Home-Based Therapy for Young Children in Low-Income Families: A Student Training Program

Abstract

The purpose of this project was to develop an internship training program that offered in-home therapy for young children with significant emotional and behavior problems. The children lived in single-parent, low-income homes in unsafe neighborhoods of a large, urban area. A year-long, training and supervision program was implemented with 10 second-year, graduate students enrolled in 5 different university programs that prepared mental health professionals. Students received specialized instruction in working with diverse families living in poverty and in an evidence-based treatment program. They initially observed veteran counselors implementing the treatment program in homes and gradually assumed responsibility for conducting sessions on their own. Students’ scores on a measure of counseling self-efficacy improved significantly from pre- to postinternship. Students reported high levels of satisfaction with the training program and significantly improved confidence levels in their counseling skills at the conclusion of their internship experience. The limitations of these preliminary outcomes for this pilot program are discussed along with the need for more research in this understudied area.

Attitudes of Counselors Regarding Ethical Situations Encountered by In-Home Counselors

“…In-home counseling stands apart from counseling in an outpatient setting in the different treatment approaches that are utilized, the unique population that this modality serves, the unique demands placed upon clinicians (Mattek, Jorgenson, & Fox, 2010), the type of training, and the pace of change that can be expected from the in-home clientele (Adams & Maynard, 2000;.…”

“…This type of family has been commonly known as multi-stressed and is defined as "usually high stressed, and having multiple problems involving drug/alcohol abuse, domestic violence, truancy, financial difficulties, assault/battery, depression, and other mental illnesses" (Adams & Maynard, 2000, p. 49). Several researchers have noted the severity of behavioral and emotional problems of in-home clients (Mattek, Jorgenson & Fox, 2010;Lawick & Bom, 2008;Mosier et al, 2001). Lawick and Bom (2008) noted that multi-stressed families generally possess stress factors in all major facets of their lives, which may contribute to a sense of distrust to the outside world-including helping professionals.…”

“…These students believed that it was intrusive or rude for them to interrupt the parent in their own house (Snyder & McCollum). Indeed, researchers have noted that in the home setting, the power differential that exists between the counselor and the family has been flattened (Madsen, 1999;Mattek, Jorgenson, & Fox, 2010;. Because the counselor is on the family's turf, they must be respectful of appearing as intrusive, yet still be able to facilitate the counseling session effectively.…”

“…In-home counseling has been shown to increase both attendance and participation of adolescents and their families in counseling sessions in comparison with an outpatient setting (Slesnick & Prestopnick, 2004;Speck, 1964). This counseling modality is especially amenable for impoverished families who lack transportation or childcare (Mattek, Jorgenson, & Fox, 2010). Mosier et al (2001) measured the outcomes of 104 in-home clients at a large multistate organization in the Rocky Mountain Region.…”

“…Today, in-home counseling services are provided by mental health professionals from various backgrounds to treat a wide array of presenting problems, including both mood and psychotic disorders (Kalucy et al, 2003), antisocial behavior (Curtis, Ronan, & Borduin, 2004), substance abuse (Gruber & Fleetwood, 2004), and diabetes (Harris & Mertlich, 2003). While clients most commonly treated are children and adolescents who possess emotional and behavioral disturbances (Liddle et al, 2005;Mattek et al, 2010, Mosier et al, 2001, in-home counseling has also been shown to be a promising treatment with families (Curtis, Ronan, & Borduin, 2004;Liddle et al, 2005;Yorgason et al, 2005) and older persons (Cabin, 2010;Maxfield & Segal, 2008). Typically, the population of clients who receive in-home counseling are referred to as multichallenged or multistressedfamilies, and possess multiple problems that are chronic and severe in nature (Adams & Maynard, 2000;Lawick & Bom, 2008;).…”