Intervening in Children’s Lives: An Ecological, Family-Centered Approach to Mental Health Care


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Authors describe ‘ecological’ model of intervention
(October 2007 Issue)

“Intervening in Children’s Lives:
An Ecological, Family-Centered Approach to Mental Health Care”
By Thomas J. Dishion and
Elizabeth A. Stormshak
American Psychological Association Washington, D.C., 2007

By Paul Efthim, Ph.D.

How refreshing to encounter a book that unapologetically encourages psychotherapists to work with children and families over a span of years, in contrast to the current ethos in which brief therapies are expected to bring lasting change to complex problems in only weeks or months.

"Intervening in Children's Lives" by psychologists Thomas Dishion and Elizabeth Stormshak of the University of Oregon describes a systematic approach to child and family treatment. The authors draw on the seminal work of Bronfenbrenner and other developmental psychologists in laying out their "ecological" model of intervention.

Going beyond standard clinical diagnostics, the ecological approach strives to evaluate not only the child but also the impact of his or her environment, which might include parents, siblings, school, peers and other relevant domains. The goal is to use this broad-spectrum view to design interventions to reduce and eliminate problem behavior and emotional distress. For example, instead of traditional child therapy, where the parents sit in the waiting room, a therapist working in the ecological model targets other systems in a child's life as necessary, such as parental skill deficits or school-related factors.

True to their developmental perspective, Dishion and Stormshak assert that periodic, brief interventions can be used to deliver effective treatment in, say, six to eight sessions over two to three years in some cases. Therapists seek to identify how the family ecology may need to be changed over time. If this approach sounds like family systems therapy, it should - but the authors go further, looking at how larger systems beyond the family, such as school and peer environments may contribute to a child's problems.

Psychologists should think less like medical doctors and more like dentists, say the authors. Rather than expecting mental health treatment to "cure" a psychological problem as if it were a disease, we should frame our work with children and families as similar to good dentistry, in which the patient's hygiene, diet, preventative practices and periodic check-ups are necessary to maintain oral health. Collaboration is continually emphasized throughout this approach.

The first section of the book reviews the intervention literature with a particular emphasis on longitudinal studies by the authors and others. The second part describes strategies for establishing collaborative relationships during the initial evaluation phase of treatment, which is labeled the "Family Check-Up." A third section presents a menu of interventions featuring motivational interviewing techniques and sample scripts. The last section looks at relevant professional and ethical dilemmas.

One of the book's strongest points is its attention to scholarly research in developmental psychopathology, sociology and other disciplines. It was sad to read that some well-regarded group intervention programs (e.g., summer camps for at-risk youth) may actually do more harm than good, due to peer modeling of problem behavior - an ecological effect that might be overlooked from a naļve standpoint of wanting to help troubled kids.

The flip side of the book's methodological sophistication is that some readers will find its tone too academic. One wishes the authors would go into greater depth with the clinical cases, which are numerous but offer only basic descriptions of patients and methods for working with them. The families presented tend to be struggling with complex, severe problems, suggesting that this approach may be more suitable for clinic-based treatment teams rather than for solo practitioners who are not part of a larger system of care.

Recommended for scholars and researchers in the field of child and family intervention, this volume will also be welcomed by training programs and newer clinicians interested in taking a more systematic approach to this most challenging and worthy area of practice.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds faculty appointments at the Massachusetts School of Professional Psychology and the Boston Institute for Psychotherapy.