Am J Community Psychol (2007) 39:191–196
DOI 10.1007/s10464-007-9104-5
ORIGINAL PAPER
Systems change reborn: rethinking our theories, methods,
and efforts in human services reform and community-based
change
Pennie G. Foster-Fishman Æ Teresa R. Behrens
Published online: 18 May 2007
Springer Science+Business Media, LLC 2007
Abstract This article introduces the reader to this special
issue on Systems Change and highlights six lessons learned
about theory, methods, and interventions for systems
change that emerged across the included articles. The value
of a systems approach to systems change is examined,
including the need for frameworks, methods, and change
activities that attend to the characteristics of systems.
Keywords Systems change Mental models Systems
thinking Social change
Community Psychology is ultimately concerned about social
justice and social change. These goals require a sophisticated
understanding of the contexts that give rise to social problems (Seidman, 1988) and the use of research methods and
change strategies that attend to the complexities of social
settings (Tseng et al., 2002). Although our field has dedicated considerable attention to these concerns, our abilities
in these areas still lag behind the considerable need in our
society for transformative change. This special issue on
Systems Change was developed to increase the conceptual
and methodological tools available to those involved in
designing, implementing, and assessing social change.
Why focus on systems change?
We purposively used the frame of ‘‘Systems Change’’ for
this special issue for several reasons. First, the term
P. G. Foster-Fishman (&)
Michigan State University, 125 D Psychology Building, East
Lansing, MI 48824, USA
e-mail: fosterfi@msu.edu
T. R. Behrens
W. K. Kellogg Foundation, Battle Creek, MI, USA
‘‘systems change’’ explicitly connotes a change in a system. For us the term ‘‘system’’ better captures the ecological and social change emphasis of our field than the
more often used term ‘‘context’’. In general, a system is a
collection of parts that interact together and function as a
whole (Ackoff & Rovin, 2003). While the term context can
also connote this complexity, it more typically refers to a
discrete environmental (e.g., neighborhood, school, organization, community) characteristic that has influence on a
phenomenon of interest. Sense of community, classroom
size, leadership style, and decision-making opportunities
are all examples of contextual characteristics that are often
measured or targeted for intervention by community psychologists. While these are all valuable foci for research
and intervention efforts, these discrete variables do not
capture the overall purpose and essence of the contexts
within which they are embedded. Neighborhoods, schools,
organizations, and communities are complex and dynamic;
their character emerges through the interactions and interdependencies across the many actors, niches, and
activities that exist within them. Attention to only one or a
few system characteristics when attempting to foster social
change can create null results and even have dire consequences. For example, Tseng and Seidman (2007) in this
issue describe how California’s school reform movement
failed, in part, because leaders considered a reduction in
classroom size as essential to educational performance and
ignored the inevitable fact that the creation of new classrooms would create a need for more teachers within the
system. Without this resource the school system hired
relatively unqualified individuals to fill this gap and inadvertently sacrificed classroom quality for classroom size.
Because significant social change requires that we alter
the status quo, and the status quo is maintained and constrained by the systems we live within (Seidman, 1988), a
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focus on understanding and changing systems seems a
worthwhile venture for community psychologists. Thus, it
is our hope that this special issue reinvigorates a more
deliberate consideration of the term ‘‘system,’’ and all it
conveys, in the research and intervention work of community psychologists.
The second reason for using the systems change frame
for this issue is that many recent initiatives by federal and
state governments and national foundations have adopted
the term ‘‘systems change’’ to illustrate their goal of creating sweeping and sustained transformative impact on
neighborhoods, communities, and service delivery systems.
In these efforts, a ‘‘system’’ such as a neighborhood, the
mental health delivery system, or even a whole community,
is the focus of change. Though popular, many of these
efforts have struggled to achieve what was promised. As
professionals engaged in this work ourselves (as a funder,
evaluator, technical assistance provider, and designer) we
looked to the literature to help us better understand how to
do systems change effectively. We found few articles in
our field that were pertinent to this concern. We hope this
special issue will help to expand the contributions made by
community psychologists to this field of study.
Third, for the past 20 or more years, a large academic
discourse has been occurring around the concept of systems
though this dialogue has not often involved community
psychologists. As concepts such as chaos theory have begun to be applied to social as well as biological and
physical systems, numerous debates concerning what a
system is and how it should be understood, changed, and
evaluated have occurred within the fields of systems
thinking. It is our hope that this special issue helps to
bridge the academic worlds of community psychology and
systems thinking because we believe that efforts to create
social change can be strengthened by insights gained in the
systems science. We also believe that the largely theoretical discourse on systems can benefit from grounding in the
practical world of community change work.
Am J Community Psychol (2007) 39:191–196
represent the diversity of the work in our field, targeting a
range of systems, problem areas, and strategies for change.
They include:
•
•
•
An introduction to the special issue
With these three purposes in mind, we sought articles for
this special issue that represented exemplar descriptions of
the theories, methods, and practice of systems change
work. In the call for papers systems change was defined as:
‘‘change efforts that strive to shift the underlying infrastructure within a community or targeted context to support
a desired outcome, including shifting existing policies and
practices, resource allocations, relational structures, community norms and values, and skills and attitudes.’’ While
authors were not required to incorporate systems thinking
into their papers, many did. The following 17 articles
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•
New theoretical frameworks for systems change efforts.
Christens, Hanlin, & Speer (2007) describe how the
sociological imagination is a powerful tool for facilitating social change. Foster-Fishman, Nowell, & Yang
(2007) present their framework for transformative
systems change that integrates systems thinking and
organizational change principles. Tseng & Seidman
(2007) introduce a systems framework for understanding social settings for youth that emphasizes social
processes, resources, and a setting’s organization of
resources.
Valuable methods for assessing systems and documenting change. Durlak et al. (2007) present results from
their meta-analysis of competence-promotion outcome
studies that demonstrate that social systems affecting
children and adolescents can be altered. Emshoff et al.
(2007) described their longitudinal analysis of community health collaboratives in Georgia and illustrate,
using HLM, that collaborative characteristics, over
time, influence the degree of systems changes made.
Hirsch, Levine, & Miller (2007) illustrate the power of
systems dynamics modeling for explaining the challenges of school reform efforts. Janzen, Nelson, Hausfather, & Ochocka (2007) describe how they engaged
consumers of mental health services in a participatory
action research process to document and track their
systems change activities. Kreger, Brindis, Manuel, &
Sassoubre (2007) present a framework for tracking the
indicators of collaborative systems change efforts.
Rich case examples of systems change. Griffith et al.
(2007) present a process for addressing institutional
racism in the health care system. O’Connor (2007)
describes a strategy for eliciting and altering the mental
models used by members of interagency teams. Campbell, Nair, & Maimane (2007) describe their efforts to
create a health competent community in a rural South
Africa community plagued by HIV/AIDS. Ford (2007)
details how his action research efforts with one police
department facilitated and supported the transformation
to community policing. Staggs, White, Schewe, Davis,
& Dill (2007) discuss their attempts at incubating
systems change in the service delivery system for
children in Chicago. Suarez-Balcazar et al. (2007)
describe their efforts at creating a healthy food system
within the public schools in Chicago.
Commentaries on the future of systems change. Kelly
(2007) discusses the implication of these articles for
current and future community psychologists. Behrens
& Foster-Fishman (2007) generate a list of systems
Am J Community Psychol (2007) 39:191–196
change principles that can be culled from these articles.
Parsons (2007) posits that complex adaptive systems
theory may be particularly useful for the endeavors
pursued by community psychologists.
Overall, this group of articles tells a compelling tale of
the passion for social change within our field and the
challenges faced in pursuit of social justice. We introduce
you to these articles by first highlighting a few insights
about the theories, methods, and processes of systems
change that emerge from this body of work.
Insights about theory as it relates to systems change
Theory is useful because it provides a framework from
which to understand or explain what we observe or to
predict what we anticipate will happen. Part of our own
journey as co-editors of this special was to familiarize our
selves with the large body of literature on systems thinking
and transformative change.1 As we reviewed the articles in
this special issue, from this expanded framework, several
insights emerged about the value of integrating a system’s
perspective into our field’s systems change efforts. We
highlight these insights below.
Attention to a system’s boundary and the processes
used to define it can improve the efficacy of systems
change endeavors
For some systems theorists, the process of defining a system’s boundary is the most critical step in a systems change
endeavor (Checkland, 1981; Midgley, 2000). Boundaries
clarify what is important and valued; they make explicit the
focus of inquiry (including the problem definition) and the
potential range of impact of a change initiative. Thus,
boundary clarity not only helps the configuration of intervention and analyses efforts, but it also increases the
transferability of the findings to other similar contexts. In
this special issue Foster-Fishman and her colleagues describe how they engage system members in clarifying two
types of boundaries in their systems change efforts: (a) how
the problem is defined; and (b) who and what should be
considered as part of the system given this problem definition.
Because system boundaries are an arbitrary construct,
the act of defining boundaries is an essential step in any
systems change endeavor (Midgley, 2000). For example,
Christens et al.’s (2007) article in this special issue illus1
While there is not space in this article to provide a comprehensive
review of the systems literature, we refer interested readers to Bob
Williams’ website (http://users.actix.co.nz/bobwill) for an excellent
summary of key systems theories.
193
trates how the obesity problem in America is redefined
when the boundaries of this problem are redrawn to include
the increase in corn farm subsidies and thus the abundance
of inexpensive fructose corn syrup as an additive in processed foods. By expanding the system boundaries in this
way, Christens and colleagues highlight the need for
solutions that expand beyond individual or even community level healthy eating programs.
The delineation of system boundaries can create
opportunities for change or, when drawn too narrowly,
reduce the resources available for system functioning.
Thus, one lever for change is the intentional expansion of a
system’s boundaries. For example, in rural communities in
South Africa that were plagued by HIV/AIDs, Campbell
and her colleagues (2007) attempted to expand the HIV
health care and support system available to these communities in multiple ways, including inviting tribal chief
leaders and local service agencies to join these communities in these efforts. In the school system examined in
Suarez-Balcazar’s et al.’s (2007), change agents found an
opportunity for systems change when they considered the
new food vendors as part of their healthy food initiative.
Overall, this suggests that more attention is needed to
how community psychologists define the problem situation
and the boundaries around the targeted system. In many
ways, the processes for creating these delineations fit well
with the values and practices of community psychology.
Systems theorists argue that problem definitions and system boundaries needed to be examined and negotiated with
multiple system stakeholders in an ongoing and iterative
dialogic process. (See Checkland, 1981 and Midgley, 2000
for excellent descriptions of these processes). These processes not only clarify boundaries for the change agent or
researcher, but also serve to expand stakeholders’ understandings.
A change in a system level outcome is not the same as,
nor does it guarantee, system change
Systems change agents and researchers often focus on
improving discrete system parts––such as a policy change
or the infusion of new resources. The literature is rife with
examples of systems change efforts that have yielded these
outcomes yet still failed to create a sustained change in a
system or a shift in the status quo. Systems thinking helps
to explain why system level outcomes often fail to leverage
systemic change by reminding us that a sole emphasis on a
unitary system part (e.g., policy change) is usually insufficient for sustained system transformation (unless, of
course, one is fortunate enough to locate that butterfly
flapping its wing). Systems are made of parts––and their
interactions––and it is the interaction between parts that
define system functioning, give birth to entrenched patterns
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of interaction, and generate root causes to significant
problems (Senge, 1990). A shift in a system part––such as
a policy change––will only transform the status quo if that
part also leverages necessary changes in other system
elements. The character of the interdependencies and patterns across system components ultimately determine if
such leverage can occur.
This suggests that researchers and change agents interested in systems change need to redirect their focus to
understanding and shifting the interdependencies within
systems and the consequences of those interactions. FosterFishman et al. (2007) describe an approach to systems
change that considers system parts, their interactions, and
critical levers for change. Hirsch et al.’s (2007) article
highlights how inaccurate conclusions can be drawn when
system interactions are ignored.
Am J Community Psychol (2007) 39:191–196
reader to a third method (complex adaptive systems theory)
well suited for dealing with systems that are constantly
adapting to their environments.
•
•
Insights about methods for systems change
Community psychologists have long lamented the significant gap between the theories of community of psychology
and the methods that are employed. Luke (2006) was
perhaps the most recent critic, noting the significant
incongruity between our foundation in ecological theory
and our primary use of methods that rarely go beyond the
intra-individual level. Certainly, when systems change efforts are embedded within systems thinking theories, they
risk the same lack of alignment. Systems thinking requires
attention to a complex web of interdependencies, an
awareness of the ‘‘whole’’ not just the parts, and the ability
to recognize multi-directional cause-effect relationships
with all causes emerging as the effect of another system
dynamic. The regularity model of causation (x predicts y)
that we typically rely on in our research is frankly illequipped to deal with such complexity.
Several of the articles in this special issue illustrate
innovative methods for thinking about and changing systems. This leads us to our next lesson learned about systems change.
Systems change agents and researchers need methods
that are equipped to capture system complexity
Systems are complex in many ways. For example, they
contain a web of interactions, have members who hold
multiple, diverse worldviews, and are self-organizing,
adjusting to environmental threats and opportunities.
Appropriate methods would attend to these complexities.
We highlight two methods that are illustrated in this special
issue that are particularly well equipped to attend to system
interdependencies and multiple system realities. Parsons
(2007) in her commentary to this issue introduces the
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Systems dynamics modeling. Hirsch, Levine, & Miller’s
(2007) article in this special issue illustrates an
application of systems dynamics modeling (SDM).
SDM is viewed by some system’s theorists as the most
advanced methodological technique for mapping and
assessing system activities and outcomes. It rests on the
notion that systems consists of reinforcing and balancing feedback loops, not uni-directional causal chains,
and that an understanding of these interdependencies
sheds light on systems functioning. While a statistician
familiar with the complexities of SDM is needed to run
computational modeling, SDM tools can also be used to
visually graph a system manually (Kim, 1999).
Soft systems methodology. Soft systems methodology is
an approach for understanding human systems that
emphasizes the social construction of reality and the
presence of multiple, valid perspectives of a problem
situation and its solution (Checkland, 1981). One goal
in SSM is to generate multiple ‘‘rich pictures’’ of a
system that portray these different worldviews and then
work with systems stakeholders to integrate and
accommodate these different perspectives. SSM fits
well with the values and processes of community
psychologists; it is intentionally designed to give voice
to diversity within a setting and avoids the risk of
forced consensus by requiring stakeholders to create a
worldview that accommodates different perspectives.
Griffith and colleagues (2007) and Suarez-Balcazar
et al. (2007) in this special issue describe the value and/
or use of SSM in their systems change efforts.
Insights about systems change efforts
Five articles in this special issue (Suarez-Balcazar; Staggs,
O’Connor, Ford, and Campbell) provide rich case study
illustrations of systems change efforts. All articles describe
honest portrayals of the complexity of this work and the
challenges we face as we engage in systems change efforts.
We highlight below three lessons learned that emerge
across these cases. Kelly, in his commentary in this issue,
does an excellent job of discussing the implications of the
lessons learned from these cases for the future of community psychology.
Levers targeted for change need to have cross level
influences within the targeted system
Systems change happens when levers for change are targeted that can trigger shifts across system components. The
Am J Community Psychol (2007) 39:191–196
papers in this special issue targeted multiple and diverse
levers, including changing organizational policies (Ford,
2007; Suarez-Balcazar et al., 2007), shifting system
members (Ford, 2007; Suarez-Balcazar et al., 2007),
strengthening and expanding relationships (Campbell
et al., 2007; Durlak et al., 2007; Emsoff et al., 2007;
Kreger et al., 2007; O’Connor, 2007; Staggs et al., 2007;
Suarez-Balcazar et al., 2007); infusing new or different
resources (Suarez-Balcazar et al., 2007), altering practices
(Ford, 2007; O’Connor, 2007; Staggs et al., 2007), shifting
system regulations (Ford, 2007; Tseng & Seidman, 2007)
and changing system member’s mental models (Ford,
2007; O’Connor, 2007). In many ways, this list represents
the deep and apparent structures Foster-Fishman et al.
(2007) emphasize in their systems change framework.
As the cases described in this special issue illustrate,
levers that managed to alter conditions and practices in
other subsystems or system layers were the most effective
at facilitating systems change. For example, Ford (2007)
describes how the policies and practice ideas implemented
by a new police chief initiated some significant changes in
community policing efforts by beat cops. Emsoff et al.
(2007) discusses how inter-organizational efforts facilitated
some changes within local organizations and communities.
Stagg’s et al. (2007) and Suarez-Balcazar et al. (2007), on
the other hand, describe the challenges to system change
efforts when initial levers are not positioned to create these
cross-level influences.
How can a change agent determine if the targeted levers
for change are positioned to trigger system wide transformation? At least in these case examples, the extent to
which the initial lever for change was tightly coupled with
other subsystems was critical to the success. When targeted
levers for change were dynamically linked with other
system components, either exerting strong direct influences
or having multiple, dense connections within the system,
they were more successful at influencing system wide
change. This suggests that attention to the character of the
connections across system parts is a vital step in identifying
which levers to target for change.
Systems change requires a shift in system members’
‘‘skill sets and mindsets’’ (Ford, 2007)
Most system change efforts spend considerable energy
building the capacities of individuals and communities,
with the belief that setting members need the knowledge,
skills, and behaviors to implement the required changes.
However, if systems change efforts really intend to shift the
status quo, shifts in mindsets or mental models are also
necessary. Senge (1990) describes mental models as cognitive frameworks that are constructed from one’s knowledge and assumptions that guide decision making and
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action. Mental models (or mindsets) maintain, constrain,
and determine the status quo (Ford, 2007; Foster-Fishman
et al., 2007). They provide individuals with frames that
dictate their own behaviors, explain other’s action, and
direct resource and opportunity allocations. In other words,
even if system members have developed the new capacities
needed to implement a new program or practice, they are
unlikely to implement or sustain these changes if the shifts
do not cohere with their worldviews about how things
should be done. Ford’s (2007) paper provides an excellent
case example of a systems change effort that changed both
skill sets and mindsets, ultimately transforming the status
quo. O’Connor (2007) introduces in this special issue a
systems change strategy for identifying and changing
mental models.
Discourse processes that engage system members in
ongoing opportunities to discover and alter their
worldviews are effective mechanisms for shifting
mindsets and fostering systems change
Discourse involves honest, frank discussions that strive to
generate new understandings about organizational and
community life. In critical discourse processes, assumptions are revealed and multiple, competing perspectives
and solutions are explored, debated, and valued (Fear,
Rosaen, Bawden, & Foster-Fishman, 2006). Overall, when
real conversations happen in an ongoing manner, new ways
of being can emerge; old mental models get unfrozen and
reformulated (Lewin, 1951) and significant social change
takes hold.
Several of the authors in this special issue highlight the
role and value of discourse processes in their systems
change efforts. For example, Ford (2007), O’Connor
(2007), and Suarez-Balcazar et al. (2007) discuss the
importance of engaging multiple stakeholders in ongoing
dialogic processes where opportunities for exploring the
gap between current realities and desired states occur.
While community psychologists have highlighted the
importance of discourse processes in the past, a commitment to systems change efforts may require a renewed
effort in discovering effective processes and strategies for
engaging system members in these difficult, though vital
conversations.
Conclusion
In many ways we view this special issue as a call to action
for the field of community psychology. We are encouraging the field to embrace the theories and methods called for
when one considers a systemic approach to systems change.
The articles and commentaries included in this special
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issue describe the successes and challenges in systems
change work and highlight, to some extent, the value of a
systems focus when we strive to shift the status quo. Of
course, if we are to be effective in our efforts, we must
strive to socialize not only the next generation of community scholars in the ‘‘system’s way’’, but also the
funders and change agents that design and create expectations for these efforts. Only when the initiatives, theories,
methods, and resources directed towards systems change
efforts become aligned with the complexity and realities of
systems will our pursuit of a just world be realized.
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
The Behavior Analyst Today
Volume 7, Number 2, Spring, 2006
Editor’s Note: This article originally appeared in Bernfeld, G.A., Farrington, D.P., & Leschied, A.W. (Eds.) (2001).
Offender rehabilitation in practice: Implementing and evaluating effective programs (pp. 167-188). Copyright John
Wiley & Sons Ltd. Reproduced with permission.
The Struggle For Treatment Integrity
in a "Dis-integrated"
Service Delivery System
Gary A . Bernfeld
St. Lawrence College
QUALITY ...
Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction
and skilful execution; it represents the wise choice of many alternatives.
Anonymous
Abstract
The purpose of this chapter is to describe an innovative family preservation program for delinquents, which
exemplifies effective correctional treatment: Community Support Services of the St Lawrence Youth Association in
Ontario Canada. Over 7 years, the program utilized the Teaching-Family Models (see Chapter 7 by Dean Fixsen, Karen
Blase, Gary Timbers and Montrose Wolf in this book) integrated clinical, administrative, evaluation and supervision
systems to ensure quality and treatment integrity. These systems will be delineated, along with some of the challenges of
implementing an integrated treatment within a fragmented children's' services delivery system. The intention is to do so from
a "multilevel systems perspective" (Bernfeld, Blase & Fixsen, 1990), in which four levels of analyses are used to examine
the delivery of human services: client, program, agency and societal. Finally, suggestions are made for contextual supports
for innovative programs, so as to foster their effectiveness, longevity and key role as catalysts for systemic change in
children's services.
Keywords: family preservation, delinquents, corrective treatment, Teaching Family Models, integrated treatment,
contextual supports, children’s services.
EMPIRICAL FOUNDATIONS
Community Support Services of the St Lawrence Youth Association was specifically developed in 1988 to
offer intensive, short-term and flexible support to 12–15-year-old young offenders (juvenile delinquents) who
are "at risk" of being placed in more restrictive residential settings, such as closed or secure custody. The aim
was to start with the treatment orientation and procedures used by Alberta Family Support Services (Olivier,
Oostenbrink, Benoit, Blase & Fixsen, 1992) with mostly child welfare clientele, and adapt them for use with
young offenders. Thus, the two programs shared the same broad goal of integrating the well-researched
treatment methods of the Teaching-Family Model (see Chapter 7) with the service delivery strategies of the
Homebuilders Model (Whittaker, Kinney, Tracy & Booth, 1990), an exemplary family preservation program.
Other literature supporting the development of the Community Support Services model include:
•
Clinically appropriate treatment, as defined in meta-analytic literature reviews (e.g. Gendreau, 1996;
Chapter 2 by James McGuire and Chapter 4 by Friedrich Lösel, both in this book), includes behavioral
systems family therapy, intensive structured skill training and structured one-on-one paraprofessional
188
The Behavior Analyst Today
•
•
•
•
•
•
Volume 7, Number 2, Spring, 2006
programs.
Andrews, Leschied and Hoge's (1992) review identified a number of key risk factors for delinquency,
which establish appropriate targets for treatment, including: cognitions (antisocial attitudes and values),
family factors (low levels of affection/cohesiveness and supervision/monitoring, poor discipline, and
neglect and abuse) and peer influences (association with antisocial companions and isolation from noncriminal peers).
Patterson, Reid and Dishion (1993) provided detailed empirical support for their developmental model of
antisocial or coercive behavior, in which parents are key to the early training for antisocial behavior. As
well, their research targeted the teaching of appropriate family management skills as essential to
rehabilitating delinquents.
Christensen and Jacobson (1994) reviewed research on psychological treatment delivered by
paraprofessionals and concluded that paraprofessionals are usually as effective as professionals. Given that
the need for mental health services exceeds the supply of professionals and the costs savings afforded by
paraprofessionals, they concluded that services delivered by non-professional therapists merit wider use
and further research.
Multisystemic therapy, developed and carefully evaluated by Scott Henggeler (see Chapter 5 by Daniel
Edwards, Sonja Schoenwald, Scott Henggeler & Keller Strother in this book) targets risk factors across the
delinquents' family, peer, school and neighborhood contexts. It uses an intensive family preservation
approach, combined with an eclectic mix of cognitive-behavioral services.
Andrews et al. (1992) have continued to emphasize the importance of treatment integrity for programs
treating delinquents. Some of the key elements of therapeutic integrity, detailed by Alan Leschied, myself
and David Farrington (see Chapter 1 of this book), include: a coherent and empirically based theoretical
model; an individualized approach to assessing and treating client risks/needs; a detailed program manual;
structured and formal staff training; meaningful staff supervision; and monitoring of treatment process.
These and other factors are incorporated in Gendreau and Andrews' (1996) Correctional Program
Assessment Inventory (CPAI), which is discussed in Chapter 12 of this book by Paul Gendreau, Claire
Goggin and Paula Smith.
Paul Gendreau (Chapter 12 of this book) and others (e.g. Friedrich Losel in Chapter 4 of this book) have
also stressed the importance of system factors. These include: the program's careful selection of line staff
for their skills and values; the efforts at disseminating knowledge to staff; the program director's
credentials and skills in the area of behavioral intervention; the support for the program from the host
agency; and the broader service delivery system; funding; etc.
Two annual reports on Community Support Services provide further details on the model's empirical "roots"
(Bernfeld, Bonnell et al., 1995; Bernfeld, Cousins et al., 1990).
OVERALL PROGRAM
The program is delivered to young offenders and families in homes, schools and the community at large.
This in-home service is designed to work in collaboration with the family to reduce the youth's offending
behavior, prevent the youth's placement in a more restrictive residential setting, strengthen the emotional and
psychological well-being of the youth and family and promote their self-sufficiency. Community Support
Services aims to empower the young person and family with information, skill based teaching, respect,
responsibility and empathic relationships. This service is concerned with the ecology of the youth and family
in the context of the community. There are two different referral routes to the program:
1. Whenever possible, the program prefers to work in a family preservation mode. This involves accepting
younger children currently on probation in the community, who are at moderate to high risk of
reoffending.
2. An alternative type of referral involves youths currently in custodial settings, who need assistance in
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returning to their community and families, or, in the case of older offenders, those who need preparation
for semi-independent living. This reflects a family reintegration or semi-independent living approach.
The preference is to work with referring agents (probation officers) to identify clients who are "at risk" for
the most intrusive intervention, secure custody early on, and assist their families in maintaining the young
offender in the home environment. This early intervention approach (Referral Route #1) is designed not only
to reduce costs by preventing future offences and residential placements, but also to maximize the impact and
brevity of our services. Bernfeld, Cousins et al. (1990) provide further details on the development of
Community Support Services.
HALLMARKS OF COMMUNITY SUPPORT SERVICES
Community Support Services treat young offenders who are 12–15 years of age at the time of their
offence—and therefore only serve post-adjudicated youth. Referrals are made by probation officers in the six
county areas around Kingston, Ontario, Canada. This area, over 200 kilometers in length and 150 in width, is
largely rural, with one larger city (population 125,000) and two small urban centers. Total population is over
250,000. Travel times by car to serve rural clients range from 30 to 90 minutes or more. Electronic pagers and
cellular phones are the primary means by which the staff keep in touch with clients. There is a total of six frontline staff working a 40-hour flexible workweek along with a director (the author), a supervisor and an
administrative coordinator.
As noted earlier, Community Support Services integrates the treatment methods of the Teaching-Family
Model (see Chapter 7 in this book) with the service delivery strategies of family preservation programs such as
Homebuilders (Whittaker et al., 1990). The first six hallmarks of Community Support Services listed in Table
8.1 reflect the service delivery strategies it generally shares with family preservation programs, as well as
other ecological programs like Multisystemic Therapy (see Chapter 5 in this book).
Table 8.1 Hallmarks of Community Support Services
FLEXIBLE
COMMUNITY-BASED
FAMILY-CENTRED
BASIC NEEDS
INTENSIVE TREATMENT/DIRECT SERVICE
FOLLOW-UP
TEACHING
GOAL-DIRECTED
EMPIRICALLY BASED
STAFF TRAINING/SUPERVISION MODEL
Overall, Community Support Services is similar to these programs in the scope of its services or "to whom"
it is directed, the youth's social ecology, as well as in its service delivery model or "how" it operates. The
latter refers to programs which are home based; strength-oriented and family preservation focused; intensive and
time limited; individualized and client-directed; as well as combining clinical and concrete services.
However, the last four hallmarks listed in Table 8.1 underscore the differences between Community Support
Services and ecological or family preservation programs in content or "what" interventions are offered. While
others use an eclectic mix of cognitive-behavioral treatments, Community Support Services specifically
organizes the implementation of these interventions within the Teaching-Family Model's standardized human
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service systems. Hallmarks of Community Support Services include:
1. Flexibility: The staff are on-call 24 hours a day, 7 days a week; fit the family's schedule; and are willing to
work with any problem (staff are generalists).
2. Community-Based: Employees, called "specialists", work wherever they are needed (school, home, etc.),
but not in an office. They work in the family's context, to decrease problems in generalization and
maximize relevance and learning of the skills taught. Thus, staff are more like coaches than therapists.
3. Family-centered: The program works with the young offender and the entire family with the goal of
preventing problems in the younger siblings and strengthening parenting capacity. It puts families in
charge of their own service and helps them become more aware of a broader range of options available to
them. The services offered "fit" the family's context and are implemented in a respectful and collegial
manner. Staff establish supportive, empathetic relationships with family members, in keeping with the
philosophy that "everyone is doing the best they can with what they've got."
4. Basic needs: The family's needs for food, transportation, employment, budgeting, etc. are assessed and the
focus is to teach the family skills in these areas (e.g. how to successfully apply for a job), including selfadvocacy.
5. Intensive treatment/Direct service: The intensive phase of service lasts 8–12 weeks. Caseloads are of two
young offenders and their families at a time. Thus, at any one time, staff serve two youths in the intensive
phase of service and six to eight in the follow-up mode. On average, over 214 hours of service is provided
to each case of which 35 per cent is face to face (Bernfeld, Bonnell et al., 1995). The intensive phase of
service starts with three to five visits per week and fades to one direct contact per week and several phone
contacts.
6. Follow-up: After the intensive phase of service ends, there is a 1-year follow-up period, during which
services gradually fade to monthly phone contact. "Booster sessions" are provided on a planned basis (e.g.
at the start of a new school year), or as needed during crises. The use of a 1-year follow-up period and
booster sessions are unique.
7. Teaching: Community Support specialists build on strengths of families and use a cognitive-behavioral
approach to counseling to teach a wide range of skills to young offenders and their entire family (e.g.
anger management, positive parenting skills, effective communication, rational problem-solving, social
and life skills, etc.). The service is individualized, practical and skill-oriented. Teaching is "matched"
between parents and children. For example, a parent is first taught how to appropriately give an
instruction, then a youth is taught how to follow one, and finally, the parent is taught how to effectively
praise the youth (by being behaviorally specific and commenting on youth skills). The goal is to develop
positive, self-sustaining spirals of appropriate interaction between parents and children that will be
maintained long after the direct service has ended.
8. Goal-directed: Initial psychological testing which is part of the evaluation process, plus the program's
intensive in-home assessment help develop the master treatment plan within the first 2 weeks of service.
Thereafter, weekly and daily goals are derived and reviewed with supervisors and peers. The goals involve
working with the youth's "social ecology". This is because difficulties are not conceptualized as residing
solely "in" children, but in the reciprocal, mutually impactful interactions between the child and others
in the environment (Fixsen, Olivier & Blase, 1990).
9. Empirically-based: Community Support Services was based on the research literature on delinquency and
the Teaching-Family Model, which was discussed earlier.
10. Staff Training/Supervision: These areas are critical and often under-developed in less structured
community programs. This is because intensive support is needed for employees working in an intensive,
crisis-oriented service. Staff are provided with a weeklong, 40 hour Pre-Service Workshop (half of which
involves didactic instruction and half of which consists of behavioral rehearsals of clinical skills) along
with a 500-page manual. This is followed by a 2-week orientation period, and then weekly case
consultations with the supervisor, along with bi-weekly team meetings to allow for case reviews with peers,
and bimonthly in-service training to develop new program technology. In addition, there are at least
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monthly field observations, in which the supervisor observes the employees working with families during
home visits and provides the staff with written feedback. Finally, professional development plans are
reviewed monthly, to guide the maturing clinical skills and judgement of the specialists. Overall, employees
spend more than 20 per cent of their time in individual, group or peer super-vision, and this is critical to
program integrity and quality.
Taken as a whole, Community Support Services, like Alberta Family Support Services upon which it is
modeled, offers contextual therapy. Bernfeld, Cousins et al. (1990) define this as "helping people learn to
cope with their emotional and interactional issues in their own settings to maximize relevance, acquisition, and
implementation and to minimize generalization problems" (p. 22). This report also provides more details on
the treatment model, including an example of the treatment planning process, and case profiles. As well, it
presents the extensive list of services provided by staff that are documented in case files in order to track
program implementation.
The family-centered approach to treatment ensures that the treatment plan developed jointly with the
family members fits their unique context. Staff also share their weekly goals and daily agendas with the
family—and, most importantly, are prepared to be flexible as families' needs change. The intensity, on-call
support and strength-oriented focus of the service help us build a solid relationship with family members and to
facilitate behavior change. Ultimately, our ability to work in the family's home depends on how we help the
family accomplish its goals.
PROGRAM EVALUATION: A SUMMARY
Bernfeld, Bonnell et al. (1995) describe the computerized Management Information System developed for
Community Support Services. This system integrates the evaluation needs of the program with supervision,
management and administrative systems. This practical and cost-effective program evaluation approach is
integrated with routine service delivery. It generates automated monthly reports of the service's processes and
outcomes. As an example of the former, time management data is collected on all members of staff, in order to
track their different activities. These range from direct work with families (i.e. face to face and on the phone) to
indirect services (e.g. preparing for family visits, meetings, paperwork, travel, etc).
Outcome evaluation data collected at pre- and post-treatment, and at 3 month follow-up on 155 youths over 5
years is discussed in detail by Bernfeld, Bonnell et al. (1995) and will only be briefly summarized here. A homebased, family-centered treatment technology is evolving which seems to reduce entry of young offenders into the
residential care system. While the results are encouraging, they should be interpreted with caution, given the lack
of a comparison group. Bernfeld, Cousins et al. (1990) discuss the principles that guided the development of the
"in-house" program evaluation model. These recognize the challenges in evaluating a flexible, strength-oriented
program, without compromising its implementation with families in crises. In-depth analyses of these and other
issues are provided by Pecora, Fraser, Nelson, McCroskey & Meezan (1995).
Client benefits demonstrated by the program include reliable or statistic -ally significant reductions in youth
behavior problems, as measured by the Child Behavior Checklist (Achenbach, 1991) and parent-youth
communication problems, on Robin and Foster's (1989) Conflict Behavior Questionnaire. Reliable improvements
were also noted for the youths on the Social Skills Rating System (Gresham & Elliott, 1990).
Youth recidivism after a 15-month follow-up period (55%) compared favorably to the 67 per cent rate reported
by Hoge, Leschied and Andrews (1993) based on a 6-month follow-up for young offenders in open custody in
Ontario. Moreover, the data indicated that Community Support Services achieved reliable reductions in the
seriousness of offences, the total number of offences, the number of multiple convictions, as well as a longer
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interval between offences. Consumers (parents, youth, probation officers, etc.) were generally satisfied with the
program and provided detailed feedback about the program's strengths and areas for improvement.
While 97 per cent of the young offenders were predicted by probation officers at intake to the program to
require residential placements, only 42 per cent were actually placed out of home in the 15 months of follow-up,
averaging less than 2 months per placement. A cost analysis indicated that for every $1.00 spent on Community
Support Services over 5 years, about $1.48 might have been saved in residential care costs. The data suggest that
cost savings of about a quarter of a million dollars per year in residential dollars alone could be attributed to
Community Support Services. It was in fact suggested that these modest savings are a conservative estimate of
the benefits of the program, for a number of reasons.
Hoge et al. (1993) reviewed Ontario-wide young offender programs and found that they averaged a relatively
low score of 0.29 on the subgroup of scales reflecting treatment on the CPAI (Gendreau and Andrews, 1996).
The provincial average of 0.29 means that 29 per cent of the 56 items were present across all Ontario programs.
Sector-specific averages were: probation, 0.21; open custody, 0.26; secure custody, 0.29; and the nine community
support teams (including Community Support Services), 0.51. In comparison, using the scoring guide provided
by Leschied, Hoge and Andrews (1993), the Community Support Services program scored above 0.70 on the
scale —meaning that more than 70 per cent of the program characteristics indicative of effective treatment were
present.
LINK TO THE TEACHING-FAMILY MODEL
The Teaching-Family Model (see Chapter 7 in this book) is the "heart" of Community Support Services. From
its original roots in a 1968 group home for delinquent adolescents called Achievement Place, the TeachingFamily Model has developed into an integrated service delivery system. Today there are over 134 group homes
serving over 1,724 children annually across the United States that serve not only delinquents but also abused,
neglected, emotionally disturbed, autistic and developmentally challenged children and young adults. In addition,
the Teaching-Family Model has been recently adapted for youths in treatment foster care (over 524 children
annually across the USA), independent living and home-based services (over 350 families served annually across
the USA). Over 100 publications on the model have researched its effectiveness and carefully evaluated its
individual treatment components over the past 30+ years. In fact, over $30M of United States' government funding
have supported the careful research and detailed development of the clinical, administrative, evaluation and
supervision systems which ensure that the Teaching-Family Model is delivered with integrity.
Figure 8.1 provides an overview and Tables 8.2–8.5 detail the home-based version of the Teaching-Family
Model, in terms of its goals as well as its treatment, program and treatment planning systems. All have been
carefully integrated so as to support the systematic implementation of this model. Chapter 7 in this book and
Bernfeld, Blase et al. (1990) present the conceptual and research basis for program development and dissemination
vis-à-vis the Teaching-Family Model.
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Figure 8.1 Overview of home-based services in the Teaching-Family Model.
Table 8.2 Goals of home-based services in the Teaching-Family Model
A.
HUMANE
1.
Compassion
2.
Respect
3.
Positive regard
4.
Cultural sensitivity
5.
Adherence to TFA* ethical standards
B.
EFFECTIVE
1.
Resolve referral issues
2.
Achieve treatment goals
3.
In-house evaluation validates service utility
4.
Contribute to the systematic evolution of the Teaching-Family Model
C.
INDIVIDUALIZED
1.
Service tailored to fit unique needs and strengths of family
2.
Fit of services determined via referral issues, family goals and direct observations of staff
D.
SATISFACTORY TO STAKEHOLDERS
1.
Consumers: children, family members, referral sources, allied professionals
2.
Dimensions: cooperation, communication, effectiveness and concern of staff
3.
Achieve treatment goals
E.
COST-EFFICIENT
F.
REPLICABLE
G.
INTEGRATION OF ABOVE GOALS
* TFA = Teaching-Family Association. Adapted from Dean L. Fixsen and Karen A. Blase (pers. comm., April,
1989). Note: Tables 8.2–8.4 were adapted from those developed by Fixsen and Blase during their years of
consultation and Community Support Services. They are precursors to the 1994 TFA Standards for home-based
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services. The standards can be obtained from TFA at http://www.teaching-family.org
Table 8.3 Integrated program components of home-based services in the Teaching-Family Model
A.
PROGRAM CLARITY (guides for decision making)
1.
Philosophy
2.
Goals
3.
Treatment processes
5.
Ethical standards
B.
STAFF SELECTION (the general "unteachables")
1.
Caring and commitment
2.
Common sense
3.
Intelligence
4.
Background knowledge
5.
Willingness to learn
6.
Philosophical fit
C.
STAFF TRAINING (treatment related skills and knowledge)
1.
Pre-service and in-service training in:
• Program goals and philosophy
• Treatment processes and skills
• Clinical judgements
• Program operations
2.
Emphasis on teaching of concepts and skill development
3.
Opportunities for shared learning and program development
D.
STAFF SUPERVISION (putting it into practice)
1.
Assure treatment implementation
2.
Develop staff skills
3.
Enhance clinical judgements
4.
Solve special problems
5.
Create new technology
7.
Support personal development
E.
STAFF EVALUATION (assessing clinical implementation)
1.
Treatment-related skills
2.
Clinical judgements
3.
Youth, parent and stakeholder surveys .
4.
Annual staff certification by TFA*
F.
PROGRAM EVALUATION (assessing service implementation)
1.
Family benefits and program costs
2.
Accountability to consumers
3.
Demographic information
4.
Feedback for program development
5.
Annual and triennial site certification by TFA*
G.
PROGRAM ADMINISTRATION (putting/keeping it all together)
1.
Facilitate treatment processes and integration
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2.
3.
4.
5.
6.
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Support treatment staff
Meet operating requirements
Interface with other systems
Encourage innovation
Evolve effective programs
* TFA = Teaching-Family Association. Adapted from Dean L. Fixsen and Karen A. Blase (pers. comm., April 1989).
Table 8.4 Integrated treatment components of home -based services in the Teaching-Family Model
A.
TEACHING SYSTEMS
1.
Proactive
2.
Reactive
3.
Intensive
B.
RELATIONSHIP DEVELOPMENT
1.
Non judgmental
2.
Person-centered
3.
Partnership
C.
MOTIVATION SYSTEMS
1.
Flexible and individualized
2.
Precise and positive
3.
Person-centered
D.
SELF-DETERMINATION
1.
Rational problem-solving
2.
Self-control
3.
Expressing feelings
E.
COUNSELLING
1.
Empathy and concern
2.
Support and reassurance
3.
Feelings and relationships
F.
SKILLS CURRICULUM
1.
Individualized
2.
Appropriate alternatives
3.
Social prosthesis
G.
ADVOCACY
1.
Self-advocacy and assertiveness
2.
“Systems” issues
3.
Professionalism
H.
CONTEXTUAL TREATMENT
1.
Relevant settings and people
2.
Fosters acquisition and generalization
3.
Matching skills and supports
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I.
COMMUNITY STANDARDS
1.
Social acceptability
2.
Community values
3.
Ethical standards
J.
TREATMENT PLANS
1.
Interactional nature of problems
2.
Fit the family
3.
Implementation issues monitored
K.
INTEGRATION OF TREATMENT COMPONENTS
1.
Maximize opportunities for change
2.
Clinical judgment
3.
Outcome oriented, process sensitive
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Adapted from Dean L. Fixsen and Karen A. Blase (pers. comm., May, 1990).
Table 8.5 Treatment planning and implementation for home-based services in the Teaching-Family Model
A.
REFERRAL ISSUES
—Legal reasons
—Problem oriented
B.
TREATMENT RATIONALE
—Youth/Family reasons
—Solution oriented
C.
TREATMENT GOALS
—Focus on key issues
D.
SKILLS RELATED TO GOALS
—Appropriate alternatives to problems
E.
BEHAVIORS RELATED TO SKILLS
—How to do and say things differently
Adapted from Dean L. Fixsen, Karen A. Blase, Karen A. Olivier and Arlene C. Oostenbrink (pers. comm.,
June, 1990).
The Teaching-Family Association oversees the quality assurance evaluations that hold organizations
accountable for the programs that utilize and disseminate its model. To become a member of this association,
a new organization must be formally affiliated with an already certified site for 5 years, receive systematic help in
developing Teaching-Family Programs and undergo a rigorous evaluation at the service or treatment level and the
organization level. The agency must meet all practice standards regarding the selection, training, supervision and
evaluation of front-line staff, trainers, evaluators and supervisors. The association has established standardized
procedures for how these functions are delivered in a certified organization. A site must be recertified annually.
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In addition to maintaining records of staff supervision and training to assure the quality of the programmatic
support, treatment implementation is ensured by the annual certification of individual staff. This involves a
combination of consumer satisfaction data, in which staff must average a rating of "6.0" on a 7-point scale that
reflects satisfaction of consumers (parents, youths, case managers and others) with various aspects of service. As
well, independent reviewers assess the actual in-home performance of staff and a 50-page report is completed
which summarizes both the consumer and on-site data and qualitative observations. Thus, the Teaching-Family
Association provides a mechanism for assuring the consistency and quality of the imple mentation of the
Teaching-Family model internationally. Note that this is a non-profit organization whose primary function is to
disseminate the model and ensure its planned, databased, evolution.
What is hopefully apparent from reading the above and Tables 8.2–8.5 is that the Teaching-Family Model's
vertically and horizontally integrated systems represent our "best practices" in how to translate knowledge
about effective correctional treatment into practice with integrity, while ensuring quality assurance. The model
addresses the previously noted treatment integrity and systems factors in the literature by Gendreau (1996) and
Andrews et al. (1992). As well, it represents the only systematic, published attempt in the area of human
services to develop, disseminate and evolve an integrated service delivery system.
Community Support Services worked towards site certification in the Teaching-Family Model from the
early to the mid-1990s, when a change in the leadership of the provincial government drastically altered the
funding arrangements and made pursuit of certification impossible. The program was about 1 year away from
being certified, when the attempt had to be formally halted. Currently, Community Support Services is
operating without formal implementation of all of the Teaching-Family Model systems. However, with its
start-up in 1988, it represents one of the oldest family preservation programs in Canada, and the most
experienced program of its kind for young offenders.
CHALLENGES TO IMPLEMENTATION
In this section, some of the challenges of implementing an integrated treatment like Community Support
Services within a fragmented children's services delivery system will be described. The intention is to do so
from a multilevel systems perspective (Bernfeld, Blase et al., 1990), in which four levels of analysis are used to
examine the delivery of human services: client, program, organization and societal.
Client level
Clinical challenges occur at the interface of the treatment planning, program and treatment systems detailed in
Tables 8.2–8.4. For example, given the intensive, home-based nature of the service, it is not surprising that the
family's potential "resistance" represents a challenge to overcome. As reviewed by Ralph Serin and Denise
Preston (see Chapter 10 of this book), internal treatment responsivity factors include client motivation,
personality and cognitive deficits, while external factors reflect therapist, offender and setting characteristics.
Treatment effectiveness depends on matching types of treatment and therapists to the types of clients.
Intensive supervision of staff in Community Support Services is critical to the matching process, so that the
treatment fits the family. This is because the families of young offenders can sometimes be either difficult to
engage, nonreinforcing to work with and/or reside in locations which are inaccessible or hazardous for staff. As
well, the multiple problems of the target familie s and the intensity of the service impact directly on staff, who are
immersed in the family often on a daily basis. Therefore, specialists need support from a supervisor who is
intimately familiar with the staff's professional issues, so that these do not interfere with the optimal delivery of
services.
Also key to the matching of treatment to family is the expectation that there be a 2-week long, in-home
assessment of family issues before a contextually sensitive master treatment plan is designed. Finally, the weekly
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review of this plan allows for adjustments to the intervention, as the family's needs or outside circumstances
evolve. This is especially important, as optimal matching must be a dynamic process. Moreover, in order for staff
supervision to successfully impact on treatment effectiveness, it has to be intensive (occupy about 20% of staff
time), multimodal (occur at individual, peer and group levels) and multi-site (office and field based). The latter
reflects the range of supervisory activities (including regular field observations of staff interactions, and various
meetings) and the various paperwork and time management systems which document program implementation.
The above examples should not imply that issues at the client level operate in isolation of the other levels that are
discussed earlier. The fact that there are interactions between multiple levels of the service delivery system
underscores the importance of this perspective on treatment integrity. For example, proposals by the labor union
(at the program level), which had the potential to limit service intensity, accessibility and flexibility, had to be
addressed to protect the integrity of the service. Also, shifting priorities of the juvenile justice system (at the
societal level) impact continually on the targeting of the service. Finally, the program's preference for working in
a family preservation mode continually brought the program in conflict with systemic pressures to serve youth
currently in custodial care or those being released after spending long periods of time in out-of-home placements.
Program level
The family and community-centered nature of the service was at odds with the focus of the other programs
offered by the agency, which were residential. It often took the creative intervention by the agency's Executive
Director, Merice Walker Boswell, to solve any inter-program misunderstandings or rivalries that undermined
Community Support Services. Special meetings of all agency staff and the involvement of the Community
Support Services supervisor in regular meetings with her colleagues helped share information and build informal
interdepartmental "coalitions". Throughout, the Executive Director reminded employees of the superordinate
goal that all agency staff shared—to support, rehabilitate and advocate for children within the young offender
system.
However, once again, the interactions between the multiple levels were critical to effective implementation
of the service. For instance, at the organizational level, the agency's structure facilitated efforts at the program
level to set up and evolve towards the Teaching-Family Model's treatment planning, program and treatment
systems. This is because the agency was relatively "loosely coupled", so that individual programs like
Community Support Services could set up independent systems to select, train and supervise staff, and
evaluate employees individually and the program as a whole. Moreover, the program was autonomous enough
to integrate these functions within its own operations and tie them directly to the Teaching-Family Model's
protocols. This is quite unlike large bureaucratic organizations, like those in Corrections, which usually set up
independent departments in these key areas, with differing mandates and procedures.
Moreover, because Community Support Services was positioned as a "leading edge" program by the
Executive Director (a key organizational issue), it was supported in its efforts to pilot and refine new staff
training and program evaluation systems, which were later exported across the agency. Elements of its
computerized management information system (see previous discussion) were incorporated later in all other
agency programs.
The personnel selection process for Community Support Services was adapted from structured interviews
used in the Teaching-Family Model. Applicant ratings on similar interviews have been shown to predict onthe-job performance (Maloney et al., 1983). Our interviews included an hour-long written package requiring,
among other things, answers to a series of behavioral vignettes that assess the applicant's responses to
hypothetical problem situations similar to those encountered on the job. The 90-minute interview itself assessed
the applicant's answers to similar questions, along with performance on behavioral role plays. The latter
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assessed an applicant's teaching ability at baseline, after instructions in using the teaching interaction techniques
of the model, and after feedback. Three interviewers rated the applicant's performance in these and many other
areas, and the comparative data was analyzed in making hiring decisions.
Organizational level
The Executive Director of this small (50 employee) non-profit agency actively encouraged innovation. This is
unlike the process in la rge bureaucratic organizations, which supports the status quo. Due to her skilful efforts
with staff and managers, the Board of Directors passed a motion committing the agency to the Teaching-Family
Model. This supported the agency's work at achieving certification as a site. Resources were gathered to support
this effort in a "low profile" manner, as the external zeitgeist shifted to a "punishing smarter" perspective.
While Community Support Services was the focal point, the new secure custody program was set up according
to some key treatment aspects of this model.
As well, the mentorship of the Community Support Services Director (the present author) by the Executive
Director was essential in the development of his networking skills with other peers in the local and provincial
juvenile justice system. These included the program's key consumers—the local Supervisor of Probation and
senior policymakers in the provincial government. In fact, the program's interactions with the referring agency
(Probation) were critical to efforts to operate in a family preservation mode, and serve youths with appropriate
risk levels. As Bernfeld, Blase et al. (1990) noted, a program director's personal relationship with key
administrators and policymakers continues to be critical to program survival and dissemination.
Finally, the management philosophy of the Executive Director was compatible with the Teaching-Family
Model's view of administration as integral to effective treatment services. From this perspective, "there is no
such thing as an administrative decision—every decision is a clinical decision" (D. L. Fixsen, pers. comm., 12
December 1988). This requires flexibility in the application of everything from accounting, budgeting and
human resources systems, so as to support short-term, community based, crisis services. For example, there was
a need to develop a unique system to calculate "flex time" while ensuring staff accountability. As well, given
the highly mobile and decentralized nature of the service and the fact that staff usually worked out of their own
homes, new policies governing staff travel had to be established. These are just a few of the many procedures
that needed to be developed or creatively interpreted to accommodate program implementation.
Societal level
Bernfeld, Cousins-Brame and Knox (1995) comprehensively delineate the challenges of implementing
an integrated treatment like Community Support Services within a fragmented children's services delivery
system. The paper also describes a "sister" program for child welfare clients, operated in collaboration with
another agency. The authors demonstrate how the different structural and systemic supports for the other
program were essential to mitigating the impact of challenges to integrity and enhancing its implementation and
effectiveness. The major types of issues identified by Bernfeld, Cousins-Brame et al. are listed below, each with
an example:
1.
Referrals. These reflect periods of scarcity, occasions when too many referrals arrive at a time when the
program has only a single opening or other occasions when inappropriate types of referrals are made. An
example of the latter is when a young offender is suddenly referred just a few months prior to his 16th
birthday, when he will "graduate" from one government ministry's services to those run by another
ministry. This has more to do with assisting probation officers in managing their workload, than in
working with those most at risk of reoffending. On one occasion, Community Support Services received
many simultaneous "priority" referrals that were caused by an administrative decision to save money by
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3.
4.
5.
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quickly returning many young offenders in custodial residences to their families. The local justice system's
fiscal crisis necessitated our involvement to prevent family crises, irrespective of the risk level of the
youths.
Roles. Government policy favouring custodial dispositions, the legal role of probation officers and their
lack of extensive training in the juvenile delinquency field make it difficult for some of them to see the
benefits of community-based treatment in general, and intensive family preservation treatment in
particular. Not surprisingly, they favor legal sanctions (e.g. charging a youth with breaching probation),
threats of punishment and reincarceration. They feel that these are the best means at their disposal to
protect society—and reduce their liability—should a youth reoffend, or begin to experience non-criminal
(e.g. family) problems in the community. Thus, government policy, the "hard line" political climate and the
reluctance of key "gatekeepers" in the juvenile justice system to take risks impact on the autonomy and
integrity of programs like Community Support Services.
Communication. Success in formal communication with probation officers is variable at best, in spite of
continual efforts by managers of Community Support Services and Probation to have regular meetings or
staff retreats to strengthen relationships, etc. There is little regular communication with some probation
officers, lots of supportive contact with others and intermittent, crisis-oriented communication with the
rest. Thus, problems can "fester" or be expressed obliquely by the officer's premature removal of a child
from the home. The communication problem and the different focus of Probation vis-à-vis Community
Support Services (crisis/reactive versus prevention) may also be exacerbated by the relative autonomy of
probation officers.
Commitment. It was difficult to build commitment in probation officers to Community Support
Services, as it was a new, pilot program. Also, the timing of its introduction in 1988 was unfortunate, as
it coincided with the government's privatization of public agencies. Two other factors hindered the effort
to convince probation staff that the family preservation effort was not just another temporary "fad". First
was the government's history of introducing new program models with little advance planning and then
dropping them shortly thereafter. Another factor was the lack of training offered to staff about the
benefits of this approach. Though training in cognitive behavioral services was eventually offered years
later, probation officers had little direct experience with it and little supervision in how to implement
such treatments on the job.
Envy and Power. Given that probation officers are primarily concerned with case management, some
of them are understandably envious of the small caseloads carried by family preservation staff, as well as
their flexible working hours. This is especially true for the probation officers who preferred front-line
work, or for those upset by the increasing caseloads, paperwork and office-bound nature of their work.
Issues of the probation officers' blatant use of power were especially apparent in the early years, when
they would tell families (sometimes inaccurately) what Community Support Services staff would do for
them or would make placement decisions without consulting the specialists. More subtly, there was the
above-noted power struggle over referrals and the continued pressure on the staff to "inform" on family
members who were suspected of other illegal activities.
Value systems and practice. Overall, the values and practices of family preservation staff are quite
different than those of traditional casework. In Community Support Services, the focus is the home and
community, as well as an immediate response, flexible hours of work and a short-term, intensive
orientation. These attributes, as well as the goal of empowering families by building on their strengths,
often challenge the probation officer's focus on what is wrong, or on information obtained "second
hand" rather than via direct observation. This is because their legal role and large caseloads do not
permit an intensive, collegial approach with families. Finally, probation practice is still "punishmentoriented" and reactive, even if the theories they're being occasionally exposed to are more therapeutic.
This is likely to continue until their job description permits more time for them to deliver treatment, or
their supervision structures become more intense to guide this desired change in practice. Ultimately,
probation practice will not change until there are major shifts in the broader government policies and the
"hard line" attitude that is popular in the current political climate.
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This list is a brief overview of some the challenges discussed by Bernfeld, Cousins-Brame et al. (1995) to
implementing an integrated treatment like Community Support Services within a fragmented children's services
delivery system. It is contended that these issues are critical to the integrity of any human service delivery
program. As well, a program's ultimate effectiveness is a function of its ability to surmount day-to-day challenges
to its implementation—no matter how strong its empirical base or its success in limited demonstration projects.
THE IMPORTANCE OF STRUCTURAL SUPPORTS
This chapter has primarily focused on delineating the challenges that one program, Community Support
Services, has faced in its ongoing efforts to effectively deliver its rehabilitation services to young offenders in a
disjointed service delivery system. As such, its struggles are a microcosm of others. While the use of the highly
integrated treatment and program support systems pioneered by the Teaching-Family Model (see Chapter 7 by
Dean Fixsen, Karen Blase, Gary Timbers & Montrose Wolf, in this book) reduced implementation problems
within the program, it could not completely insulate the program from a variety of external challenges. To fully
understand the nature of these challenges to treatment integrity, we need to look "outside the black box" of our
correctional interventions.
An eclectic literature exists on the diffusion of innovations and the management of change in large-scale
human service systems, some of which has been reviewed by Bernfeld, Blase et al. (1990), Bernfeld, CousinsBrame et al. (1995), Fixsen et al. (Chapter 7 of this book) and by Alan Leschied, Gary Bernfeld and David
Farrington (Chapter 1 of this book). This literature teaches us that the long-term survival of innovative human
service programs requires a unique confluence of supportive factors at the program, organizational and societal
levels. Some of these factors were already delineated in the previous section, which detailed the organizational
structure of Community Support Services' host agency.
Moreover, specific suggestions can be made for contextual supports for innovative programs like Community
Support Services. These include a detailed plan at the senior levels of government which:
•
•
•
•
anticipates resistance to change system-wide and is prepared to support long-term implementation;
ensures adequate numbers (or a "critical mass") of programs across the province;
provides immediate top to bottom staff training; and
shifts a proportion of fiscal resources from existing residential services to innovative community programs.
Overall, in order to systematically disseminate innovation, government needs to develop a comprehensive,
multilevel and long-term implementation plan. For example, if such a plan was in place when Community
Support Services began, it would not have allowed the program's referrals to be managed by the Probation
Service. Problems arising from this situation, discussed earlier, were a result of "the fox being in charge of the
hen house". Instead, the referral structure should have resembled the system for Alberta Family Support Services.
There, an independent government committee at the regional level made referrals if and only if they had already
decided to remove youths from their homes. This committee was accountable to senior levels of government for
reducing reliance on residential services, and could only refer youths to the family preservation program if it had
an opening. This structure preserved the autonomy and integrity of the program and ensured a steady supply of
referrals. In Alberta, the agency making referrals had a vested interest in the success of the innovative service and
was not in competition with it. As discussed previously, the state of affairs was quite different for Community
Support Services, which resulted in an ongoing struggle for integrity. This is just one way a comprehensive
implementation plan by government could have worked.
It is contended that external or contextual supports are essential to innovative programs like Community
Support Services, so as to foster their effectiveness, longevity and key role as catalysts for systemic change in
children's services.
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References
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington:
University of Vermont, Department of Psychiatry.
Andrews, D. A., Leschied, A. W., & Hoge, R. D. (1992). Review of the Profile, Classification, and Treatment
Literature with Young Offenders: A Social-Psychological Approach. Toronto, Ontario: Ministry of
Community Social Services.
Bernfeld, G. A., Blase, K. A., & Fixsen, D. L. (1990). Towards a unified perspective on human service delivery
systems: Application of the Teaching-Family Model. In R. J. McMahon & R. DeV. Peters (Eds),
Behavior Disorders of Adolescents: Research, Intervention and Policy in Clinical and School Settings, pp.
191-205. New York: Plenum.
Bernfeld, G., Bonnell, W., Cousins-Brame, M. L., Kippen, J., Knox, K., Kyte, D., Landon, B., Simmons, C., &
Wright, P. (1995). Community Support Services: Annual Report. Kingston, Ontario: St Lawrence Youth
Association. [Reprints of the entire report (90+ pp.): $10.00 to cover copying and postage.]*
Bernfeld, G., Cousins, M. L., Daniels, K., Hall, P., Knox, K., McNeil, H., & Morrison, W. (1990). Community
Support Services: Annual Report. Kingston, Ontario: St Lawrence Youth Association. [Reprints of the text
portion of this report (up to p. 32): $5 to cover copying and postage.]*
Bernfeld, G. A., Cousins-Brame, M. L., & Knox, K. (1995, May). Contextual Challenges to Family-centered
Services: Can Integrated Treatment Operate in a "Dis-integrated" Service System? Workshop presented at
the Growing '95 conference, Toronto.
Christensen, A., & Jacobson, N. S. (1994). Who (or what) can do psychotherapy?: The status and challenge of
nonprofessional therapies. Psychological Science, 5, 8-14.
Fixsen, D. L., Olivier, K. A., & Blase, K. A. (1990). Home-based, Family-centered Treatment for Children,
Unpublished, Hull Child & Family Services, Calgary, Alberta.
Gendreau, P. (1996). The principles of effective intervention with offenders. In A. T. Harland (Ed.), Choosing
Correctional Options that Work: Defining the Demand and Evaluating the Supply, pp. 117-130. Thousand
Oaks, CA: Sage.
Gendreau, P., & Andrews, D. A. (1996). Correctional Program Assessment Inventory (CPAI), 6th ed. Saint
John, New Brunswick: University of New Brunswick.
Gendreau, P., & Goggin, C. (1997). Correctional treatment: Accomplishments and realities. In P. Van Voorhis,
D. Lester & M. Braswell (Eds), Correctional Counseling and Rehabilitation, 3rd ed., pp. 271-279.
Cincinnati, OH: Anderson Publishing Co.
Gresham, F. M., & Elliott, S. N. (1990). Manual for the Social Skills Rating System. Toronto, Ontario: Psycan.
Hoge, R. D., Leschied, A. W., & Andrews, D. A. (1993). An Investigation of Young Offender Services in the
Province of Ontario: A Report of the Repeat Offender Project. Toronto, Ontario: Ministry of Community
and Social Services.
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Leschied, A. W., Hoge, R. D., & Andrews, D. A. (1993). Evaluation of the Alternative to Custody Programs in
Ontario's Southwest Region. Toronto, Ontario: Ministry of Community and Social Services.
Maloney, D. M., Warfel, D. J., Blase, K. A., Timbers, G. D., Fixsen, D. L., & Phillips, E. L. (1983). A method for
validating employment interviews for residential child care workers. Residential Group Care and
Treatment, 1, 37-50.
Olivier, K. A., Oostenbrink, A., Benoit, G., Blase, K. A., & Fixsen, D. L. (1992). Alberta Family Support
Services: Annual Report. Calgary, Alberta: Hull Child & Family Services.
Patterson, G. R., Reid, G. D., & Dishion, T. J. (1993). A Social Interactional Approach to Family Intervention:
Antisocial boys, Vol. 4. Eugene, OR: Castalia.
Pecora, P. J., Fraser, M. W., Nelson, K. E., McCroskey, J., & Meezan, W. (1995). Evaluating Family-Based
Services. New York: Aldine de Gruyter.
Robin, A. L., & Foster, S. L. (1989). Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems
Approach. New York: Guilford Press.
Whittaker, J. K., Kinney, J., Tracy, E. N., & Booth, C. (1990). Reaching High-Risk Families: Intensive Family
Preservation in Human Services. New York: Aldine de Gruyter.
*Reprint requests for CSS annual reports are available from: Ms Mary Lynn Cousins-Brame, Director of Services,
St Lawrence Youth Association, P.O. Box 23003 Amherstview Postal Outlet, Kingston, Ontario, K7N 1Y2 Canada.
Please make cheque payable in Canadian funds to the St Lawrence Youth Association.
Author contact information:
Gary Bernfeld, Ph.D.
Coordinator and Professor
Bachelor's Program in Behavioural Psychology
School Of Human Studies and Applied Arts
St. Lawrence College
100 Portsmouth Ave.
Kingston, ON
K7L 5A6 CANADA
Tel: (613) 544-5400, ext. 1676
Fax:(613) 545-3900
e-mail: gary@bernfeld.com
web: http://www.sl.on.ca/fulltime/bachelor/index.htm
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CE Questions for Bernfeld article on Treatment Integrity
Gary Bernfeld
1. A broad goal of Community Support Services (CSS) of the St Lawrence Youth Association was to integrate the wellresearched _____ methods of the Teaching-Family Model with the _____ _____ strategies of a family preservation
program.
2. Describe 3 types of clinically appropriate treatment, as defined in meta-analytic literature reviews that comprise the
empirical bases of CSS?
3. A successful treatment model of treatment that targets risk factors across the delinquents' family, peer, school and
neighborhood contexts is called _____-systemic therapy,.
4. What are the key elements of treatment integrity?
5. List and explain any three of the first 6 hallmarks of CSS that reflect how it is similar in the scope of its services to
ecological or family preservation programs
6. List and explain any three of the last 4 hallmarks of CSS that reflect its uniqueness, in terms of the content or
"what" interventions it offers.
7. Taken as a whole, Community Support Services offers ‘contextual therapy’. Define the latter term.
8. List and briefly describe 5 integrated program components of home-based services in the Teaching-Family Model
9. List and briefly describe 8 integrated treatment components of home-based services in the Teaching-Family
Model
10. How does the Teaching-Family Association’s site certification process enable quality assurance?
11. Utilizing Bernfeld, Blase et al.’s (1990) multilevel systems perspective, explain some of the challenges in implementing
an integrated treatment like Community Support Services within a fragmented children's services delivery system .
Provide two examples at the client, program and organizational levels and four examples at the societal level.
12. Provide four examples of contextual supports for innovative programs like Community Support Services.
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205
The Human Services Profession I choose is my current profession, a Mental Health and Substance Abuse
Caseworker. I provide professional counseling, life skills training, medication management, time management
training, and connect clients to educational support, vocational support, and clinical support for substance abuse and
mental health issues. The primary system related to my profession is providing a structured living environment to
clients while in the early stages of recovery. A few of many other systems with which I interact are Vocational
Rehabilitation, Dress for Success, Housing for New Hope, Intensive Outpatient Providers, and the TASC
(Treatment Accountability for Safer Communities) Program.
I receive client referrals from TASC for clients who are currently incarcerated and upon release would be in an
unsafe living environment or homeless, which would promote continuous drug and/or illegal activity. TASC
provides case management services to clients with substance abuse or mental illness who are involved in the justice
system. This system combines the influence of legal consequences with treatment and support services to
permanently interrupt the cycle of addiction and crime. Vocational Rehabilitation provides counseling, training,
education, transportation, and job placement services. I refer clients in need of any of these services to this system
because VR can assist them with becoming independent and with finding a job and staying on the job. Another
system I utilize through the referral process to assist clients with job placement, resume preparation, as well as
image and career coaching is Dress for Success. In order for clients to meet criteria for residential services at the
facility I work for, they have to be enrolled with an Intensive Outpatient Provider for substance abuse and mental
health treatment via groups and 1:1 sessions. I work very closely with Intensive Outpatient Providers in the
development of Person-Centered-Plans and Crisis plans for our clients. In addition to coordinating services and
transportation for clients, IOP’s and I tracks a clients progress and devise team decisions on matters such as a clients
capability to manage additional privileges and/or employment
It is important to think systematically within human services professions to ensure the best result and progress
possible for the client/community. For example, I plan to open a recovery house of my own one day. Properties in
the Southern area of Durham are inexpensive. One may think that it would be plausible to buy a property in that area
because of the price. Unfortunately, this area is infested with drugs and illegal activity. Thinking systematically it
would be unrealistic to house individuals who desire to stop using drugs in an area riddled with drugs. Once I open
my recovery house have to hire experienced Staff members who have skills in the area of relapse
prevention/awareness, medication management, NCIS training, and other skills related to this field. I would not hire
someone with a background in accounting or construction to work with my clients. Once I am open I need to have a
working relationship with other community and state agencies to connect my clients with resources and a avenue to
make and receive referrals for services.
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