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Clinical Research
Families, Cultural and Larger Systems
Fam Proc 35:191-210, 1996
Involvement, Collaboration, and Empowerment: A Model for
Consultation with Human-Service Agencies and the Development of
Family-Oriented Care
YOEL ELIZUR, Ph.D.a
aYoel
Elizur, Ph.D., Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem 91905, Israel.
Systems consultation to provider agencies can contribute considerably to the development of a collaborative,
family-oriented approach in these agencies. The possibilities for such an undertaking depend on the establishment of
working relationships at two interfaces: between the system consultant and the agency, and between the agency and its
client families. A framework for developing these relationships in three sequential phases is proposed: involvement,
collaboration, and empowerment (ICE). Each phase is characterized by a dominant issue that is processed at the time. It
is possible for relationships to begin at a more advanced phase and to work through two or more phases simultaneously.
However, premature attempts to do so, which often occur in agencies' work with involuntary clients and "difficult to
engage" families, generate resistance and lead to an impasse. The applicability and usefulness of the ICE model is
demonstrated by presenting the 6-year development of a family involvement and partnership program in Israel's juvenile
correction system.
There is a song that needs to be sung in our culture: a song of the rhythms of relationships, a song of people enriching
and expanding each other.... We are born with the capacity for collaboration, accommodation, and mutuality.... But this
collaborative process needs highlighting in our culture, because what we usually notice are differences and discord.... This
is the song our society needs to hear: the song of me-and-you, the song of the person in context, responsible to and for
others. [Minuchin & Nichols, 1993, pp. 283-287]
OVER recent years, family therapists have become increasingly concerned with service delivery issues and the
consequences of social agencies' involvement in family life. A variety of dire effects, especially for families that suffer
severe and chronic problems, have been documented: (a) fragmentation and decontextualization, which stigmatize patients
and alienate them from their families (Elizur & Minuchin, 1989); (b) a weakening of family boundaries and cohesiveness,
dilution of family process, and a greater dependency on larger systems (Colapinto, 1995; Imber-Black, 1988); and (c)
depowerment and repression (Boyd-Franklin, 1989). At the same time, there is a recognition that human-service-provider
(HSP) systems are an indispensable part of families' supportive environment and that the denial or restriction of access to
vital services is a major problem by itself. Moreover, a growing awareness of the inequality and abuse of power and
privilege within the family is promoting a more activist societal position vis-à-vis families. An integrated response to these
issues depends in large part on the development and dissemination of collaborative models of care. It is encouraging to find
that the applications of systems consultation in different types of services have multiplied during the last decade, and that
family therapists are integrating this role into their professional identity (Berg, 1994; Carpenter & Treacher, 1993;
McDaniel, Hepworth, & Doherty, 1992; Wynne, McDaniel, & Weber, 1986).
The purpose of this article is to contribute to the use of systems consultation with HSP systems that wish to promote their
relations with families and/or to develop family-based care. The focus is on the relational system that is formed between
system consultants and agencies on one level, and between agencies and families on the other. It is proposed that the
success of systems consultation depends to large degree on the development of resilient working relationships on these two
levels. In this way, consultation parallels therapy, where such an alliance has consistently been found to be a nonspecific
factor that is highly prognostic of positive change (Strupp, 1982). When organizations invest in their relations with
families, there is a better chance that common goals will be achieved. This claim is supported by ecological research that
found an improvement in family functioning and child development when collaborative, family-oriented care was used by
major HSP systems such as hospitals and day care schools (Bronfenbrenner, 1986).
Imber-Black (1988) compares joining with a larger system to "entering a new culture with norms, values, beliefs, legal
requirements, and world views that may be unfamiliar. The consultant must enter with respect for this new culture...
seeking resources rather than deficiencies and affirming the participants" (p. 201). In some agencies the staff will approach
consultation as a challenge to creativity and growth, while in others the consultant will be confronted with the typical
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suspicious attitude adopted toward outside experts who presumably come to define problems and prescribe solutions. It is a
difficult bridge to cross in these latter cases, and somewhere during the crossing a parallel process will often appear in the
relationship between families and the staff undergoing the training. In other words, the consultant's mere entrance into the
organizational culture is a crucial but insufficient step in the process of family-based program development. Difficulties of
teamwork at the agency-family interface are to be expected, particularly in situations that involve compulsory referrals and
the exercise of social control (Colapinto, 1988).
The ICE model presented here suggests guidelines for the formation of working alliance at these two interfaces. Briefly,
it is proposed that the relations between families and provider staff, and between consultants and agencies, develop in three
phases, each of which is defined by a major transactional pattern that is negotiated at the time: involvementestablishing
basic bonding and communication channels; collaborationpartnership based on the recognition of common goals,
methods, and threats; and empowermentsharing of power and responsibility. These phases unfold sequentially in that the
working through of prior issues lays the foundation for successful coping with later issues. Resistance and relational
dysfunctions are often the result of premature attempts to bypass a phase. At the same time, it is recognized that some
relationships begin, quite appropriately, at higher levels of development, in which case two or more developmental issues
can be processed simultaneously.
This article is organized in three sections. The first presents the ICE model, maps out the functional course of
development, and outlines typical dysfunctional relationships that are encountered during different phases. In the second
part, the model is applied to the consultation relationship by showing how the ICE phases are successively negotiated
during the establishment of a family-based program. The final part illustrates this process by an account of a family
involvement and partnership program that was developed in Israel's Youth Protection Authority (YPA).
THE DEVELOPMENTAL SEQUENCE
The ICE model proposes that growth in nonprimary relational systems takes place in sequential phases whose unfolding
follows an inner logic: the establishment of more fundamental patterns provides a basis for the processing of higher-level
patterns. Unlike other developmental models that are primarily focused on family relations (for example, Doherty,
Colangelo, & Hovander, 1991; Wynne, 1984), the ICE model was created with a focus on the more distant, relatively
task-oriented, nonprimary relationships that develop at higher levels of the social ecology. Hence, more universal, less
emotionally loaded terms of involvement, collaboration, and empowerment are used to indicate the major tasks. Figure 1
presents this functional sequence by describing the affective, cognitive, and instrumental transactions that characterize each
phase.
Figure 1.
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ICE developmental phases and characteristic patterns expressed in three transactional modes.
For purposes of theory and research, phase-specific patterns are defined clearly and distinctly, but in real life they often
intermingle, and the primacy of relational patterns at any given point in time is always relative. For example, during the
establishment of involvement, experienced therapists utilize opportunities to prepare the way for collaboration and
empowerment. At times they may also collapse two or even three phases into one, by rapid involvement through
establishing a collaborative or an empowering relationship. The process tends to be much slower with compulsory
referrals, when the caregiver is charged with social control over the family. In these cases, involvement often proves to be a
difficult undertaking by itself; even when the family is motivated to make quick progress, the staff has to monitor carefully
the degree of collaboration and transfer of power.
The processing of each task is always a function of reciprocal transactions among members of the relational system.
Relationships are co-determined and, during their formation, both sides are engaged in a mutual process of testing,
monitoring, and trust-building. Unfortunately, relationships between HSP systems and families all too often develop in a far
from optimal way, get stuck in an impasse, and can be extremely destructive. Figure 2 delineates three typical courses of
dysfunctional development that were found to occur frequently between families and agencies. It is not an inclusive list. A
variety of dysfunctions may develop in different settings, depending on such factors as service-users' characteristics,
organizational structure and ideology, and the larger social context.
Figure 2.
Dysfunctional relationships and their typical course of development.
The mere occurrence of these "negative" transactions does not necessarily indicate pathology. Dysfunctional transactions
are part of normal development, much like the experiencing of basic mistrust, which is not pathological in itself and has a
place in our mature emotional and behavioral repertoire (Erikson, 1968). Impasse is the result of rigid, dysfunctional
transactions, when available resources are insufficient to disrupt the negative repetitiveness. In such cases, the capacity to
work through higher-phase, developmental processes is impaired, and the ICE model suggests that interventions be
targeted at the most basic dysfunctional pattern on the developmental ladder.
ESTABLISHING FAMILY-BASED PROGRAMS
Consultant-Agency Involvement
The development of family-based programs depends on the adoption of an appropriate paradigm by directors of services,
administrators, and therapists who are not systems-oriented. Unfortunately, the invitation of system trainers to work with
the staff does not necessarily reflect a real willingness to integrate family-oriented work within the agency (Haley, 1975).
Too often, family therapy training has been initiated without a prior clarification of relevant service-delivery issues. When
trainers and consultants wish to enter into such a dialogue, they have to convince agency directors that effectiveness and
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cost efficiency of institutional care are enhanced by collaborative family-based models (McGowan, 1990). In this dialogue,
they are dealing with the first developmental task of involvement with the agency's leaders.
The following general lines of reasoning may help to establish the consultant's involvement on a policy-making level: (a)
the reduction of family resistance and noncompliance can resolve many of the difficulties about which staff complain; (b)
the mobilization of family resources can distribute the burden of work; (c) partnership with the family is in itself a general,
change-promoting factor that can add significantly to the task-oriented work; and (d) continuity of care is best served by
working with families and helping them to help the client over the long run. The last point is especially pertinent for
residential care facilities. When aftercare support is insufficient, the changes that have been painstakingly achieved tend to
fade away when clients return to their families and communities (Mayer, Richman, & Belcerzak, 1977; Taylor & Alpert,
1973).
Evaluation research provides support for these ideas, particularly when the evidence is pertinent to the particular domain
and populations with which the HSP system is concerned. The development of methodologies and use of research findings
for the promotion of family preservation programs is a good illustration of this point (Fraser, Pecora, & Haapala, 1991;
Wells & Biegel, 1991). Though quantitative outcome research of different types of family-based programs is as yet sparse,
a creative search of the literature can be used to substantiate specific points in favor of the proposed program. For example,
when an agency considers the families of its user population "difficult to engage," the consultant can suggest the
employment of strategic and structural strategies whose efficacy for that specific purpose has been demonstrated in clinical
research programs (Szapocznik, Perez-Vidal, Brickman, et al., 1988).
A particularly convincing approach is to introduce in a jargon-free language, and with embedded research findings, some
useful systemic concepts that help to organize the consultant's argument. For example, the concept of agency triangles (Carl
& Jurkovic, 1983) helped me to clarify and emphasize how a systems-oriented approach can enhance traditional delivery
models. The graphic representation of the agency-client dyad within the triangle made the new paradigm less threatening to
staff accustomed to individual work. The subsequent exposition of the agency-family and family-client sides of the triangle,
and how they co-determine agency-client relations, underlined the innovative facets of the systems model. In more
advanced presentations, other agencies involved with the family were included in the picture. These presentations always
had a pragmatic focus: to demonstrate how the agency's work had been hindered by lack of attention to triangular
relationships and to highlight new intervention strategies unveiled by systemic thinking. Once this reasoning was accepted,
the focus naturally turned to the agency-family interface.
Consultant-Agency Collaboration
A directorate's decision to work more closely with families is a necessary but insufficient step on the road to change. At
this point, the main task of consultation is to establish a working relationship with the agency's leaders and staff, based on
the recognition of common goals. A process of joint problem solving is initiated by sharing difficulties, and consultants
apply their knowledge and skills to the agency's situation. Consultants need to be aware that the modification of an
institutional working model is a homeostatic disrupting process (Lappin & VanDeusen, 1994). In family-based services,
the ICE model may be assimilated smoothly by the staff, a first-order change that adds some new ideas to an existing model.
With most other services however, the work with families demands second-order change and may threaten the position and
power of some administrative and clinical workers. This calls for a careful and reflective negotiation process, during which
the consultant deals with institutional "resistances" and custom-fits the new model to the agency's culture and social context.
For a fuller explication, together with practical suggestions, of how patterns of collaboration can be established between
consultants and agencies, the reader is referred to an earlier article about ecosystemic training (Elizur, 1993). The article
demonstrated the collaborative implementation of a family-based program using examples from the first 3 years of the YPA
family involvement project. In brief, it was proposed that the conjoining of staff training with organizational development
takes place via three intertwined processes: (a) adapting the model to the HSP system by using anthropological-like
sensitivity and respect for the institutional culture, together with an openness to learning about locally developed methods
and achievements; (b) working on-site with the complex dynamics of training groups, which are frequently composed of
trainees with different professional and power standing in the organization; and (c) introducing modifications into the
organizational ideology and patterns of work, using a flexible and pragmatic approach that challenges the staff without
arousing widespread resistance.
The parallel mapping of the agency-family interface in terms of the ICE relationship patterns can help the consultant
adapt the family-based program to the local situation and decide how much the staff should be challenged. For example, a
discussion of strategies for collaboration would be threatening and/or meaningless in agencies that do not regularly engage
families. The same focus would be fruitful with other agencies that have already become invested in developing their
relations with families. This illustrates that, in real life, the agency-consultant and agency-family interfaces are intertwined.
At such times, isomorphic interventions that deepen collaboration at the different interfaces may reinforce each other
(Liddle, 1988).
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Consultant-Agency Empowerment
The hiring of a consultant is by itself an act in which the agency's leaders confer a degree of power on an outsider by
acknowledging before the staff, formally or informally, that the consultant has professional knowledge from which the
agency seeks to benefit. As consultants become more involved in the agency's ecosystem and establish a collaborative
relationship with its leaders, they increase their leverage. This is a piecemeal process and, though setbacks are only to be
expected, each small organizational change facilitates more substantial reforms. Consultants should be aware of the degree
of authority that they acquire over time, especially when working with large and complex bureaucracies that feel
overpowering. As in therapy, the processing of relationship issues that are related to the use of power and expert
knowledge (Amundson, Stewart, & Valentine, 1993) helps to resolve critical and distancing attitudes that may be conveyed
by some staff members. Consultants are perceived as threatening, and there is a "healthy" need to test their reliability and
wielding of power. Will they respect "local" culture and expertise? Will they undermine workers in order to achieve their
mission? How devoted are they really to the agency and its goals relative to their own self-interests? Can they be trusted to
keep organizational secrets?
As in the case of collaboration, empowerment in the consultant-agency relationship should begin during the process of
custom-fitting the family-based program to the organizational structure and culture, and to its relational patterns with
families. Preparations for empowerment can be initiated during the first joint evaluation of the family-agency interface, as
consultants enter into a democratic type of dialogue in which they learn from the agency's way of working with families. In
my experience, many "paraprofessionals" who were exposed to the ICE model felt professionally empowered when their
family involvement work was acknowledged and given a proper place within the wider frame of developing working
relations with families. In general, the identification of competencies and the ability to take "one-down" positions support
consultees and help to prevent deskilling. Consultants can then gently challenge consultees to become engaged in a
progressive upgrading of skills and practices that is necessary for the successful integration of the family-based program
within the local working context.
The process of empowerment culminates in the successful termination of consultation when a family-based approach
ceases to be "a project" but has become an integral part of the agency's routine and the consultant is no longer needed for
maintenance or further development. As in therapy, the processing of this phase can lead to a heightened experience of
esteem and competency, as well as keeping the door open for future consultation. On the consultants' part, it demands an
ability to reconcile oneself to imperfect progress, which may prove to be a particularly difficult task for those who have
adopted a broadly critical attitude toward HSP systems. At this phase, the ICE model provides a much needed perspective
for looking at currently developing relations between provider systems and families. This perspective fosters acceptance of
small gains, which are perceived to be a part of the slow and long-term "learning curve" of the institution. The joint
highlighting of these gains is an essential reinforcement of continuity of development.
A FAMILY-BASED PROGRAM IN THE YPA
The process that led to the adoption of an ICE, family-based program by YPA will be described by highlighting some of
the milestones that stood out over the 6 years of systems consultation. After a brief description of the work context, the
emphasis will move to the development of involvement, collaboration, and empowerment between YPA and the consultant.
This development was associated with the establishment and gradual dissemination of the ICE program among the various
YPA institutions.
The YPA Context
The YPA is a unit within the Ministry of Labor and Social Affairs, in charge of institutional care and rehabilitation of all
juvenile offenders in Israel. It monitors and supervises 35 small residential centers, which are spread throughout the
country. There are 630 beds altogether, and a total of about 1,300, ten to twenty-year-old internees pass through these
centers each year. They range from locked correctional institutions, which are total and authoritative, to semi-open
community hostels, in which internees study and work in their local community, and have regular contact with their
families.
The YPA system is the last station in the correctional treatment continuum and, consequently, its institutions contain the
most frequently convicted, difficult-to-treat and recidivous adolescents. A study of 2,050 juveniles who were sentenced to
residential treatment, found that inmates typically came from poor, socially marginal, families of North African or
Middle-Eastern descent, with an average of six children (Weiss, Wozner, & Teichman, 1994). Some 53.5% began their
delinquent behavior before age 13, the age of criminal responsibility, and by the age of 14, 77.9% were already involved in
criminal activity. By the time of their referral to YPA they had been involved in an average of 7.76 misdemeanors and 5.44
felonies. The average age for beginning internment is 13.45, and most inmates stayed for a period that ranged from 1 to 4
years, with mean of 19.7 months.
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Obviously, YPA internees and their families do not belong to the ranks of "friends and supporters of psychotherapy."
They have strong feelings of deprivation and resentment against society, and their prior contacts with a wide variety of HSP
systems were riddled with experiences of failure and blame. Many of the families are disorganized and have a history of
child abuse and neglect. The forced placement of their child in a correctional institution is experienced as a depreciating
and stigmatizing act; social workers and institutional staff are perceived to be society's long arm, agents of the "enemy."
Consequently, sporadic attempts to apply "traditional" forms of family therapy before the initiation of the ICE program often
ended in frustrating impasses related to therapists' triangulation in family-staff conflicts (Tenne, 1993).
Evolution of an ICE Program in YPA
The ICE model was formulated during the development and implementation of a YPA program called "family
involvement with treatment," which included a mixture of training, organizational development, and consultation (Elizur,
1993; Elizur, Tene, & Wagshal, 1994). A bird's-eye view of a 6-year process reveals five phases that can be distinguished
on the basis of discontinuous modifications in the consultation contract.
A word of caution before the narrative is presented: although the following history was authorized by the YPA director,
the punctuation of events is subjective, like all accounts of a continuous and complex process. By beginning this chronicle
with my first contact with the YPA system, I am aware of the danger of obscuring the process that takes place before
professional consultation is sought (Saunders, 1993). This should be kept in mind when looking at the "preparation phase,"
during which I prepared myself by learning about YPA work. However, the system had begun to prepare itself for family
involvement before my entrance onto the scene. Some YPA workers took initiative in contacting families, and though their
work was irregular and did not lead to second-order organizational change, it did serve to raise consciousness about the
necessity for systematic work with families. Furthermore, there was a volunteer organization of professionals (ELEM)
concerned with improving the level of social services for youth in distress. ELEM volunteers from Israel and the U.S. did a
great deal of preparatory work and lobbying within YPA on behalf of collaboration with families. They recruited me and
have provided continuous support. At the point of initiating the family program, neither side was fully aware a how long
and complex the road would be.
Preparation and Involvement
At the beginning of 1988, I was charged with formulating a proposal for a YPA, family-oriented training program. A
3-month observation period was granted, during which I visited various institutions, observed committees, interviewed
officials at different levels of YPA hierarchy, and met with representatives of related systems: the juvenile court, the
probation department, and the police. No professional interventions were made. It was a phase of creating involvement and
a mutual checking out of possibilities for future collaboration. My observation revealed that YPA staff held negative, often
adversarial attitudes toward families, and identified with the "save the children from their families" ideology. Many workers
felt resentful of the parents' attitudes and behaviors, which they perceived to undermine their rehabilitative work, and they
had little appreciation for family strength. My report to YPA and ELEM detailed these findings and, based on the
application of systems thinking and practice, suggested a program for changing family-staff relations and working in
partnership with families (Elizur, 1988). A literature review supported the newly proposed program, and the brief summary
that follows demonstrates the use of appropriately presented research for enhancing involvement and motivation.
It was affirmed that for many years family dynamics have been known to play a critical role in juvenile delinquency
(Jacob, 1975). Correlations were found not only with major family characteristics, such as large families, poverty,
substance abuse, parental criminality, and mental health problems (Geismer & Wood, 1986), but also with various aspects
of family interaction, such as parental conflict, negative affect, and restrictive policy that goes together with lax and
inconsistent policing (Rutter, 1994; Tolan, Cromwell, & Brasswell, 1986). In addition, some of the most effective early
childhood programs that had promising results in terms of preventing juvenile delinquency took an ecological approach
(Yoshikawa, 1994; Zigler, Taussig, & Black, 1992). Family interventions and parental involvement were found to be a key
factor in their success. Some of the family therapy pioneers became specifically involved in working with families of
delinquents, and they used this experience for developing their approaches (Alexander & Parsons, 1977; Minuchin,
Montalvo, Guerney, et al., 1967). As family therapy moved toward greater pluralism and integrative clinical models, it was
successfully applied to different settings that work with problem youth (Henggeler, Melton, & Smith, 1992; Szapocznik
& Kurtines, 1989). A review of the most recent outcome studies with families of adolescents concluded that "these studies
taken together indicate that family therapy interventions appear to decrease adolescent conduct problems and delinquent
behavior when compared to individual therapy, treatment as usual, and no therapy" (Chamberlain & Rosicky, 1995, p.
445).
Notwithstanding these findings, family work with juvenile offenders is, with few exceptions, community-based and
therefore unavailable to most of the high-risk offenders in residential facilities. Their out-of-home placement in the U.S. is
often in large training schools away from their communities, or in juvenile detention facilities that "in many jurisdictions are
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being used for purposes that make them virtually indistinguishable from adult jails" (Schwartz, 1989, p. 59). In
comparison, Israel's juvenile courts and YPA facilities put less emphasis on punishment and more on education and
treatment. Though it is a more hospitable environment for family-based care, therapy models that were developed in
community work with juvenile offenders outside Israel could not be transplanted in their pristine form to our local
institutional setting.
Negotiations that followed the submission of the report led to the adaptation of the family-based model to YPA
situational constraints and provided me with new insights based on experience that I had accumulated in the YPA. On its
part, the YPA directorate developed the organizational flexibility that is necessary for incorporating the family-based
approach. At this initial point, a contract was made for implementing a family-based program in one community hostel, Bet
Elem, whose director and social worker had had some previous training in family therapy. They were highly motivated and
their involvement with the project and the consultant was quickly established. It was to be a demonstration project with an
independent evaluation procedure by a researcher who was a member of ELEM's professional committee. The watchword
was caution: ELEM had to monitor its funding appropriations and the YPA needed to take care not to commit itself
prematurely to regular family-based work.
Bet Elem Demonstration Program
During an intensive 2-year training program at Bet Elem, I collaborated closely with its director and social worker. The
joint goals were staff training and the creation of family-friendly organization and work routines. The director and social
worker conducted family sessions jointly and arrived at a differential definition of their respective roles vis-à-vis families.
They felt empowered to push and expand their professional role functioning with residents and families and, in turn, they
empowered me to become the hostel's supervisor. Two significant developments can be singled out during this process.
The first occurred when I was asked to hold a monthly seminar with the whole staff, including the house-mother and group
counselors. Their engagement with the new model was crucial for creating the desired family-friendly milieu. Subsequently,
the staff collaborated in the implementation of a comprehensive and differential approach toward each boy and his family,
and they came to feel empowered as part of the hostel's professional team. The other important development was the
teamwork with the probation department and other community agencies that were involved with the hostel's cases. Their
representatives became regular participants in the training group and, consequently, they became co-therapists, empowered
to hold joint sessions with the "hostel's families."
Bet Elem became the YPA's showcase and, as I phased out my involvement, the staff was empowered to continue
advancing the family-based program on their own and to present their accomplishments at national forums. In contrast,
there was an informal "control group" of social workers from other community hostels that did not fare as well. They
observed the training group during the first year and brought family cases for supervisory discussions in the second.
Although they managed to work with some families, they were seldom broadly empowered by their respective directors to
implement the family model in their hostels. Consequently, these hostels' directors, other staff members, and community
agencies did not get significantly involved with families during this phase. By the end of this 2-year experience, the
conclusions were that the family-based program could be applied effectively in YPA institutions. However, the teaching of
systems knowledge and skills as a way of enabling social workers to carry out family interventions proved to be insufficient
in the absence of the hostels' commitment to a basic change in their approach toward families.
The ICE Program in Community Hostels
The YPA directorate commited itself to adopting the Bet Elem experience as a model for its community hostels. It was
also decided that for the time being, no new outside consultants would enter the hostels. This was intended to allow for the
development of inner organizational resources, a compromise between the desire to move forward and the risk of breaching
boundaries too fast and too soon. The YPA had been a relatively closed system, and there were allegations that it had been
avoiding evaluation research for fear of negative results and public criticism (Tenne, 1986). Loyalty and the careful
deliberation of any change in policies were important principles, and the involvement, let alone empowerment, of outsiders
was to be monitored with vigilance. Furthermore, there were reservations concerning the applicability of the full ICE
program to the maximum security institutions and other "closed" residential centers that were located far distant from the
internees' communities.
Under the new contract, a family therapy teacher was hired to conduct a training course with a group of the hostels' social
workers and YPA supervisors who had not yet been involved in the program. As the consultant, I was to supervise YPA
staff supervisors who had participated in the Bet Elem training group. They entered new hostels and worked with the whole
staff and with community agencies in order to implement the ICE program. Their extensive experience inside the system
proved valuable, yet, with each hostel, they had to work through each of the ICE phases. In one hostel, involvement was a
critical issue: the director stopped the training process rather early complaining that the supervisor was unsuitable, and only
3 years later did he ask to rejoin the program. Collaboration was a problem in another hostel, and it was not resolved until it
was realized that the staff was feeling pushed to integrate the program too fast. The high motivation of Bet Elem was not
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characteristic of all institutions, and in some cases much patience was necessary in order to establish basic involvement and
collaboration with the staff.
These 2 years were similar to the middle part of therapy, with slow and significant progress, as well as setbacks. The
family therapy course increased the number of motivated professionals in YPA who had learned to think in systemic terms;
yet, as we had previously found, the director and staffs commitment was a sine qua non for changing the institutional
environment. Systems consultation within the institutions was necessary in order to support their social workers' push for
change. Indeed, the supervisors' work demonstrated that the program could be adopted by hostels where their social
workers' attempts at family work had previously been undermined. However, the number of YPA supervisors was limited,
and they held many other organizational functions, which severely restricted their availability. Supervision was usually
bought from outside experts who had been working for years with YPA and were found trustworthy. Some of these experts
had a traditional psychodynamic approach and, with few exceptions, they were individually oriented. Changing supervisors
was a delicate issue, yet sometimes unavoidable, if the community hostel project was truly to serve its function as a
springboard for state-wide institutional reform. When, at the end of this period, my contract came up for renegotiation, it
was time to quit or make a discontinuous, new leap forward.
A National Family-Oriented Policy
A new contract moved me "upstairs" to work directly with the YPA director and to sit on a senior family-involvement
committee that was then established. The objective was to integrate family-based care into the organization. This was a
major breakthrough and, consequently, the ICE phases were to repeat themselves at this organizational level. The first issue
was trust and loyalty, which was particularly pressing since an outside consultant is not legally bound by government
regulations concerning disclosure of departmental affairs. Issues of confidentiality were discussed and agreed on before I
was allowed entry into an inner circle that deals with issues that are politically and personally sensitive. The collaborative
work that followed ushered in the adoption of the ecological approach as a basic principle for staff training and for ongoing
supervision. It ceased to be equated with other forms of training, such as in group or art therapy, which were provided
contingently. The policy for working with supervisors was changed, and all new supervisors recruited from outside YPA
were required to be in line with the new paradigm. In principle, there was to be one such supervisor per institute. However,
if an institute's staff indicated a wish to maintain contact with an established, individually oriented supervisor, an additional
systems trainer would be assigned as well. The hours of supervision were apportioned between the two of them and they
were responsible for coordinating their work.
The next 2 years were devoted to statewide dissemination of the ICE program. Training was never forced from above.
Rather, it was encouraged by inviting the institutions to submit special budget proposals to the family-involvement
committee, specifying how family-based work was to be integrated into their unique context. A unique program that was
focused on the family involvement phase was initiated by a YPA superintendent who had participated in the family training.
The staff and families of closed institutions were less threatened and found that the limited focus on involvement made this
program easier to apply than the full ICE model. The closed institutions that integrated this program into their routine
succeeded in engaging 85-90% of the families, and, subsequently, there was a substantial reduction in the number of
escapees. The program was also introduced among institutions with Arab populations, where, for cultural and institutional
reasons, families were found to be particularly detached from their institutionalized children (Weiner & Kupermintz, 1993).
Though the objectives of this program are more circumscribed and the families are "only" asked to come for 5 "family days"
during the year, we have noticed significant effects on many levels, including an improvement in staff-family relations. Like
others before us, we have found that the involvement of one family member can make a significant contribution to the
residents' welfare, even with the more dysfunctional cases where parenting had been inconsistent and unreliable (Weiner
& Weiner, 1990). By the end of these 2 years, the funds provided for the program were for the first time insufficient to meet
the needs. There was an exponential growth in the number of institutions that implemented a partial or full version of the
ICE program.
Phasing Out Consultation
Six years later, there was a mutual feeling that the consultant was no longer needed for the system to continue its work
with families. My last task was to put down in writing the basic principles of family-based work in YPA, articulating a
differential approach for the various types of institutions. The ICE framework, which was formulated more fully at this
point, responded to this need by providing for different programs in accordance with current relations at the family-institute
interface.
The family-involvement committee is concerned with the further development and continued dissemination of the
program. Its contact with me, as the consultant, is maintained on a followup, as-needed basis. The committee is also in
charge of planning the yearly, one-day, national YPA conference devoted to family work, which was inaugurated soon after
the inception of the program. Symbolically, all the speakers in the last conference, which took place during my writing this
article, were YPA staff members who presented unique aspects of their work with families. For the first time, I came to this
8
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conference to listen and not to present.
Under a new contract, I was hired to work with a recently established committee in order to introduce systematic
evaluation procedures into the YPA. Regular evaluations are to focus on residents, their families, and family-institutional
relations. The procedures will require all YPA institutions to meet with families from the early phase of entry, and to do a
regular home visit. This new project testifies to the growing confidence in YPA, namely, that its work can be evaluated.
Notwithstanding the limitations of this narrative, it serves to highlight the themes of involvement, collaboration, and
empowerment that crisscrossed YPA relations with families and with the consultant. The transformation of the YPA into a
family-based delivery system is far from complete and, though the map is somewhat clearer now, there are many crossroads
ahead. The continuing work on evaluation and research will probably serve as a catalyst, while the separation of the
consultant from the program empowers the staff to take charge of developing family work on their own.
The Case of Yariv
Yariv is the second son of an immigrant family that came from Russia when he was 10. From the beginning, his
adjustment was plagued by serious social and academic difficulties. The school psychologist reported an average
intelligence quotient, impulsivity, difficulties with tasks that require sustained mental effort, low self-image, and an
immature level of social judgment and skills. The parents, who were barely managing economically, were very little at
home, and avoided contact with the school. When his mother did come to school, she expressed impotent exasperation with
Yariv's irresponsible behaviors and attacked the school for taking a tough attitude without helping him enough. During his
eighth-grade enrollment, Yariv missed many school days and barely studied. He became involved with a delinquent gang
and was put on probation. Next year, he transferred to a vocational school where he started well but gradually dropped out.
At age 15, after several rather severe theft and robbery convictions, he was placed in a closed correctional institution. The
authoritative structure seemed to calm him and he was generally cooperative with the staff. He found his niche, particularly
in the intramural workshops where he was motivated to learn manual skills, made good progress, and felt valued. A year
and-a-half later, the staff, which had till then minimal contact with the parents, thought that his rehabilitation would benefit
if he were transferred to a hostel. There, he could be closer to his family, gain work experience in the community, and enjoy
more freedom while still under supervision.
Involvement
It was the third year of our YPA, family-based program, and the community hostel's staff to which Yariv was referred
had just joined the training. It was decided to put a particular emphasis on new families such as Yariv's since prior
experience had suggested that the negotiation of family-based contracts before entrance has long-term effects on the
structure and functioning of the relational system (Elizur, 1993). Consequently, the family was asked to participate in the
intake before Yariv's admission would be decided upon by the staff. The hostel explained its general organization and its
family involvement policy, asked the parents about themselves, their family history, and their expectations of the staff.
There was also a home-visit. It was a family-friendly, reaching-out that led to an increased involvement as the staff
attempted to reach a common understanding of the circumstances behind placement (Cooklin, Miller, & McHugh, 1983).
***
Once the staff was committed to work with the Yariv's family and organized its work in line with this objective, the
family did not prove to be difficult to engage. Since this family had been found to be resistant and disengaged by
professionals who had related with them before, it was a good illustration for the staff of how much the family-larger
systems interface was co-determined. The basic ingredients of this approach are simple, though setting them up can be a
long-term and complex undertaking: (a) a flexible and assertive reaching-out that includes home-visits, communicates to
the family members that their active participation is considered an important factor in treatment, and that the staff will not
give up easily on them (Balgopal, Patchner, & Henderson, 1988); (b) an empathic attitude that accepts family members'
basic feelings, affirms their self-worth, and joins their belief system (Duncan, 1992); (c) a contextualized understanding
helps the staff to relate negative behaviors (such as those that appear in Figure 2) to the family's history, culture, and
socioeconomic constraints, and not to respond in kind (Elizur, 1994); (d) a supportive stance expresses care for the family's
well-being and a willingness to supplement its resources, for example, by reimbursing travel expenses of families who live
in poverty and helping family members to access and communicate with other human services; (e) an emphasis on meeting
the family, rather than focusing on the problem, enriches the story with information about positive family qualities, and
indicates that the staff would like to explore ways of working in partnership and to empower the family (White & Epston,
1990); and (f) a strategic use of the preadmission process to highlight the hostels' therapeutic role, enhance family
motivations for teaming up, and secure a commitment to routines of family involvement and collaboration.
Collaboration
After Yariv entered the hostel and the family became familiar with its routines, they were invited to discuss what would
9
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be an appropriate community job for him. Soon afterward he began to work with an employer, who had a cooperative
relationship with the hostel, and Yariv performed well. It was a significant milestone, and the sharing of success with the
parents reinforced their bonding with the hostel. The social worker continued to meet them regularly, at first every other
week, and later once a month. Yariv was seen separately in individual sessions, though sometimes a family meeting was set
up to discuss points of conflict that emerged during his regular visits at home. The parents and the social worker began by
defining their common objectives in terms of helping Yariv to develop skills for negotiating developmental issues that
created tension at home (such as, curfew hours, helping in the house, privacy), and thereby reduce his impulsive outbursts.
The parents were critical of Yariv's "tendency to shy away from responsibility and the lying, which came easy to him
whenever he wanted to cut corners." Yet, they agreed to work with the therapist so that their pessimism, which had
accumulated over years of frustrations and failures, would not drag them down and defeat Yariv's current attempt at
rehabilitating himself. Indeed, they supported him more and more by highlighting positive signs of progress, and at the
same time they improved their own skills in working out age-appropriate agreements.
Most of Yariv's fights were with his mother, who tended to be inconsistent with him: sometimes overprotective and at
other times demanding and intrusive. The father was critical and distant. The mother's father, who lived with them,
criticized both parents as weak in relation to Yariv, and usually supported him against them. His connection with his
grandson was the best in the family. The social worker met the grandfather during his home visit, but in accord with the
parents' wish, it was decided not to involve him in regular sessions. In fact, it was important for the parents to know that
they were not in "family therapy," and they made it clear that their own relationship issues were not to be discussed. The
social worker felt uneasy and complained to his supervisor that the family was "resisting by hiding their problems"; but
since Yariv was making good progress, he continued with a solution-focused approach of doing more of what was working.
Indeed, the staff's evaluations during the year indicated a continuous improvement in maturity, social integration, and
self-image. This made it possible for Yariv to begin the draft process, giving him a chance to approach a significant
developmental milestone in Israel that many delinquent youth are denied.
***
In residential care, opportunities for working with families occur in many forms, both formal and informal: family visits,
home visits, periodic review meetings, parent and family groups, and joint meetings for handling regularly ongoing issues
or sudden problems (Harbin, 1979). Collaboration begins with a basic agreement on problems and the identification of
common goals (Marsh & Fisher, 1992), and is strengthened by joint problem solving. Psychoeducational interventions,
including the learning of new coping skills, are helpful provided that they are introduced in a way that does not make the
family feel overpowered and diminished. It is a delicate balance since a premature exploration of family dysfunctions can be
experienced as disrespectful of family boundaries and create resistance (Colapinto, 1988). Hence, the suggestion is first to
work through problems at the family-agency interface, and to create family-agency forums that enhance involvement and
collaboration (Ackerman, Colapinto, Scharf, et al., 1991; Aponte, 1976).
Families that assume a noncooperative and hostile stance fluster residential workers who invest in the child and feel
defeated by the families' pathology (Kagan & Schlosberg, 1989). Slipping into an adversarial "one-up" stance is easy and,
therefore, an important training experience is the resolution of such situations by maintaining an attitude of
nonreciprocation while supporting mastery and continuity in family relationships. The basic approach is to highlight
strengths (Minuchin & Fishman, 1981), to search for and mobilize resources in the extended family and social system
(Andolfi & Haber, 1994; Karpel, 1986). Difficulties in collaboration are more complex when the families are themselves
split by long-term conflicts that affect their way of relating with the staff and increase the risk of recreating dysfunctional
triangles. The externalization of problems can help to forge a collaborative team that works together to diminish the
problems' sphere of influence (White & Epston, 1990). In Yariv's case, this was done by focusing on ways of countering
"pessimism" and helping the social worker find ways of working with the parents as a team.
Empowerment
Half-a-year before Yariv was to be discharged from the hostel and drafted, he asked for an early release in order to be
with his family. However, the family was anxious lest he regress to his former undisciplined behavior and be influenced
again by the neighborhood gang. Father wanted to deny the request since recidivism would mean instant rejection by the
army. Mother was vacillating; she wished to maintain good relations with Yariv and wanted him home, yet she concurred
with her husband's feelings of helplessness when Yariv flaunted their authority. At the other side, grandfather was pushing
them to be more compassionate and let Yariv have some months at home before the difficult, away-from-home army
service.
This became the pivotal motif in discharge planning and family empowerment. The parents revealed that during home
visits they had more problems over such matters as curfew times than they had previously reported. They gained some
control by threatening to report Yariv's behaviors to the hostel, but they did not feel that Yariv was respectful of their
authority and personal needs. They felt dependent on the hostel's supervision, and they feared a rapid deterioration without
it. In this atmosphere of concern, they opened up to work on matters that divided the family. Consequently, the parents were
10
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able to take a unified stand and to discuss it with grandfather. In a family meeting, all sides heard each other respectfully
and agreed to a pact for the improvement of functioning at home. Confinement was to continue until disagreements would
be worked through to a degree that the parents would feel confident of taking the risk with Yariv. From that point on, the
staff was consulted regularly in order to deal with unresolved family conflicts. Later, Yariv stayed for 3 months at home.
Formally, this period was still under the hostel's supervision, but, in practice, the parents were empowered to take care of
family issues and enforce limits. Yariv was eventually drafted and at present is still in service and feels satisfied. At the
parents' initiative, the consultation relationship continued into a followup period on an as-needed basis.
***
The transfer of responsibility and authority from HSP systems to families is a gradual and reciprocal process that is most
delicate in situations that involve social control. It is built upon the experience of collaborative coping with problems,
during which the competencies of family members are confirmed, and they are encouraged to participate more fully in
decision making. The sharing of power by the institution is crucial for the family's sense of competence and empowerment,
while the sharing of responsibilities by the family is necessary in order for the staff to trust the family. At best, this mutual
recalibration of functions leads to a more normative differentiation of roles in the family-larger systems interface and
culminates in a successful termination of the relationship. In Yariv's case, the social worker assumed more fully the role of
family consultant, a professional who was trusted by the parents to help them deal with family conflicts, while they came to
experience their power to enforce limits and to monitor the pace of discharge.
Though empowerment has become a common, almost fashionable term, it is a most difficult phase to achieve with
involuntary clients. Yariv's case was presented in order to illustrate the processing of all three ICE phases, but it is not the
norm in YPA practice. Institutions do not easily give up their powers and invest so much in building up family competence,
while troubled families who have long been influenced by conditions of poverty and social exclusion do not easily change
from a position of incompetence and dependence on social services to one of responsibility. For these reasons, we have
found that the full ICE program was applicable in the community hostels, while a partial program was implemented in other
YPA institutions. Though we would have liked more institutions to adopt the full program, we compensate for the limited
possibilities that characterize some parts of the YPA system by transferring residents among different institutions, such as
was the case with Yariv. This flexible use of the YPA network as an interconnected whole expands the possibilities for
empowering families.
Cases that involve injurious behaviors accompanied by evasion of responsibility and projection of blame display in sharp
relief the dilemmas that are involved in empowering involuntary clients. The ICE model is obviously no panacea for these
situations. At best, families and their helpers, in the YPA and outside of it, attempt to face together the challenge of a
"both/and" ethical standpoint (Goldner, 1992). The challenge is to find a middle stance that protects family connections and
promotes positive features in family life, neither compromising accountability, on the one hand, nor the safety and
well-being of those who are vulnerable, on the other.
CONCLUSION
The ICE model delineates a sequence of developmental phases that can be used as a template for family-based program
development on the levels of consultation, training, and therapy. It is an integrative framework that can guide practitioners
of different orientations in developing collaborative work with families, setting intervention priorities, diagnosing and
resolving relationship impasses. The 6-year experience with YPA testifies to the viability of the ICE model and emphasizes
the importance of flexibility in creating different types of family-based programs that fit local circumstances and staff
motivations. But can the model be applied to different settings, on different scales, and serve as a useful guide to the
process of systems consultation? Though the question cannot be answered at this stage, experience during the past 2 years
has indicated that the ICE model can be useful for designing training programs for diverse professional groups that work in
a variety of service delivery systems that are characterized by limited possibilities for traditional practice of family therapy.
It has been applied to the training of senior supervisors from the Department of Social Services in the city of Lod during the
establishment of an innovative, community and family-oriented residential center for children at risk. It has also been used
to train a multidisciplinary group of professionals who do their reserve duty at the Israeli Defence Force's emergency
mental health center that cares for soldiers who are at risk for chronic PTSD as a result of refractory combat stress reaction
(Elizur, in press). Further development of the model depends on the following related questions. Can the model be usefully
applied to program development, staff training, and individual casework in different types of agencies and cultural
contexts? Can the model be tested and validated by research? Ending this article with these challenging questions is an
invitation for others to apply and to modify the model in family-oriented program development, and to continue with the
learning that takes place when the results of these naturally occurring, ecological experiments are examined.
REFERENCES
11
_____________________________________________________________________________________________________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
12
Ackerman, F., Colapinto, J. A., Scharf, C. N., Weinshel, M. and Winawer, H., (1991) The involuntary client:
Avoiding "pretend therapy." Family Systems Medicine, 9, 261-266.
Alexander, J. F. and Parsons, B. V., (1977) Short-term behavioral intervention with delinquent families: Impact
on family process and recidivism. Journal of Abnormal Psychology, 81, 219-225.
Amundson, J., Stewart, K. and Valentine, L., (1993) Temptations of power and certainty. Journal of Marital and
Family Therapy, 19, 111-123.
Andolfi, M. and Haber, R. (Eds.), (1994). Please help me with this family: Consultative resources in family
therapy. New York: Brunner/Mazel.
Aponte, H., (1976) The family-school interview: An eco-structural approach. Family Process, 15, 303-311.
Balgopal, P. R., Patchner, M. A. and Henderson, C. H., (1988). Home visits: An effective strategy for engaging
the involuntary client (pp. 65-76). In D.H. Olson (ed.), Family perspectives in child and youth services New
York: Haworth Press.
Berg, I. K., (1994). Family-based services: A solution-focused approach. New York: W.W. Norton.
Boyd-Franklin, N., (1989). Black families in therapy: A multisystems approach. New York: Guilford Press.
Bronfenbrenner, U., (1986) Ecology of the family as a context for human development: Research perspectives.
Developmental Psychology, 22, 723-742.
Carl, D. and Jurkovic, G. J., (1983) Agency triangles: Problems in agency-family relationships. Family Process,
22, 441-451.
Carpenter, J. and Treacher, A. (Eds.), (1993). Using family therapy in the nineties. Oxford: Blackwell Publishers.
Chamberlain, P. and Rosicky, J. G., (1995) The effectiveness of family therapy in the treatment of adolescents
with conduct disorders and delinquency. Journal of Marital and Family Therapy, 21, 441-459.
Colapinto, J., (1988) Avoiding a common pitfall in compulsory school referrals. Journal of Marital and Family
Therapy, 14, 89-96.
Colapinto, J., (1995) Dilution of family process in social services: Implications for treatment of neglectful
families. Family Process, 34, 59-74.
Cooklin, A., Miller, A. C. and McHugh, B., (1983) An institution for change: Developing of a family day unit.
Family Process, 22, 453-468.
Doherty, W. J., Colangelo, N. and Hovander, D., (1991) Priority setting in family change and clinical practice:
The family FIRO model. Family Process, 30, 227-240.
Duncan, B. L., (1992) Strategic therapy, eclecticism, and the therapeutic relationship. Journal of Marital and
Family Therapy, 18, 17-24.
Elizur, Y., (1988). Family therapy with young offenders: Present realities and a framework for change [in
Hebrew]. Report to the Youth Protection Authority and ELEM (Youth in Distress).
Elizur, Y., (1993) Ecosystemic training: Conjoining supervision and organizational development. Family Process,
32, 185-201.
Elizur, Y., (1994) Working with families in institutions for juvenile offenders: An ecosystemic model for the
development of family involvement. Human Systems, 5, 253-265.
Elizur, Y., (in press). "Inside" consultation through self-differentiation: Stimulating organizational development in
the IDF's care of intractable, war-related, traumatic disorders. Human Systems.
Elizur, Y. and Minuchin, S., (1989). Institutionalizing madness: Families, therapy and society. New York: Basic
Books.
Elizur, Y., Tene, D. and Wagshal, M., (1994). Working with families in the Youth Protection Authority
institutions (pp. 279-302). In M. Golan & Y. Wozner (eds.), Crime and social work: Knowledge and
interventions [in Hebrew]. Tel Aviv: Ramot Press.
Erikson, E. H., (1968). Identity: Youth and crisis. New York: W.W. Norton.
Fraser, M. W., Pecora, P. J. and Haapala, D. A. (Eds.), (1991). Families in crisis: The impact of intensive family
preservation services. New York: Aldine de Gruyter.
Geismer, L. L. and Wood, K. W., (1986). Family and delinquency: Resocializing the young offender. New York:
Human Sciences Press.
Goldner, G., (1992) Making room for both/and. The Family Therapy Networker, 16(2), 54-61.
Haley, J., (1975) Why a mental health clinic should avoid family therapy. Journal of Marriage and Family
Counseling, 1, 3-13.
Harbin, H. T., (1979) A family-oriented psychiatric inpatient unit. Family Process, 18, 281-291.
Henggeler, S. W., Melton, G. B. and Smith, L. A., (1992) Family preservation using multisystemic therapy: An
effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology,
60, 953-961.
Imber-Black, E., (1988). Families and larger systems: A family therapist's guide through the labyrinth. New
_____________________________________________________________________________________________________________
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
13
York: Guilford Press.
Jacob, T., (1975) Family interaction in disturbed and normal families: A methodological and substantive review.
Psychological Bulletin, 82, 33-65.
Kagan, R. and Schlosberg, S., (1989). Families in perpetual crisis. New York: W.W. Norton.
Karpel, M. A. (Ed.), (1986). Family resources: The hidden partner in family therapy. New York: Guilford Press.
Lappin, J. and VanDeusen, J., (1994) Family therapy and the public sector. Journal of Family Therapy, 16,
79-96.
Liddle, H. A., (1988). Systemic supervision: Conceptual overlays and pragmatic guidelines (pp. 153-171). In
H.A. Liddle, D.C. Breunlin, & R.C. Schwartz (eds.), Handbook of family therapy and supervision. New York:
Guilford Press.
Marsh, P. and Fisher, M., (1992). Good intentions: Developing partnership in social services. York: Joseph
Rowntree Foundation.
Mayer, M. F., Richman, L. H. and Belcerzak, E. A., (1977). Group care of children: Crossroads and transitions.
New York: Child Welfare League of America.
McDaniel, S. H., Hepworth, J. and Doherty, W. J., (1992). Medical family therapy: A biopsychosocial approach
to families with health problems. New York: Basic Books.
McGowan, B. G., (1990). Family-based services and public policy: Context and implications (pp. 65-87). In J.K.
Whittaker, J. Kinney, E.M. Tracy, & C. Booth (eds.), Reaching high-risk families: Intensive family preservation
in human services. New York: Aldine de Gruyter.
Minuchin, S. and Fishman, H. C., (1981). Family therapy techniques. Cambridge: Harvard University Press.
Minuchin, S., Montalvo, B., Guerney, B. G., Jr., Rosman, B. L. and Schumer, F., (1967). Families of the slums:
An exploration of their structure and treatment. New York: Basic Books.
Minuchin, S. and Nichols, M. P., (1993). Family healing: Tales of hope and renewal from family therapy. New
York: Free Press.
Rutter, M., (1994) Family discord and conduct disorder: Cause, consequence, or correlate?, Journal of Family
Psychology, 8, 170-186.
Saunders, S. M., (1993) Applicant's experience of the process of seeking therapy. Psychotherapy, 30, 554-564.
Schwartz, I. M., (1989). (In)justice for juveniles: Rethinking the best interests of the child. Lexington MA:
Lexington Books.
Strupp, H. H., (1982). The outcome problem in psychotherapy: Contemporary perspectives (pp. 39-71). In J.H.
Harvey & M.M. Parks (eds.), Psychotherapy research and behavior change. Washington DC: American
Psychological Association.
Szapocznik, J. and Kurtines, W. M., (1989). Breakthroughs in family therapy with drug-abusing and problem
youth. New York: Springer.
Szapocznik, J., Perez-Vidal, A., Brickman, A. L., Foote, F. H., Santisteban, D. and Hervis, O., (1988) Engaging
adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of
Consulting and Clinical Psychology, 56, 552-557.
Taylor, D. A. and Alpert, S. W., (1973). Continuity and support following residential treatment. New York:
Child Welfare League of America.
Tenne, D., (1986) The therapeutic milieu of the hostel [in Hebrew]. Crime and Social Deviance, 14, 65-98.
Tenne, D., (1993) Intervention with families of children residing in institutions for maladjusted youth [in Hebrew].
Society and Welfare, 14, 5-16.
Tolan, P. H., Cromwell, R. E. and Brasswell, M., (1986) Family therapy with delinquents: A critical review of the
literature. Family Process, 25, 619-649.
Weiner, A. and Kupermintz, H., (1993) Unfamiliar world: Arab children in institutions [in Hebrew]. Society and
Welfare, 13, 389-402.
Weiner, A. and Weiner, E., (1990). Expanding the options in child placement. Tel Aviv: Schocken.
Weiss, K., Wozner, Y. and Teichman, M., (1994) Institutional treatment for juvenile delinquents: 2000 offenders
after three years. Journal of Offender Rehabilitation, 21, 183-202.
Wells, K. and Biegel, D. E. (Eds.), (1991). Family preservation services: Research and evaluation. Newbury
Park CA: Sage Publications.
White, M. and Epston, D., (1990). Narrative means to therapeutic ends. New York: W.W. Norton.
Wynne, L. C., (1984) The epigenesis of relational systems: A model for understanding family development.
Family Process, 23, 297-318.
Wynne, L. C., McDaniel, S. H. and Weber, T. T. (Eds.), (1986). Systems consultation: A new perspective for
family therapy. New York: Guilford Press.
Yoshikawa, H., (1994) Prevention as cumulative protection: Effects of early family support and education on
_____________________________________________________________________________________________________________
62.
chronic delinquency and its risks. Psychological Bulletin, 115, 28-54.
Zigler, E., Taussig, C. and Black, K., (1992) Early childhood intervention: A promising preventative for juvenile
delinquency. American Psychologist, 47, 997-1006.
Manuscript received July 29, 1994; Revisions submitted October 9, 1995; Accepted February 12, 1996.
14