Beyond the Clinic: In‐home Therapy With Head Start Families

Abstract

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.

A Survey of the Attitudes and Practice Experiences of Home-Based Practitioners

“…We could speculate that this finding is due to the presumed higher motivation and energy of therapists new to home-based therapy. We know from both the literature and the data that many of the therapists conducting home-based therapy are newer to the mental health field (Aponte 1994;Thomas et al 1999). …”

“…Woodford (1999) asserts that home-based therapy is frequently interpreted within the field as a last resort for multi-problem families in crisis. Furthermore, some existing research portrays home-based therapists as less experienced than therapists who conduct treatment in more traditional settings (Halpern 1986;Thomas et al 1999;Tracy and McDonell 1991;Woodford 1999). Also, there is some confusion as to the role of the homebased worker with the worker portrayed as a therapist in some places, a preservation worker in others, or at times as both (Fishman et al 2001).…”

“…These included the therapeutic alliance (Johnson et al 2002); therapist safety (Pennington 2002;Simmons 2000); therapeutic boundaries (Christensen 1995); homebased therapy supervision and expertise (Schoenwald et al 2000;Zarski et al 1991); ethical concerns (Thomas et al 1999); assessment and intervention (Szapocznik and Williams 2000). ; treatment effectiveness (Lindblad-Goldberg et al 1998); client profiles (Aponte 1994); and within group differences by level of home-based experience (Thomas et al 1999;Tracy and McDonell 1991). Many of the questions and concerns related to home-based therapy have been addressed through the anecdotal reflections of experienced professionals and program reviewers; by means of qualitative studies; or in studies where the therapist is connected to a specific treatment model (e.g.…”

“…Yet, there is still much to learn about the practices and challenges of home-based therapy professionals (Lindblad-Goldberg et al 1998;Thomas et al 1999;Woodford et al 2006;Yorgason et al 2005). In this article, we report the findings of a research study which, using a national survey method, explored the attitudes and practice experiences of homebased therapists from three disciplines: marriage and family therapy, social work, and counseling.…”

Experiential Activities in Family Therapy: Perceptions of Caregivers and Youth

“…Most caregivers and youth found the activities entertaining and helpful in creating positive family interactions, often noting that family therapy sessions were the first time they had interacted positively as a family in quite some time. As multi-problem families often have difficulty focusing on their innate strengths (Thomas et al 1999), caregivers and youth seemed especially sensitive to constructive and positive changes. When families were asked to participate in low-risk activities, family members were able to cooperate with each other, use more democratic leadership styles, negotiate and reach consensus, and allow delegation of authority and power to the child(ren).…”