Evidence Based Therapy in Child Welfare- One Worker’s Reflections

Social worker/ preventive worker/ counselor/ therapist/ “the lady”… all titles I’ve responded to at my work, and each one relevant in its own way. But these multiple identities also capture the inherent challenges of integrating two professional spheres, one a carefully honed practice, and the other a colossal institution. One often associated with privilege, the other with poverty.

On one hand, there is a natural connection between family therapy and child welfare (specifically preventive services). Both are often involved during a time of crisis. Both are concerned with the safety and well-being of children. Both are committed to stabilizing and healing families. And the desire for child welfare to move away from historically punitive and inefficient practices toward ones that are more therapeutic and accountable is both logical and good.

On the other hand, there are also competing interests, which have made me wrestle with my own professional ethics as a clinically focused licensed master social worker (LMSW). The power differential in child welfare is much more pronounced than in family therapy alone because of the focus on safety and risk. While all helping professionals are mandated reporters, there is an intrusive (though arguably necessary) element within child welfare that still does not sit well with me.

There have been times where the pressure of fulfilling ACS requirements has directly contradicted my commitment to therapeutic rapport, self-determination, and unconditional positive regard in my work with families. That may sound like Social Work 101, but it seems many families in child welfare have simply been denied these experiences. Without them, no amount of training, funding, programming, or research is really going to help families heal and protect their children.

However, child welfare does not shoulder the challenges alone. Evidence-based models of family therapy have their own rigidity and time restrictions. And I am not convinced that these models are always in the best interest of families experiencing complex trauma and persisting barriers to basic needs. Having learned that therapeutic approaches should be adapted to the client, it can feel counter intuitive to try to make the client fit the therapy.

But I am optimistic that a good intention may evolve into good policy. One thing I have learned so far is that there is a niche of families in child welfare for whom the model of family therapy I am practicing is extremely appropriate. These families often have some interpersonal and environmental risk factors but are also stable enough to address emotional and relational needs. These families do not have the luxury to access mainstream mental health services, but in a time of crisis, come to the attention of ACS. Being able to provide in-home therapy to these families and aid in their healing has made this demanding work worth it.

 

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1 Comment

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One response to “Evidence Based Therapy in Child Welfare- One Worker’s Reflections

  1. Thank you for this post. You bring up a really important point. Would have wanted to read a hypothetical case that illustrated a situation where ACS requirements butt up against what you would judge as good practice for the families you serve.

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