Family-Focused Interventions
In Module 1, you learned how family can play a role in the disengagement process. In this section, we will look at some models of intervention that can utilize family in the process of supporting the person at risk for targeted violence.
Some initial things to think about when considering engaging family members in services:
1. Definition of Family
Who does the person at risk for targeted violence consider to be part of his or her family or other caretakers important to their daily care? The person may want to include non-nuclear family or even close friends and others not traditionally considered “family” by some mental health clinicians.
2. Family-Involvement Risks
Should the family members be involved in the services provided? While “family” has the potential to provide needed support and resources, some families may share some of the beliefs and attitudes that put the person at risk for targeted violence in the first place. The mental health clinician needs to evaluate the nature of the “family” to determine if they have the potential to be a positive influence.
3. Lack of Family Involvement
What if the family doesn’t want to get involved in the intervention process? The person at risk for targeted violence, through their beliefs and actions, may have damaged their connections to some family members, or vice versa. The mental health clinician needs to evaluate the extent to which the family or the person of concern is willing for the family to be engaged in services.
After working through the three issues identified above and determining that the family would be a support to the intervention process, there are two models of family involvement that may be helpful to pursue: attachment-based family therapy and multidimensional family therapy. Both models address some of the risk factors identified in this training as well as provide a way of building resiliency factors to assist the person at risk for targeted violence.
Attachment-Based Family Therapy
A trauma-informed model of family intervention, Attachment-Based Family Therapy (ABFT) is a well established, structured family intervention that seeks to rebuild the connection and support between the person at risk for targeted violence and his/her family members. The model acknowledges the person at risk may have experienced personal/relational trauma within the family that may have contributed to their developing concerning beliefs and behaviors. Rebuilding the connections within the family increases the resilience factors needed as part of the overall intervention plan for the person at risk.
ABFT follows a sequential, four-task process. The tasks are designed to build alliances between the family, the person at risk, and the clinician. These alliances help to accomplish the following:
- Address the relational trauma experienced by the person at risk
- Help the person at risk articulate the nature of the trauma experienced in a way that can be heard by the rest of the family
- Assist the family and person at risk to begin to address the trauma in a more healthy and collaborative manner.
Research shows the presence of trauma in the lives of many people who engage in targeted violence and those who are at risk for such behavior. The ABFT model directly addresses the relational trauma experienced and provides a structured approach to address the trauma.
For more information on Attachment-Based Family Therapy, please see the article titled, “Attachment–Based Family Therapy” at goodtherapy.org.
Multidimensional Family Therapy
Earlier in the training, you learned about the need for a multidisciplinary approach to working with people at risk for targeted violence. Also, from the public health perspective, you learned that there are many systems involved when addressing the multiple risk factors that may influence a person’s actions and beliefs. Multidimensional Family Therapy (MDFT) is a model of family therapy that recognizes the need to have multiple systems involved in the intervention process and provides a structured approach to working with the family as it negotiates the many systems involved in their life. It has been found effective in working with youth involved in or at risk for substance abuse, co-occurring mental health disorders, and conduct/delinquency concerns. The overall goal of MDFT is to help build the resiliency factors needed to better support the person at risk for targeted violence.
The model focuses on four areas of social interaction:
- The person at risk’s interpersonal functioning with family and peers
- The family’s parenting practices and level of functioning
- Family-person at risk interactions during therapy
- Better communication/advocacy between the family and key social systems involved with the person at risk (schools, mental health, juvenile justice, etc.)
The manualized, structured intervention approach utilizes a three-stage process. The overall intervention is usually delivered in 12 to 16 weekly sessions of 60 to 90 minutes each. In some cases, sessions can be held twice per week. While each stage has a specific purpose, the number of sessions needed for each stage is left to the discretion of the clinician. The stages help build connections between the family, the person at risk, and the mental health clinician. Additionally, the stages help the family identify the systems they must engage with related to the person at risk, such as the justice system, and develop better communication and advocacy skills to ensure the person at risk and the family as a whole receive needed resources and support.
For more information on this model of intervention, see MDFT.org.