The Williams Family
The purpose of this paper is to describe and conceptualize the problem of the Williams family. The two parents are Antonio, a Cuban American, and Terri, who has Italian and German roots. They have three young children living with them: Jose aged 4, Jerrodd aged 3, and a four months old named DJ. The two older kids are in the preoperational stage of development, while DJ is in the sensorimotor stage. Their fourth child, Tomas, died of Sudden Infant Death Syndrome two months ago. Mr. and Mrs. Williams have been struggling to take proper care of their children after the tragedy and were referred to this agency to see if the situation could be improved.
Problem Description and Conceptualization
The problem of the Williams family is that the parents are unable to devote enough attention to their children, which leads to them being left unsupervised and potentially in danger. The Williams also show unacceptable behavior such as domestic violence, and it has already started to affect their children. In addition, one of the children’s preschool attendance and performance has deteriorated rapidly.
The model used to conceptualize the problem is the Ecological Systems Theory by Andrea Ettekal and Joseph L. Mahoney. This Ecological Systems Theory is a recent work by two experienced authors, published in a reputable source. It divides the child’s environment into groups that influence their development by interacting with him or each other. The division is meant to assist in understanding the root causes of issues and seeing their effects more clearly.
This model has been chosen because it “explains how human development is influenced by different types of environmental systems,” which suits the Williams family case well (Ettekal & Mahoney, 2017, p. 239). The model is constituted of four systems: the microsystem, the mesosystem, the exosystem, and the macrosystem. The microsystem is the system where individuals interact directly, while also contributing to the system’s formation (Ettekal & Mahoney, 2017). The mesosystem envelopes the interactions between the different microsystems of the same individual (Ettekal & Mahoney, 2017). The exosystem is more distant; it includes microsystems not directly involved with the person, but still related to them (Ettekal & Mahoney, 2017). Finally, the macrosystem is “the set of overarching beliefs, values, and norms, as reflected in the cultural, religious, and socioeconomic organization of society” that usually affects most people in the area (Ettekal & Mahoney, 2017, p. 241). All these components are used in this paper to analyze the way the problem manifests in the Williams family.
On the microsystem level, there is an alarming number of issues in the Williams family. Terri’s addiction to alcohol and Antonio’s history of adultery seem to be the basis of most conflicts, and the latter also causes a lack of trust between the spouses. Alcoholism has been a more prominent problem lately, as neighbors reported that Terri was often too intoxicated to care for her children. There was even a case when she lost consciousness on the front porch, and one of the unattended children was almost hit by a passing car. The neglect has resulted in Jose coming to preschool wearing the same dirty clothes or sometimes missing classes. Moreover, while Jose had always been a polite kid, recently, he began to hit his peers seemingly for no reason. When asked about his actions, he told the teacher, “my daddy hits my mommy.”
As for the mesosystem, the effects of an improper home environment have become apparent to the family’s neighbors and Jose’s teacher. People living nearby have heard yelling in the William’s family house when children were at home as well as loud crying, which led them to call child protection services. The neighbors have also contacted the child abuse hotline regarding the problem that many times kids were left unattended. The teacher who noticed the drastic change in Jose’s behavior has done that as well.
The macrosystem is manifested in notions like the parents’ race being different, the stigma from Tomas’s death, and the family’s poor financial status combined with a lack of support from the state.
The Williams Assessment
In social work, there are many models of active recovery of family functions. The McMaster Model is a research-developed procedure for studying the functioning of the family. The considered model aims to develop a joint and detailed presentation of the explored family, and also allows social services to summarize and organize the collected information. The given family learning model is based on the ecological systems theory, which includes some underlying assumptions. That is the connection of elements of the family, the impossibility of understanding one family part separately from another, and the fact that the functioning of the family cannot be based just on understanding. Thus, the organization and structure of the family play an essential role in the development of the behavior of its members (Miller et al., 2000). The main objective of the represented model is to assist social services and psychologists during the process of family therapy or family assessment after several reports.
Even though the model does not reveal the full picture of family relationships, it gives the most accurate possible idea of the functioning of the family institution. Moreover, Turliuc et al. (2016) claim that “the McMaster Systemic Model provides clinicians with a conceptual framework for assessing family functioning and treating families” (p. 11). There are six dimensions in the McMaster Model, each of which helps to determine the effectiveness of the family, and has the same value in the evaluation process. These dimensions are problem-solving, communication, roles, affective responsiveness, affective involvement, and behavior control.
In any case, it will be more efficient to use the model in conjunction with the ecological system theory. As Kilanowski (2017) states in his article, “the initial theory by Bronfenbrenner was illustrated by nesting circles that place the individual in the center surrounded by various systems” (p.2). According to Bronfenbrenner’s Theory of Ecological Systems, the “psychological ecology” of a person is a set of hierarchical subsystems (Kilanowski, 2017).
The closest subsystem is the microsystem of the family, kindergarten, and school. Likewise, there is the mesosystem of social communication and living environment And the last one is the macrosystem formed by a combination of socio-economic factors, national customs, and cultural values. The fifth subsystem was added to the four main ones later; it is the chronosystem, which considered the historical development of the ecology of the first four levels.
The Family Assessment
After considering the theoretical part, the practical assessment of the situation in the Williams family can begin. The Williams family consists of Terri, a mother who has an Italian-Germanic origin, Antonio is the second member of a family, and he has Cuban American descent. The spouses have three children, all boys, Jose is four years old, Jerrodd is three years old, and DJ is four months old. Their fourth child Tomas died at the age of two months due to sudden infant death syndrome. Mr. Williams and Mrs. Williams have been married for five years, but they have known each other much longer.
Terri had a challenging childhood which affects her ability to solve problems and respond to emotional difficulties correctly. Since the woman has been sexually abused since youth, she has confidence problems and trust issues she cannot freely communicate with her husband, who abuses her regularly. Her husband, Antonio also has problems associated with childhood as he had communicative issues with his father, which caused his aggression towards his wife and children. He has two contrasting characteristics as well, which means that he overly protects his family from external interference, but at the same time, he is an aggressor himself. Moreover, both adult family members use psychoactive substances and alcohol regularly, which also leads to inadequate perceptions of reality. The death of their child in infancy served as a trigger to exacerbate the problems that spouses received in childhood and the existing problems cause difficulties in all dimensions.
Primarily, the first dimension (problem-solving) should be studied at the micro, meso, and macro levels. Hamilton & Carr (2015) state that “problem-solving is the family’s ability to resolve a problem without causing disruption to family functioning effectively. Unfortunately, the family has apparent difficulties in solving the problems in the closest environment (in the microsystem). Therefore, in the first dimension, represented childhood issues lead to the inability to resolve internal and external problems adequately and without violence. There are instrumental problems in the family, such as a lack of money, differences in parenting attitude, and Terri’s (wife) alcohol addiction. Apart from that, there are also affective, relationship-related problems, such as Antonio’s (husband) infidelities, communication issues, and verbal abuse. The family also has troubles in the mesosystem, such as Antonio’s unskilled job with low wages, poor reputation among neighbors, problems in relationships with parents, and children’s school failure. Lastly, the family has issues in the macrosystem as well; obviously, the family consisting of a drug and alcohol addict and unemployed has a low social status.
Furthermore, there is the second dimension (communication) that includes data on the exchange of information within the family, in this section, only verbal forms of communication count (Miller et al., 2000). Trust problems and weak, even aggressive perceptions of reality lead to a practical absence of verbal communication in the studied family, and spouses communicate only during fights. It can also be noticed that there are humiliations from the husband, likewise constant shouting in the presence of minors. Moreover, there are also communication issues in the mesosystem since family members cannot build dialogue, which causes problems at school and work. The inability to correctly express one’s thoughts verbally can cause issues in the social sphere (in the macrosystem) as well.
The third dimension is the roles within the family that are aimed at the distribution of responsibilities and the development of specific behaviors that will help family members to fulfill their functions effectively. In this example, family roles are violated, and family members do not perform the necessary functions. Since spouses have distorted paternal and maternal roles in their families, they unintentionally provide a violation of the distribution of characters in their marriage. Father and mother leave their children and do not provide them with the required conditions for existence, as well as Terri and Antonio do not play the role of spouses as the husband produces verbal and physical abuse against the wife very often. Moreover, the family does not perform its role in society, and members break school rules, ignore neighbor relations, and remain inactive status. Unfortunately, there is the same position in the macrosystem, and low-income family in difficult situations with uneducated children has a low social status.
The fourth dimension is emotional intelligence or affective responsiveness, which means a person’s ability to respond correctly to the level of emotional stress and specific life situations. Both spouses have a complicated past in this family, which influenced their current mental health. Terri received sexual abuse from the age of five and after verbal and physical abuse from her husband, which led to alcoholism and extremely vivid emotional reactions. Antonio had problems with his father, which led to his unrestrained aggression, and occasional insults and humiliation to loved ones.
Traumatic childhood history and recent baby’s death trigged them back to those earlier wounds. After all, Terri and Antonio are only able to respond from those more emergency feelings of guilt, shame, fear, anger, and sadness. At the microlevel, such conditions have led to constant arguments, disputes, and even fights, and such an atmosphere is not healthy for children. At the mesolevel, this state of affairs led to the complicated relations with parents, reproaches and poor relationships with neighbors and at work, and for children at school. In the end, at the macrolevel, such emotional instability spoils the social image of the family.
The fifth dimension is affective involvement, which includes an interest in the condition of other family members. In the microsystem of this family, members are not interested in each other’s situation, and parents leave their children on the street. Personal mental problems and the presence of destructive feelings of guilt, anxiety, and unconscious aggression lead to a low level of involvement in the emotional state of children and the second spouse. The parents are indifferent to their education and relationships with peers. Terri and Antonio show a lack of interest in each other as well, and the husband ignores the emotional torment of his wife. She, in turn, does not help her husband overcome difficulties because of her addictions. In the mesosystem, such an attitude expresses in the absence of reliable friends, good work, and the absence of social responsibility. In the macrosystem, a family in which indifference towards each other reigns will also be indifferent to social responsibilities and roles.
The last dimension is behavior control, which means the degree of family restriction of behavior. It is necessary to observe how family members behave in three types of situations: physically dangerous situations, situations that require the fulfillment of psychobiological needs (food, drinks, sleep, and sex), as well as cases in which social interaction is necessary (Miller et al., 2000). Problems with determining behavior in specific situations are also rooted in the childhood of spouses. Constant exposure to violence and adverse reactions to children have led to behavioral and cognitive impairment.
In the Williams family, the last criterion is violated, as the husband puts the wife in dangerous situations every day, and she silently suffers, and the children have no concept of safety. The needs of family members are fulfilled with distortion, the wife uses alcohol and drugs other than basic needs, and children are often hungry and dirty. The social interaction of all family members is ruined, and there is an inability to build healthy relationships and participate in public life. This measurement is considered mainly within the family, that is, only in the microsyste
The McMaster Model also has a practical application, and several measures can be provided to ensure the effective functioning of the family. As Beierlein et al. (2017) state in their article, the represented model “plays an important role in the assessment of the family” (p. 18). Nevertheless, the represented family has its strengths in several dimensions of the model. Firstly, the family has been together for a long time, which shows the presence of necessary communication and affection (the second and the fifth dimension). Secondly, relatives who have essential resources can help the family (problem-solving criterion). Thirdly, the spouses are challenging to endure the death of the child, which denies their indifference (the fourth dimension). Furthermore, children who are at such a young age are better suited to upbringing and changing conditions (the sixth dimension).
Diagnostic formulation
The presenting problems for the Williams family are the lock of child safety due to relationship conflict with Mr. and Mrs. Williams. The precipitating factor is the death of their twin Tomas that triggered Terri’s drinking problem.
The Williams family is experiencing multiple predisposing factors; these factors can impact the children’s safety and well-being. The predisposing factors include Tomas death, which causes Terri to start drinking again. Antonio infidelities, Terri finding out Antonio is having an affair which affected her trust towards him. Terri and Antonio had a difficult childhood with Terri’s conflicted relationship with her mother due to being abused by her stepfather and the rejection Antonio faced from his father. These factors contribute to the challenges in their relationship.
The perpetuating factors or those which cause the condition of the family to endure include Terri felt that her husband does not understand her frustration and give her enough support with the children. She has become withdrawn from him and only speaks when it is necessary. This behavior is not healthy for their relationship; they would need to find some mutual understanding to work together for the children’s wellbeing. Unresolved grief due to the loss of Tomas is also another perpetuating factor. Terri claims that fight with Antonio over money and infidelity has become violent since Tomas death. They have no income coming in due to Terri and Antonio’s unemployment, which leaves them to relay their mothers-in-law for support and financial assistant despite their differences. The lack of a support system in the family creates an unsafe household for the children.
The direction for work for this family includes child management skills to address the children’s safety in the household. Also connecting the family to the more external support system in the community that will provide social, financial, and childcare need that will re stabilize and increase their overall safety.
Micro-Level Intervention
Intervention
The micro-level intervention for the family will use the McMaster approach with elements of the Oregon model. Specific goals will be set for both parents, and their progress toward these targets will be evaluated regularly. Each of them has issues that they will have to address if they intend to overcome their disagreements. The intervention will also incorporate a boat-storm-lighthouse approach to enhance the collaboration between different family members. Alongside the other measures taken, the approach should be effective at addressing the issues that it targets.
The core of the problems experienced by the Williams family lies in the dysfunctional relationship between Antonio and Terry. Unless this central problem is addressed, both parents will continue “to facilitate dysfunctional interactions between themselves, powerfully affecting their children” (Josephson, 2015, p. 465). Considering this fact, a marital intervention designed to improve communication between the spouses has to be the first in the practitioner’s list. It should focus specific problems experienced by Terry and Antonio in effective communication (how effectively they exchange information) and affective communication (whether verbal interactions serve to promote affection) (Miller et al., 2000, pp. 170-171). The intervention has to overcome communicative barriers between the spouses and motivate them to articulate their problems and seek the ways of solving them instead of leaving the relationship to deteriorate further.
Apart from the communication problems between Antonio and Terry, another immediate issue to be addressed is the latter’s substance abuse. Apart from Terry’s detoxication program, an intervention designed to address this issue has to combine task-setting and regular family check-ups. Task-setting refers to “the therapist setting tasks for the family to accomplish between sessions and subsequently evaluating the success or failure of these tasks” (Miller et al., 2000). The practice of regular family check-ups serves to support parents through key developmental transitions, which may be vulnerable due to disrupted family functioning (Dishion et al., 2016). By combining task-setting and family check-ups, this intervention will seek to curb Terry’s alcohol abuse and Antonio’s occasional encouragement of the practice.
Lastly, improving family functioning in the case of the Williams family requires promoting family strengths, and the Boat-Storm-Lighthouse intervention appears to be a promising approach to do that. It begins with the family drawing pictures of a boat, a storm, and a lighthouse in this specific order and then writing and reading aloud a story about them (Harris & Butler, 2017). The counselor guides the reading and discussion toward the family members’ feelings before, during, and after the storm (Harris & Butler, 2017). It enables the bringing forward the strengths of the family and its approach to adversity.
The members of the Williams family tend to view its functioning as a constellation of separate individual responsibilities that do not overlap and should not be shared. Antonio interprets Terry’s failure to be a better mother as her fault and suggests trying harder without attempting to help her. Both parents leave making breakfast for the children to Jose, their eldest son, while they are still asleep in the morning. To summarize, the family members are reluctant to share responsibilities and aid each other. However, as mentioned above, the relative longevity of the family confirms there are possibilities for healthy communication and affection. Boat-Storm-Lighthouse intervention may help in bringing these forward and also promote a collective approach to problems-solving.
A social worker implementing this intervention has to demonstrate four social work competencies. The first two are the direct service provider and the research consumer (Hepworth et al., 2017). The third one is the role of an organizational analyst, as the social worker has to establish how precisely the designed intervention should fit in the organizational context of Jose’s preschool (Hepworth et al., 2017). The fourth role is that of a researcher, as the social worker would have to analyze a dynamically unfolding narrative to identify the potential strengths of the family (Hepworth et al., 2017). The successful implementation of the intervention relies on fulfilling all four roles.
Evidence suggests that such an intervention will be successful in the Williams case. As mentioned above, it is partially based on the McMaster approach, and the latter demonstrated positive results in 65 percent of families (Miller et al., 2000). According to Harris and Butler (2017), Boat-Storm-Lighthouse intervention is effective in encouraging collaboration among family members. Moreover, it is known to be especially effective in promoting resilience in families suffering because of parental substance abuse (Harris & Butler, 2017). The interventions based on the Oregon model of family behavior therapy have also demonstrated consistent, albeit modest, positive results in the families experiencing problems with substance use (Dishion et al., 2016). Hence, addressing Terry’s substance abuse, Antonio’s propensity toward domestic abuse, and related issues via task-setting and family check-ups appears to be a possibility.
Objective 1
The first target of this intervention is to help address Terry’s substance abuse issues, which are complicating her current situation. It addresses Terry’s behavior as a separate individual and her interactions with Antonio, which pertain to the microsystem as defined by Ettekal and Mahoney (2017). To achieve this goal, the social workers involved will have to address the behaviors of both partners. Terry’s current patterns of alcohol and drug consumption will have to decline, preferably to a level where she does not feel the need to consume any. Meanwhile, Antonio’s ambivalent stance on his wife’s behavior will have to stabilize into one that does not encourage her addiction in any way and supports her in her effort rather than condemn her for her habits.
Objective 2
The second goal is to improve the quality of communication in the family by changing the patterns in which the two parents interact. Antonio will have to stop trying to rationalize his infidelity and stop resorting to domestic violence to avoid discussion. In response, Terry will have to engage in more active communication with her husband rather than trying to avoid interaction and blame him. If the pair can overcome their difficulties, they will be able to engage in productive discourse and begin working toward addressing the other problems.
Measurement
As the intervention is based on the McMaster model, it will also use the McMaster family assessment device. The social worker will visit the family bi-weekly, conduct the various interventions, and test the family using the questionnaire. Additionally, both Terry and Antonio will regularly take substance abuse tests to evaluate their progress toward overcoming the habit. The results will be compared with their initial data and other test instances to determine whether changes occur. If their communication scores improve over time, the intervention can be considered successful. If there is no significant improvement, a more detailed assessment and adjustment will be necessary. If Antonio and Terry Williams prove able to reverse the practices of domestic and substance abuse respectively and improve communication and parenting skills, they will be eligible to receive children for temporary maintenance. If the interventions fail, the removal of the children should be prolonged or even made permanent.
Mezzo-Level Intervention
Intervention
The mezzo-level intervention will target the preschool where the family’s oldest child, Jose, is studying. As noted by Ettekal and Mahoney (2017), the mezzo system envelopes the interactions between the different microsystems, such as the school and the home. Jose has been reported to skip classes, experience difficulties in focusing and concentrating, and starts fights with other children. When asked about the brawls he starts, Jose motivates it by seeing the same behavior at home. Thus, after observing Antonio’s domestic abuse of Terry, Jose has internalized the idea that using physical violence at a whim was a legitimate behavioral strategy. Correcting this perception, provided it would coincide with the positive developments at home, should improve Jose’s performance and social interactions in his preschool.
The intervention will use an approach that is based on the systems theory, assuming that the boy’s behavioral issues are the result of the habits that he has learned at home. One of the fundamental premises of the systems theory maintains that family teaches essential social roles and patterns of relating to its members (Hepworth et al., 2017). The core of the problem lies in the fact that Jose follows roles and adopted in his family, and the intervention should focus on helping him to reassess this behavioral pattern (Dowling, 2018). To address this problem, the social worker will collaborate with the teacher who is responsible for Jose and work on changing the student’s perceptions of the social context of the preschool. As a result of these actions, they expect his aggression to decline and his performance to improve.
The intervention demonstrates positive prospects for Jose. Dowling’s (2018) clinical experience offers an example of a similar case when behavioral and perception patterns internalized at home caused a boy to demonstrate aggressive behavior at school. Thus, the evidence suggests that gradually changing Jose’s perception of his preschool as a social context will impact his interactions with his peers positively.
Objective 1
The first goal is to reduce Jose’s levels of aggression, expressed as the number of fights that he starts or participates in. The child justifies his behaviors by claiming that the same events occur at home, leading him to see them as the norm. After observing Antonio’s domestic abuse of Terry, Jose has internalized the idea that using physical violence at a whim was a legitimate behavioral strategy. Correcting this perception, provided it would coincide with the positive developments at home, should improve Jose’s performance and social interactions in his preschool. As such, he should become less prone to fighting, especially if he were the initiator.
Objective 2
The second goal is to improve Jose’s educational performance by reducing the number of times when he skips school and helping him concentrate on his studies. To reach this target, the social worker will have to change the boy’s perception of education in general and the preschool, specifically. Jose should see it as a welcoming environment that he wants and needs to visit to interact with his peers and learn. To that end, teacher and the social worker alike need to help Jose develop sufficient trust in and benevolence toward his co-students (Dowling, 2018). If the other interventions produce an improvement in the family’s domestic situation, Jose’s attitude toward the school should change due to this intervention.
Measurement
The school’s data and the teacher’s evaluation will be used to monitor Jose’s progress. If the number of recorded fights and skipped days decline over time, the child is likely making progress and changing his view of the school. Meanwhile, the teacher can observe Jose’s condition and interactions with other children to determine whether he is becoming friendlier with them over time. They can also provide an opinion of whether his concentration and focus are improving and suggest additional changes if any are necessary.
Macro-Level Intervention
Intervention
The purpose of a macro-level intervention is to address the needs of a community rather than those of a single person or family. A program that helps people deal with grief would likely benefit many of the local families in the long term while also addressing some of the Williams family’s issues. The death of Antonio and Terry’s son served as the trigger for the escalation of their estrangement and contributed to the breakdown of their relationship. While it is likely impossible to overcome the harm that the event has caused, the social worker may be able to help the two reconcile somewhat and prevent other families from having similar breakdowns.
Objective 1
The first goal is to reduce the tension that the tragic event in various families has created. The members have to understand the effects that the incidents have had on them and accept it. In doing so, they should become able to stop projecting their emotions and issues on each other and become less conflict-prone as a result. Once they achieve this target, it would also be more comfortable for the two to work toward resolving their communication issues. Any families in the community that may have grief-related issues can benefit from this approach, and an invitation to visit the sessions will be extended to them.
Objective 2
The second goal is to create a service that can help families manage their grief after future tragic events. Jacobs (2016) identifies “early, efficient treatment intervention” as a vital component of prevention for traumatic grief (p. 96). People whose issues are addressed before they can develop into significant trauma are less likely to resort to destructive behaviors as a result of the damage they sustain. As such, this service will try to help them recognize their grief and accept it consciously, restoring their mental equilibrium. If the service’s capabilities are inadequate, it will redirect people to appropriate medical institutions.
Measurement
Progress toward the first objective is challenging to measure objectively, as is the case with many macro initiatives. Changes on a community level can happen due to any number of factors, and isolating specific aspects is nearly impossible. Instead, the social worker will measure engagement with the service by analyzing the number of families that participate. The second goal will be evaluated in the same manner, by observing whether families that are affected by tragic events choose to attend the sessions. If local families choose not to use the intervention, then it will have failed, counting as successful otherwise.
References
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Dowling, E. (2018). Taking the clinic to school: A consultative service for parents, children, and teachers. In E. Dowling and E. Osborne (Eds.), The family and the school: A joint systems approach to problems with children (2nd ed.) (pp. 59-68).
Ettekal, A. V., & Mahoney, J. L. (2017). Ecological systems theory. In K. Peppler (Ed.), The Sage encyclopedia of out-of-school learning (pp. 239-242). Sage.
Harris, S., & Butler, C. K. (2017). Promoting resilience in children of alcoholics. In P. S. Lassiter and T. J. Buser (Eds.), Annual review of addictions and offender counseling, volume II: Best practices (pp. 64-78). Resource publications.
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Jacobs, S. (2016). Traumatic grief: Diagnosis, treatment, and prevention. Taylor & Francis.
Josephson, A. M. (2015). From family therapy to family intervention. Child and Adolescent Psychiatric Clinics of North America, 24(3), 457-470.
Miller, I. W., Ryan, C. E., Keitner, G. I., Bishop, D. S., & Epstein, N. B. (2000). The McMaster approach to families: Theory, assessment, treatment and research. Journal of Family Therapy, 22(2), 168-189.