Re: Increasing parental involvement in child abuse treatment?

["Mark J. Chaffin" <Mark-Chaffin@xxxxxxxxx>]

In response to the posting about getting abusive parents to attend meetings:

Probably the richest literature on this topic is in the substance abuse
field.  However some work has been done with child abuse.  If I may
paraphrase the data, I think the bottom line is that a) the people who seem
to need intervention the most are the ones who accept it the least and b)
the more marginalized the population, the lower the access to and faith in
mainstream interventions.  

Compliance is always a major headache for people in the field.  In designing
several of our clinical or research programs, we've looked at the compliance
literature and found a number of things that have been either suggested or
somewhat supported by the data.  I should mentioned that I don't believe any
of these things have what could be characterized as conclusive support, but
most have some data (or at least strong opinion)  behind them.  These are
some of the things were currently doing, although not all are being done in
all programs:

1)  Use motivational techniques based upon stage of change assessment.  This
involves assessing readiness for change then matching initial interventions
to that (see Prochaska's work on this, also books by W. Miller, et al.).
Often, this means using motivational techniques prior to beginning any
active change techniques. This approach has support among diverse
populations and we are currently evaluating it with two separate child
maltreatment populations, but don't have data yet.

2)  Encourage court orders with teeth, followed up by close monitoring and
immediate consequences for noncompliance.  I might mention that this is
somewhat controversial among some professionals who take more of an
empowerment approach to parents.  However, the data from various fields is
fairly clear that people come when they are coerced (the nice word for this
is "structure", but lets call it what it is). Some data from the substance
abuse literature, and limited data from the child abuse literature, suggests
that coerced patients do no worse in treatment than voluntary patients in
terms of treatment benefits, so despite widespread clinical lore that
coercion poisons treatment, I don't believe this is borne out in the
literature, although admitedly its an open empirical question.  Anecdotally,
our teenage sex offender program has around a 90% attendance and completion
rate, I believe in part because we've persuaded our juvenile judges to court
order youth and their parents to attend and implement real consequences if
they don't attend and participate.  Despite the coercion, and despite the
fact that many come in the door angry, post-discharge client satisfaction
measures look very positive. 

3)  Make it easy.  Schedule at convenient times, provide transportation
assistance (we give out bus tickets, pay gas money, etc.). Provide on-site
child care.

4)  Make it friendly.  We give door prizes (e.g. tickets to the zoo, books,
video rental gift certificates, etc.) to parents who attend.  We have
graduation cermonies with food.  We monitor client satisfaction during
treatment and have patient advocates.  

5)  Make it relevant.  Involve clients in defining some portion of needs and
goals.

6)  Never, ever let it slide.  Call before every appointment to confirm.
Call clients  immediately if there is a single failed appointment.  Notify
workers immediately of failed appointments.  Insist that the court worker
call the client.  You want to send the message that attendance is important
and taken seriously by the system.  

7)  Consider going to them.  Work in-home or in the community in some cases.


Hope these suggestions help

Mark Chaffin, Ph.D.
Center on Child Abuse and Neglect
University of Oklahoma Health Sciences Center
P.O. Box 26901; CHO 3306
Oklahoma City, OK  73190
(405) 271-8858; fax 271-2931
mark-chaffin@ouhsc.edu