches in work with the target population. Findings for this part of the questionnaire suggested that 100% of the participants had experience with low-income, urban, African-American families in various settings. The percentages of participants (for all participants) according to work settings were as follows: residential, 17.7%; school/school-based, 14.5%; outpatient clinics, 9.6%; domestic violence, homeless, or crisis shelters, 8.1%; community mental health agencies and vocational settings, 6.45% each: outreach, foster care and home-based programs, 4.8% each: counseling and other social work agencies, 3.2% each; and recreational, hospital, long term health-related; advocacy, Department of Social Services, and substance abuse, 1.6% each.
     Respondents reported that many of the families with whom they currently worked were low-income, urban, African-American families: 87.5% of the respondents reported that at least 40% of the families receiving services in their agency were low-income, urban African-America families 62.5% of those surveyed reported that at least 80% of the families who receive services at their agency were low-income, urban, African-American families; 45.8% of the respondents reported that 90% of more of the families receiving services at their agency were low-income, urban, African-American families; and 20.8% of the respondents reported that 100% of the families at their agencies were low-income, urban, African-American families.
     With regard to services often provided to low-income African-American families, concrete services appeared most often, accounting for 30.4% of the service named. Responses grouped under the category of concrete services included services which help the families gain access to food, clothing, housing and medical needs. Next in order of frequency of services provided was family therapy which made up 16% of the responses.
     Support services and individual therapy each accounted for 7.1% of the services listed. Services provided by the Department of Social Services were listed in 5.4% of the responses. Outpatient services, community-based programs, medical and health services, substance abuse services, follow-up care, community mental health services, and other social work services each accounted for 3.6% of the services listed. Other services listed each making up 1.8% of the responses were: psychiatric, residential, recreational, parenting education and group therapy services.
     Respondents’ specification of the issues most frequently brought up in family therapy with low-income, urban, African-American families were as follows: food, housing, clothing and medical, 22.3%; employment, 9.6%, finding needed resources, 8.5%; and threat of crime, 8.5%. All of these may be considered concrete needs and total 48.9% of the responses listed. These responses were followed by mental health issues and parenting skills which were each listed in 6.4% of the responses. Other issues listed and their corresponding percentages are as follows: behavior problems, missed appointments, difficult therapy issues, and substance abuse, 5.3% each; family relationships, 4.3%; physical/sexual abuse, recreational and community support and education, 3.2% each; single parenting, 2.1% and self-esteem, 1.1%,
     Of the five agencies which participated in this study which were Detroit Compact School-Based Programs, teachers (15%) and other school staff (32.5%) accounted for 47.5% of the referrals listed by Detroit-Compact respondents. Sources of referral for the other six agencies are described in Table 1.
     The workers surveyed were asked to rank, according to their perception of effectiveness, strategies and techniques they used to work with low-income, urban, African-American families. In response, participants named a wide variety of strategies and techniques which were grouped according to 20 categories. The categories and corresponding occurrence rates are displayed in Table 2.
     Respondents were asked if they identified with a particular theoretical framework in their work with the low-income, urban, African-American families. In response, 40% of the workers surveyed reported that they used many theoretical frameworks in their work with this group. Twenty percent stated that they identified with the Structural Family Therapy model. Other participants reported that they identified with Cognitive or Family Systems models; a smaller percentage of respondents reported that they identified with brief therapy; client-centered therapy; or multisystemic models at a rate of 3.3% each. Respondents were also asked to identify a theoretical framework most often used at their particular agencies. For the most part, respondents seemed reluctant to name any particular model as 44% of those surveyed reported that they did not know which family practice model was most often utilized in the services provided at their agency. Approximately 16% of all respondents named the Structural Family Therapy; 8% named the Family System model; and 4% identified an intensive family therapy model, an eclectric approach, a strategic model or a multi-systemic model.
     The last open-ended question asked participants to describe a case involving work with urban, low-income African-American families which they felt was successful as well as a case which they felt was unsuccessful. Cases involving the lack of parenting skills were named in 53% of the unsuccessful cases described and in 50% of the successful cases. The families’ lack of concrete needs was named in 33% of the successful cases described and in 35.5% of the unsuccessful cases. Issues related to violence and the need for safety were named 35.5% of the time in descriptions of unsuccessful cases and these issues were reported less often in cases described as successful. Other issues identified in unsuccessful cases were substance abuse, trauma, and single parenting which together were identified 29.4% of the time. Physical and sexual abuse was named in 23.5% of the unsuccessful cases as well.

Data Analysis: Closed Ended Questionnaire Items
     Findings indicated that the presence of extended family was important for the target population as 40% of those surveyed specified that “many” or “most” of the target families whom they served received help and emotional support from extended family. Respondents also reported that 80% of these families regarded their extended family as important. Forty-eight percent of the respondents surveyed reported that grandparents serve as primary care givers in “many” or “most” cases. Furthermore, respondents indicated that African-American grandparents play strong roles in their families in “many” or “most” of the families whom they worked with. Fifty-six percent of the respondents indicated in the families with whom they work few parents are married; and 92% of the these professionals reported that “many” or “most” of these African-American households are female headed.
     Support from church communities was not rated as highly as was expected. From the sample group, less than half of those surveyed reported that “many” or “most” of these low-income, urban, African-American families received support from church communities. Another important characteristic we identified was regarding safely issues. Over half of the respondents (52%) reported that “few” of the low-income, urban, African-American families with whom they work live in safe areas. These results seem consistent with another finding in this questionnaire in which 92% of the participants reported that “many” or “most” of the target families they worked with have experienced trauma.
     Information on practice approaches indicated 58.4% of those surveyed thought that “many” or “most” of the target families found problem-solving interventions beneficial; and 54% of the participants thought that positive change for the families was most likely to occur when the worker used a directive approach. Eight-eight percent of the respondents indicated that it was critical to gain the trust of African-American family leaders. Sixty-eight percent of the respondents reported that “few” or “some” of the families with whom they worked were resistant to their interventions. Eight-eight percent of those surveyed reported that “many” or “most” of the target families with whom they worked lacked concrete resources; while 68% reported that many or most of these families struggle to meet basic survival needs. Sixty percent of these respondents also reported that “many” or “most” of the parents in these families needed help with establishing parenting boundaries. It was reported that by 76% of those surveyed that “many” or “most” of the parents they worked with needed information regarding parental rights, employment, and access to concrete resources.
     Survey research findings together with extensive review of literature concerning practice with poor African-American families facilitated the articulation of the five framework components which constitute a knowledge base necessary for professionals who intend to serve low-income, urban, African-American families. These are: 1) strength/resilience; 2) gender roles; 3) extended family; 4) Black Church, religion and spirituality; and 5) trauma, grief and loss. Similarly, a number of intervention strategies were articulated which are intended for professionals who intend to intervene or help low-income African-American families to more effectively function in their social environments.

Reference

Thomas, E. J. (1992). The design and development model of practice research in Research utilization in the social services,
      Grasso, A. J., & Epstein, I, Eds. Binghamton, New York: Haworth Press