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Developing an assessment protocol for sexually abused adolescents in treatment programs : a single case… Kastens, Ingrid 1989

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DEVELOPING AN ASSESSMENT PROTOCOL  FOR SEXUALLY ABUSED ADOLESCENTS IN TREATMENT PROGRAMS: A SINGLE CASE STUDY OF THE PROCESS By INGRID KASTENS B.S.W., U n i v e r s i t y of B r i t i s h Columbia, 1980 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES SCHOOL OF SOCIAL WORK We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA September 1989 Copyright: I n g r i d Barbara Kastens, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia Vancouver, Canada DE-6 (2/88) - i i -ABSTRACT This t h e s i s evolved as part of a p r a c t i c e - t h e s i s combination o p t i o n f o r the completion of the degree of Master i n S o c i a l Work. The purpose of combining r e s e a r c h with p r a c t i c e was to allow f o r a l e a r n i n g experience i n each area. Both the p r a c t i c e and research were conducted w i t h i n Nisha C h i l d r e n ' s S o c i e t y . (Nisha S o c i e t y i s a n o n - p r o f i t o r g a n i z a t i o n d e d i c a t e d to the p r o v i s i o n of high q u a l i t y p r o f e s s i o n a l treatment and c o u n s e l l i n g s e r v i c e s f o r a d o l e s c e n t s and f a m i l i e s . See Appendix A f o r a more d e t a i l e d de s c r i p t ion.) The major work of the t h e s i s focused on developing a p r a c t i c a l and u s e f u l assessment process designed to give a b e t t e r p i c t u r e of s e x u a l l y abused adolescents who end up i n treatment programs. Not a great deal i s known about which s e x u a l l y abused a d o l e s c e n t s w i l l r e q u i r e i n t e n s i v e treatment programs, and which ones w i l l not. It i s of concern that the p r o f e s s i o n a l community does not have a good p i c t u r e of who the s e x u a l l y abused a d o l e s c e n t s who have s e r i o u s emotional and b e h a v i o u r a l problems r e a l l y are i n terms of socio-demographics, developmental s t a t u s , and emotional h e a l t h . A need e x i s t s to c l a r i f y which instruments would provide the most c r u c i a l i n f o r m a t i o n . There i s a l s o a need to c l a r i f y the r o l e of personal a t t r i b u t e s and the r o l e of c h a r a c t e r i s t i c s of the environment as they both impact on the s t r e s s - c o p i n g and r e s i l i e n c y a t t r i b u t e s of adolescents i n treatment. In order to e f f e c t i v e l y counsel or plan f o r s e x u a l l y abused a d o l e s c e n t s , we need to b e t t e r understand - i i i -sexual abuse as one of s e v e r a l p o s s i b l e pre- and/or c o - e x i s t i n g sources of i n d i v i d u a l s t r e s s or trauma. The assessment design used an e c o l o g i c a l or s t r e s s - c o p i n g model of abuse framed w i t h i n a normative developmental p e r s p e c t i v e . The t h e s i s focused on developing the assessment p r o t o c o l , r a t h e r than on the impact of c h i l d sexual abuse on a d o l e s c e n t s . Thus a very l a r g e and time consuming part of the r e s e a r c h has been the s e l e c t i n g of the seemingly best s u i t e d measures. The measures and framework chosen, and the r a t i o n a l e f o r these c h o i c e s are d e s c r i b e d i n d e t a i l w i t h i n t h i s r e p o r t . The f i n a l chapters of t h i s t h e s i s focus on the f i n d i n g s of the " t r i a l r u n " / s i n g l e case study and the i m p l i c a t i o n s f o r s o c i a l work. - i v -CONTENTS Page Ab s t r a c t i i Chapter One - I n t r o d u c t i o n 1 D e f i n i t i o n of C h i l d Sexual Abuse Purpose of the Research Chapter Two - L i t e r a t u r e Review S The Prevalence of Sexual Abuse S o c i e t a l Awareness Why an E c o l o g i c a l Model? Why a Developmental P e r s p e c t i v e ? Adolescent Development R e s i l i e n c y R a t i o n a l e f o r S e l e c t i o n of Issues Chapter Three - Method 20 Conceptual Model S i n g l e Case Design R a t i o n a l e f o r the Measures S e l e c t e d Measures Included i n the S i n g l e Case " T r i a l Run" Measures of A t t r i b u t e s of I n d i v i d u a l Adolescents Measures of the Environment The Importance of A s s e s s i n g Self-Esteem Rosenberg Self-Esteem Scale Hare Self-Esteem Scale The Importance of A s s e s s i n g Depression Hopelessness Scale C h i l d r e n ' s Depression Inventory N o w i c k i - S t r i c k l a n d Locus of C o n t r o l Scale I n t e r p e r s o n a l M a t u r i t y Level Assessment Sexual Abuse Impact C h e c k l i s t s Family Assessment The Family Assessment Measure The Concept of L i f e S t r e s s Family Inventory of L i f e Events and Changes Adolescent Family Inventory of L i f e Events and Changes Family Problem C h e c k l i s t Eco-Map The School Essay Chapter Four - P r e s e n t a t i o n of F i n d i n g s 72 Case H i s t o r y Self-Esteem Hopelessness and Depression Locus of C o n t r o l I n t e r p e r s o n a l M a t u r i t y Level E f f e c t s of Sexual Abuse Family F u n c t i o n i n g L i f e S t r e s s Resources and Connections School Chapter F i v e - D i s c u s s i o n of F i n d i n g s 88 The S i n g l e Case Study Comments on the Process of Assessment C o g n i t i v e C o n s i d e r a t i o n s C u l t u r a l C o n s i d e r a t i o n s Importance of Supplemental Measures and Observations Answering the Research Questions: Recommendations How a l l of t h i s Relates to Treatment Questions Remaining f o r Future Research Co n c l u s i o n B i b l i o g r a p h y 109 Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J Appendix K Appendix L Appendix M Appendix N Appendix 0 Appendix P Appendix Q 116 Nisha C h i l d r e n ' s S o c i e t y Rosenberg Self-Esteem Scale Hare Self-Esteem Scale Hopelessness Scale C h i l d r e n ' s Depression Inventory N o w i c k i - S t r i c k l a n d Locus of C o n t r o l Scale I- L e v e l Interview Guide Sexual Abuse Impact C h e c k l i s t s Family Assessment Measure Family Inventory of L i f e Events and Changes Adolescent-Family Inventoy of L i f e Events G Change s Family Problem C h e c k l i s t Eco-Map L's I-Lev e l Assessment The "School Essay" Consent Form Approval of U.B.C. O f f i c e of Research S e r v i c e s LIST OF FIGURES I. FAM P r o f i l e Page 83 - v i -I must begin by paying t r i b u t e to those who helped get me through: To my f r i e n d s and f a m i l y who understood and encouraged me and continued to love me without demanding a whole l o t i n r e t u r n . To Ruth, Penny, S h e l l e y , L a u r i e , and e s p e c i a l l y Tom, and a l l my supporters at Nisha who provided v a l u a b l e and much ap p r e c i a t e d support, feedback and encouragement. To the teens and f a m i l i e s who have shared t h e i r s t o r i e s and i n s i g h t s with me over the years. To Kathryn, who always had yet another idea f o r me to pursue. To my computer, with whom I have developed a deep love-hate r e l a t i o n s h i p . My h e a r t f e l t thanks to a l l of you. I n g r i d - 1 -CHAPTER ONE: INTRODUCTION Th i s r e s e a r c h draws on the work of researohers Bagley (1984, 1985) and F i n k e l h o r (1986, 1987) i n the areas of sexual abuse, Rutter (1981, 1985) i n the area of r e s i l i e n c y , and on the comprehensive c h i l d sexual abuse l i t e r a t u r e review undertaken by Wachtel (1988). In h i s r e p o r t Wachtel w r i t e s that " d e s p i t e the assessment f r e q u e n t l y found i n the l i t e r a t u r e that we s t i l l can say very l i t t l e that i s c o n c l u s i v e about the e f f e c t s of c h i l d sexual abuse, there does seem to have been c o n s i d e r a b l e recent advance both i n conceptual c l a r i t y and i n b u i l d i n g up an e m p i r i c a l knowledge base. The l i t e r a t u r e can be read as posing i n c r e a s i n g l y pointed questions i n an attempt to tease out c h i l d sexual abuse e f f e c t s " (p. i i ) . In the e a r l y days of c h i l d sexual abuse awareness i n North America, s o c i a l s e r v i c e p r o f e s s i o n a l s and r e s e a r c h e r s searched f o r widespread general e f f e c t s ( P e t e r s , 1996) However, i t was noted that s u r v i v o r s of c h i l d sexual abuse d i s p l a y e d q u i t e a v a r i e t y of e f f e c t s . This l e d to the study of the importance of d i s t i n g u i s h a b l e d i f f e r e n c e s ( A l t e r - R e i d , 1986). In 1981 Mrazek and Mrazek s t u d i e d the nature of the abuse (eg. r e l a t i o n s h i p to the abuser, d u r a t i o n , frequency, f o r c e ) . Age, gender and other a t t r i b u t e s of the c h i l d sexual abuse s u r v i v o r were a l s o s t u d i e d (Augustinos, 1987; F i n k e l h o r , 1982; F r i e d r i c h , 1987; Gomes-Schwartz, 1985; - 2 -Marten, 1985). As w e l l , demographic i n f o r m a t i o n was s t u d i e d (eg. race, socio-economics). Then there were s t u d i e s of the s i g n i f i c a n c e of the circumstances surrounding the d i s c l o s u r e (Adams-Tucker, 1986; Gold, 1986; P e l l e t i e r and Handy, 1986). E v e n t u a l l y r e s e a r c h e r s began to t e s t c l u s t e r s of f a c t o r s . Gold (1986), and Seidner and Calhoun (1984) noted that the s u b j e c t i v e experience of the sexual abuse appears to be of s i g n i f i c a n c e . As though the p i c t u r e were not cloudy enough al r e a d y i n terms of s e p a r a t i n g out the e f f e c t s of sexual abuse, i n 1985, O l i v i e r wrote about the g e n e r a l l y abusive s i t u a t i o n s surrounding c h i l d sexual abuse (eg. c o - e x i s t i n g p a r e n t a l pathology, p a r e n t a l a l c o h o l i s m , p h y s i c a l abuse, n e g l e c t ) . It i s due to the above o u t l i n e d complexity around the problem of c h i l d sexual abuse that t h i s t h e s i s takes an e c o l o g i c a l or s t r e s s - c o p i n g model w i t h i n a normative developmental p e r s p e c t i v e . This model came out of Wachtel's (1988) sexual abuse l i t e r a t u r e review. As noted, he i n turn drew on the sexual abuse w r i t i n g s of F i n k e l h o r and Browne (1986), and on other l i t e r a t u r e i n the areas of s t r e s s - c o p i n g and r e s i l i e n c y (eg. Rutter, 1985). This model w i l l be d e s c r i b e d i n d e t a i l i n the f o l l o w i n g chapter. - 3 -D e f i n i t i o n of C h i l d Sexual Abuse The best d e f i n i t i o n I have come across of c h i l d sexual abuse was found i n a proposal f o r demonstration p r o j e c t funding submitted by Marymound Inc. to Health and Welfare Canada: " C h i l d sexual abuse i s a sexual act imposed on a c h i l d who l a c k s emotional, m a t u r a t i o n a l , and c o g n i t i v e development. The a b i l i t y to l u r e a c h i l d i n t o a sexual r e l a t i o n s h i p i s based upon the a l l - p o w e r f u l and dominant p o s i t i o n of the a d u l t or o l d e r adolescent p e r p e t r a t o r , which i s i n sharp c o n t r a s t to the c h i l d ' s age, dependency, and subordinate p o s i t i o n " ( S g r o i , 1983, p.9). We b e l i e v e that a c h i l d i s unable to consent to sexual a c t s with i n d i v i d u a l s where there i s a three year age d i f f e r e n c e between the p e r p e t r a t o r and the v i c t i m ( F i n k e l h o r , 1979). Our d e f i n i t i o n of c h i l d sexual abuse a l s o i n c l u d e s sexual a c t s c o e r c i v e l y imposed on i n d i v i d u a l s , r e g a r d l e s s of an age d i f f e r e n c e between v i c t i m and o f f e n d e r . " (Marymound group, 1987, p.3). Purpose of the Research Perhaps the foremost question which needs to be addressed w i t h i n t h i s t h e s i s i s , why bother to assess at a l l ? The answer to t h i s i s that how h e l p i n g p r o f e s s i o n a l s assess, and how we begin to see people's d i f f i c u l t i e s , impacts on the kinds of s o l u t i o n s we seek. The purpose of assessment i s to make the i n t e r v e n t i o n more e f f e c t i v e and more tailor-made f o r the i n d i v i d u a l or f a m i l y . For example, an assessment might t e l l us that c e r t a i n i n d i v i d u a l s might do - 4 -b e t t e r without an i n t e n s i v e , i n t r u s i v e r e s i d e n t i a l approach. Other i n d i v i d u a l s , f o r example, might not b e n e f i t from i n s i g h t o r i e n t e d i n t e r v e n t i o n s since assessment might t e l l us that they have not yet developed the c o g n i t i v e a b i l i t i e s r e q u i r e d f o r t h i s approach. Thus assessment which allows f o r m u l t i p l e assessment t o o l s , a l s o allows f o r d i f f e r e n t i a l treatment. The r a t i o n a l e f o r m u l t i p l e assessment t o o l s i s f u r t h e r d i s c u s s e d l a t e r on i n t h i s t h e s i s . The purpose of t h i s r e s e a r c h i s to d i s c o v e r how we can b e t t e r assess the c l i n i c a l and s o c i a l concerns presented by abused and t r o u b l e d a d o l e s c e n t s i n treatment programs. While t r o u b l e d a d olescents represent a r e l a t i v e l y small p r o p o r t i o n of the p o p u l a t i o n at l a r g e , they are heavy consumers of mental h e a l t h and other s p e c i a l i z e d r e s o u r c e s . A need e x i s t s to c l a r i f y the r o l e of personal a t t r i b u t e s and c h a r a c t e r i s t i c s of the environment as they impact on s t r e s s - c o p i n g a b i l i t y . There i s a need f o r a p r a c t i c a l and c l i n i c a l l y u s e f u l assessment procedure f o r s e x u a l l y abused adolescent s. To date, much of the resea r c h has been p r e - t h e o r e t i c a l , m e t h o d o l o g i c a l l y q u e s t i o n a b l e , and l i m i t e d with regard to c o m p a r a b i l i t y of f i n d i n g s ( P a r r y , 1988). What i s needed are s t u d i e s which r e l a t e to the immediate c l i n i c a l and s o c i a l needs of these high p r o f i l e , t r o u b l e d , abused teens, and s t u d i e s which o f f e r a c l e a r conceptual r a t i o n a l e . - 5 CHAPTER TWO: LITERATURE REVIEW The Prevalence of Sexual Abuse Of a l l the resear c h on sexual abuse, the r e s u l t s from prevalence s t u d i e s have been the most impr e s s i v e . U n t i l r e c e n t l y most c l i n i c i a n s , p o l i c y makers, and s o c i a l s c i e n t i s t s doubted that people would be w i l l i n g to re p o r t h i s t o r i e s of sexual abuse to survey r e s e a r c h e r s . Yet as f a r back as the 1800's i t was recorded that women were r e p o r t i n g sexual abuse to Freud: Almost a l l my women p a t i e n t s t o l d me that they had been seduced by t h e i r f a t h e r s . I was d r i v e n to recogn i z e i n the end that these r e p o r t s were untrue and so came to understand that the h y s t e r i c a l symptoms are de r i v e d from f a n t a s i e s and not from r e a l o c c u r r e n c e s , " (Freud, 1938, t r a n s l a t e d to E n g l i s h i n 1966, p. 584). We have h o p e f u l l y come a long way si n c e then. It has become c l e a r that people w i l l not only report h i s t o r i e s of sexual abuse, but a l s o that they w i l l do so i n l a r g e numbers ( F i n k e l h o r , 1986). In 1984, Badgley conducted and pu b l i s h e d a G a l l u p Canada random sample survey of the prevalence of sexual abuse. A s t r a t i f i e d p r o b a b i l i t y sample was drawn f o r the e n t i r e country of Canada. P r o f e s s i o n a l i n t e r v i e w e r s went door to door, asked respondents to complete a s e l f - a d m i n i s t e r e d q u e s t i o n n a i r e , and waited as i t was completed. The sample c o n s i s t e d of 1006 females and 1002 males from 210 Canadian communities. 34% of females and 13% of males repo r t e d unwanted sexual a c t s before the age of 18. - 6 -U n t i l l a t e l y the e x p l o s i o n of l i t e r a t u r e and s t a t i s t i c s on c h i l d sexual abuse has l a r g e l y been a North American i n t e r e s t . Only r e c e n t l y are we beginning to a l s o hear r e p o r t s of widespread prevalence of sexual abuse r e v e a l e d i n other c o u n t r i e s (Rush, 1980; F i n k e l h o r , 1984). S o c i e t a l Awareness The past decade has seen growing p u b l i c and p r o f e s s i o n a l awareness of the i n c r e a s i n g number of r e p o r t s of c h i l d sexual abuse, with emerging p i c t u r e s of the p o s s i b l e longterm, perhaps m u l t i - g e n e r a t i o n a l , impact of such abuse. The reason that the i s s u e of sexual abuse has only r e l a t i v e l y r e c e n t l y entered the p u b l i c s p o t l i g h t with such magnitude i s l a r g e l y because the problem was taken on by a c o a l i t i o n of groups who are w e l l experienced i n promoting s o c i a l problems -s p e c i f i c a l l y the women's movement and the c h i l d r e n ' s p r o t e c t i o n movement ( F i n k e l h o r , 1984). More r e c e n t l y , government support and the media have a l s o helped to i n c r e a s e s o c i e t a l awareness reg a r d i n g the problem. Thus f a r much has been s t a t e d r e g a r d i n g what i s known about sexual abuse The remainder of t h i s chapter w i l l focus on the perspectives/models/bodies of l i t e r a t u r e which were combined w i t h i n t h i s t h e s i s ( e c o l o g i c a l theory, normative developmental theory, r e s i l i e n c y theory) i n an e f f o r t to b e t t e r understand the needs of s e x u a l l y abused a d o l e s c e n t s i n treatment programs. - 7 -Why an E c o l o g i c a l Model? An e c o l o g i c a l or s t r e s s - c o p i n g model seems a l o g i c a l approach to deal with the breadth of i n f o r m a t i o n and w r i t i n g on the subject of c h i l d sexual abuse and i t s e f f e c t s . A systems viewpoint seems to be e s s e n t i a l i n examining the problem we c a l l emotional d i s t u r b a n c e . Apter (1982) s t a t e s that " e c o l o g i s t s t y p i c a l l y do not c o n s i d e r emotional d i s t u r b a n c e a p h y s i c a l d i s e a s e l o c a t e d s o l e l y w i t h i n a c h i l d , but p r e f e r to look at a d i s t u r b e d ecosystem, i n which d i s t u r b a n c e can be more p r o f i t a b l y viewed as a " f a i l u r e to match" (p. 57). E s p e c i a l l y i n the case of s e v e r e l y t r o u b l e d youth, i t seems c l e a r from a reading of the c u r r e n t l i t e r a t u r e that the t a r g e t e d c h i l d i s seldom, i f ever, the whole problem. In order to be e f f e c t i v e , d i a g n o s i s and treatment of t r o u b l e d c h i l d r e n must be much more comprehensive and f u n c t i o n a l than i t has been i n the past. It seems c l e a r that we can b e n e f i t by g a t h e r i n g data from as many sources as p o s s i b l e ; that i s , we need to be i n c l u s i v e i n s t e a d of e x c l u s i v e i n what i n f o r m a t i o n we u t i l i z e i n our t h i n k i n g about the youth we attempt to serve. Over recent years Germain (1981), T u f t s (1984), Chandler (1985), Rutter (1985) and others have attempted to s i n g l e out p e r t i n e n t aspects of the environment f o r r e s e a r c h , assessment and i n t e r v e n t i o n . T h i s type of e c o l o g i c a l or s t r e s s model has p r e v i o u s l y been a p p l i e d to p h y s i c a l c h i l d abuse theory ( G a r b a r i n o C G i l l i a m , 1980). Recent t h e o r e t i c a l w r i t i n g s on the importance of seeing the e f f e c t s of abuse as changing over time have been - 8 -p u b l i s h e d by Bagley & Young (198?), and T u f t s C1984). These developmental approaches are very compatible with an e c o l o g i c a l model. Sometimes an e c o l o g i c a l model i s d e s c r i b e d as a people-in-environment approach. Germain (1981) w r i t e s that "a concern f o r person-in environment i s the d i s t i n g u i s h i n g and u n i f y i n g c h a r a c t e r i s t i c of s o c i a l work," (p.323). She g i v e s a good d e s c r i p t i o n of an e c o l o g i c a l p e r s p e c t i v e as f o c u s s i n g on the n a t u r a l l i f e processes of a d a p t a t i o n , s t r e s s , coping and the environmental nutriments r e q u i r e d f o r r e l e a s e of adaptive c a p a c i t i e s . A l l human beings, indeed, a l l organisms, engage i n continuous and r e c i p r o c a l adaptive processes with t h e i r environments. A l l experience a v a r i e t y of s t r e s s f u l s i t u a t i o n s across the l i f e c y c l e . They cope with them with v a r y i n g degrees of e f f e c t i v e n e s s that depend, i n pa r t , on i n t e r n a l resources and, i n p a r t , on the nature of the environment. Even i n t e r n a l resources, however, depend i n good measure on the q u a l i t i e s and p r o p e r t i e s of past and present environments.... L i t t l e i s known so f a r about what c o n s t i t u e s a n u t r i t i v e environment, given the v a r i a b i l i t y of people's needs, c a p a c i t i e s , and a s p i r a t i o n s and t h e i r lack of knowledge about the r e v e r s i b i l i t y of i l l e f f e c t s of noxious environments (Germain, 1981). E c o l o g i c a l assessment s t r a t e g i e s represent e f f o r t s to u t i l i z e more i n f o r m a t i o n i n the development of e f f e c t i v e programs f o r t r o u b l e d c h i l d r e n . Hobbs £1975) has documented the inadequacy of our c u r r e n t c a t e g o r i z a t i o n system and the l i m i t e d d i a g n o s i s - i n t e r v e n t i o n , c h i l d - o n l y focus on which i t i s based. Focusing a l l our a t t e n t i o n on the c h i l d while i g n o r i n g the f a m i l y , school, and community that surround him 9 -or her can make the i d e n t i f i c a t i o n and remediation of d i f f i c u l t i e s almost i m p o s s i b l e . In 1977 Bronfenbrenner wrote that "much of American developmental psychology i s the s c i e n c e of the strange behavior of c h i l d r e n i n strange s i t u a t i o n s with strange a d u l t s . " Bronfenbrenner was t a l k i n g about the ways i n which we study c h i l d r e n a f f e c t i n g the kinds of programs we develop f o r them. Small s t u d i e s lead to narrow programs, and the e c o l o g i c a l viewpoint s t r e s s e s the need to go beyond such narrow v i s i o n s of behavior and development and to f i n d ways to focus on the i n t e r a c t i o n of c h i l d r e n with c r i t i c a l aspects of t h e i r environments. In summary, we must give up our search f o r a magical answer to the problems presented by t r o u b l e d c h i l d r e n . Instead we must l e a r n to think i n terms of t r o u b l e d systems and i n c r e a s e our understanding of the r e c i p r o c a l person-environment i n t e r a c t i o n p a t t e r n s . An e c o l o g i c a l approach adopts a more dynamic p e r s p e c t i v e than one that c o n s i d e r s only s i n g l e - s o u r c e , s i n g l e - d i r e c t i o n , s i n g l e - t a r g e t i n f l u e n c e s : we need to think about the i n t e r a c t i o n of e f f e c t s between i n d i v i d u a l s and t h e i r circumstances. This p e r s p e c t i v e focuses on the i n t e r p l a y between person and environment, encouraging us to note h o w . c h a r a c t e r i s t i c s of the environment may i n f l u e n c e the persons l i v i n g i n i t . It i s t h i s dynamic view of the changing r e l a t i o n s between persons and the environment i n which they l i v e that guides the analyses we pursue here. - 10 -The responsiveness of the environment to the needs of the c h i l d may i n f l u e n c e the meaning the c h i l d makes of events; the meaning w i l l i n f l u e n c e the c h i l d ' s response; and the c h i l d ' s behavior w i l l i n f l u e n c e how the environment responds. Trauma and r e p a i r are dynamic, ongoing processes i n which the i n d i v i d u a l i n t e r a c t s with the m u l t i p l e systems that are the elements and context of l i f e (Moore Newberger and De Vos, 1988) . - 1 1 -Why a D e v e l o p m e n t a l P e r s p e c t i v e ? Not o n l y does t h i s t h e s i s t a k e an e c o l o g i c a l a p p r o a c h , but i t does so i n l i g h t o f a d e v e l o p m e n t a l p e r s p e c t i v e . In e s s e n c e t h e t h e s i s makes an e f f o r t t o i n t e g r a t e t h e two fr a m e w o r k s . T h i s m a r r i a g e o f frameworks r e q u i r e s us t o c o n s i d e r the need t o examine competence a t m u l t i p l e l e v e l s o f a n a l y s i s , t h e i m p o r t a n c e o f u n d e r l y i n g d e v e l o p m e n t a l p r o c e s s e s , how e n v i r o n m e n t a l c o n d i t i o n s i n f l u e n c e t h e d e v e l o p m e n t o f t h e p r o c e s s e s and t h e i r b e h a v i o r a l m a n i f e s t a t i o n , and how i n d i v i d u a l s c an i n f l u e n c e t h e s o c i a l c o n t e x t i n ways t h a t w i l l a f f e c t t h e i r own f u r t h e r d e v e l o p m e n t . Whatever t h e s t r e s s o r e v e n t , c h i l d r e n ' s r e a c t i o n s t o s p e c i f i c c r i s e s a r e seen t o d i f f e r i n r e l a t i o n t o d e v e l o p m e n t a l s t a g e s . Human f e e l i n g and b e h a v i o r i s p e r h a p s b e s t u n d e r s t o o d as a f u n c t i o n o f m u l t i p l e domains i n t e r a c t i n g and e v o l v i n g o v e r t i m e . The meaning a c h i l d makes o f e x p e r i e n c e s i s c r i t i c a l f o r u n d e r s t a n d i n g how t h a t e x p e r i e n c e a f f e c t s t h e c h i l d . T h i s has s t r o n g i m p l i c a t i o n s f o r c l i n i c a l p r a c t i c e - f o r example, a t h e r a p i s t c a n n o t change t h e p r e c i p i t a t i n g e v e n t s , but may h e l p t o a l t e r b e l i e f s about the s e l f and o t h e r s t h a t may have been d i s t o r t e d by the c o g n i t i v e p r o c e s s e s . T h i s e n t i r e l a t t e r c o n c e p t i s once a g a i n c o r e t o t h e t h e o r y b e h i n d I - l e v e l ( s e e c h a p t e r t h r e e o f t h i s r e p o r t ) . - 12 -H i l l i a r d (1973) w r i t e s that d i s s i m i l a r b a s i c t h e o r e t i c a l assumptions about the nature of development r e s u l t i n three general c a t e g o r i e s of developmental theory: l e a r n i n g t h e o r i e s ; m a t u r a t i o n a l t h e o r i e s ; and c o g n i t i v e - d e v e l o p m e n t a l t h e o r i e s . The b a s i c assumption of l e a r n i n g theory i s that what i s most s i g n i f i c a n t i n development i s the environment and who we grow up to be has to do mostly with the l e a r n i n g c o n d i t i o n s and the i n f o r m a t i o n a v a i l a b l e i n our environments. The b a s i c a s s u p t i o n of m a t u r a t i o n a l theory i s that what i s most s i g n i f i c a n t i n development i s the organism (the i n d i v i d u a l ) and that who we grow up to be has to do mostly with our g e n e t i c make-up. The b a s i c a s s u p t i o n of c o g n i t i v e - d e v e l o p m e n t a l theory i s that what i s most s i g n i f i c a n t i n e x p l a i n i n g development i s both the environment and the organism and that who we grow up to be has to with the i n t e r a c t i o n between the g e n e t i c make-up of the organism and the environment ( p . 1 ) . This t h e s i s takes a c o g n i t i v e - d e v e l o p m e n t a l approach. From a developmental p e r s p e c t i v e adolescence i s g e n e r a l l y viewed as a t r a n s i t i o n a l p e r i o d b r i d g i n g c h i l d h o o d and adulthood (Hopkins, 1983). B i o l o g i c a l changes, p r i m a r i l y i n the form of sexual maturation, mark the onset of t h i s p e r i o d ( P etersen and T a y l o r , 1980) which e v e n t u a l l y c a l l s f o r changes i n the a d o l e s c e n t ' s p s y c h o l o g i c a l development and s o c i a l behavior. These a l t e r a t i o n s , with t h e i r s w i f t onset and demands f o r adjustment, make the p e r i o d of adolescence one of extreme v u l n e r a b i l i t y (Hopkins, 1980). Ebata (1986) notes that adolescence has s t e r e o t y p i c a l l y been viewed as a c h a o t i c , tumultuous p e r i o d . Although recent s t u d i e s have tempered and modified t h i s view (e.g., Douvan and Adelson, 1966; O f f e r and O f f e r , 1975; Garbarino and K e l l y , 1986) much more a t t e n t i o n has been paid to the problems of adolescence - 13 -to d e s t r u c t i v e behaviour or maladjusted i n d i v i d u a l s r a t h e r than to w e l l - a d j u s t e d , f u l l y f u n c t i o n i n g youth. C l e a r l y , the m a j o r i t y of adolescents do w e l l i n s o c i a l , academio and p e e r - r e l a t e d endeavors, d e s p i t e what may be normative mood v a r i a t i o n and problems (Larson, 1980; Rutter, 1976). We can think of the range and v a r i a b i l i t y i n normal and d y s f u n c t i o n a l p a t t e r n s of development as part of a continuum of adjustment and p s y c h o l o g i c a l w e l l - b e i n g that are developmental outcomes, or products of growth and s o c i a l i z a t i o n . T r a d i t i o n a l l y , p s y c h o l o g i s t s have focused on maladjustment and have considered mental h e a l t h as freedom from aberrant d y s f u n c t i o n a l , or p a t h o l o g i c a l symptoms. More r e c e n t l y , however a g r e a t e r focus has turned to examining the degree to which an i n d i v i d u a l f u n c t i o n s s u c c e s s f u l l y i n the world and on the s k i l l s and a b i l i t i e s necessary f o r competent f u n c t i o n i n g . It i s f o r these above mentioned reasons that an I - l e v e l ( I n t e r p e r s o n a l M a t u r i t y Level) i n t e r v i e w i s i n c l u d e d i n the assessment package f o r t h i s t h e s i s . Not only does the I - l e v e l i n t e r v i e w assess c o g n i t i v e - d e v e l o p m e n t a l l e v e l , but i t a l s o allows f o r an assessment of s t r e n g t h s by nature of i t s open ended format. As w e l l , I - l e v e l theory i s r e s p e c t f u l of whatever coping skills/mechanisms have enabled the adolescent to get by thus f a r i n s p i t e of sometimes very d i f f i c u l t l i f e ( e c o l o g i c a l ) s i t u a t i o n s . I - l e v e l as an assessment and treatment planning t o o l i s f u r t h e r d i s c u s s e d i n chapter three of t h i s paper. - 14 -Assessment, t h e r e f o r e , must target more than merely the presence or absence of problems. Assessment must a l s o take i n t o account the degree to which i n d i v i d u a l s adapt to the presence or absence of s k i l l s , c h a r a c t e r i s t i c s , and a b i l i t i e s that allow them to meet environmental demands and c h a l l e n g e s . An emphasis on a s s e s s i n g s o c i a l a d a p t a t i o n i s a l s o important i n that i t g i v e s an i n d i c a t i o n not only of the kinds of resources and o p p o r t u n i t i e s that are a v a i l a b l e to the i n d i v i d u a l that may promote development of s k i l l s but a l s o to s t r e s s e s and o b s t a c l e s that may hinder or p r o h i b i t the development of these s k i l l s ( o r encourage the development of behaviors that are l e s s d e s i r a b l e yet may be "adaptive" given the p a r t i c u l a r s i t u a t i o n ) . Once again, I - l e v e l addresses a l l of t h i s . The presence of psychopathology i n ad u l t p o p u l a t i o n s has been r e l a t e d p o s i t i v e l y to the occurence of both p o s i t i v e and negative l i f e events (Myers, 1974). Thus, f o r example, a change of res i d e n c e or o b t a i n i n g a new job, r e g a r d l e s s of whether or not i t was d e s i r e d , may be s t r e s s - i n d u c i n g . Adolescents i n treatment programs have commonly experienced frequent changes i n r e s i d e n c e and s c h o o l s . - 1B -Adolescent Development U n t i l r e c e n t l y l i t e r a t u r e r e g a r d i n g adolescent development was based on the work of E r i c E r i c k s o n (1968). He t h e o r i z e d that adolescents need to develop a sense of i n d u s t r y and i d e n t i t y i n order to be able to develop s a t i s f y i n g r e l a t i o n s h i p s . Within t h i s framework i t i s b e l i e v e d that a sense of i n d u s t r y i s developed through success at work or sc h o o l , and a sense of i d e n t i t y i s developed by means of the process of disengagement from the f a m i l y (Deutch, 1967; Bi o s , 1979). T h i s model of the need to separate i s c u r r e n t l y being c h a l l e n g e d ( M i l l e r , 1976, 1984; G i l l i g a n , 1982; Surrey, 1987). These w r i t e r s propose that development occurs w i t h i n r e l a t i o n s h i p , and suggest that r e l a t i o n s h i p d i f f e r e n t i a t i o n i s a process marking adolescence. Other c h a r a c t e r i s t i c s a s s o c i a t e d with adolescence i n c l u d e f l u c t u a t i n g moods; strong sexual f e e l i n g s ; f l u c t u a t i o n s between dependency/independency; "hanging-out"; experimentation with drugs, a l c o h o l , sex, intimacy; r e b e l l i o n a g ainst f a m i l y ; strong involvement with a peer group; i n t e 1 1 e c t u a 1 / c o g n i t i v e growth; moral growth; a b i l i t y to plan f o r the f u t u r e (Bosomworth, 1980; S c o f i e l d , 1987). Adolescence i s a time of change and i n v o l v e s a quickening of pace of l i f e events. The many new p h y s i c a l , p s y c h o l o g i c a l , and s o c i a l experiences common to i n d i v i d u a l s during t h i s stage may e x p l a i n the high r a t e s of problems ad o l e s c e n t s encount er. Coddington's work (1972) v e r i f i e s the extreme l e v e l s of l i f e events experienced i n adolescence. It - 16 -i s f o r these t h e o r e t i c a l reasons that the Adolescent Family Inventory of L i f e Events (A-FILE) was i n c l u d e d as one of the measures i n t h i s r e s e a r c h p r o j e c t . (See d e s c r i p t i o n of A-FILE i n chapter three and Apppendix K.) The m u l t i p l i c i t y of b i o l o g i c a l and s o c i a l changes c o n f r o n t i n g a d o l e s c e n t s may c r e a t e new demands that have the p o t e n t i a l f o r t r i g g e r i n g o f f many new behavior problems. The t r i g g e r s are m u l t i p l i e d f o r adolescents who have experienced c h i l d sexual abuse. Due to the c h a r a c t e r of behavior and mood i n adolescence, there i s the r i s k that e a r l y signs of d i s o r d e r and problems may be dismissed as p r e d i c t a b l e changes of "normal" adolescence (Weiner, 1970). In c o n c l u s i o n , "adolescence i s an important time i n the development and demonstration of competence. I t c a l l s f o r t h both the d e s i r e to f u n c t i o n s u c c e s s f u l l y i n the world and the need to f e e l good about that a b i l i t y . Often d e f i c i t s that were only p o t e n t i a l i n childho o d become r e a l i n adolescence, when demands f o r s o c i a l l y d e s i r a b l e c h a r a c t e r i s t i c s and s k i l l s i n c r e a s e markedly i n school and the world of work" (Ebata, 1986). While changes i n i n d i v i d u a l behavior may i n f l u e n c e f a m i l y f u n c t i o n i n g , such changes may a l s o r e q u i r e r e s t r u c t u r i n g environmental c o n d i t i o n s to be more conducive to the development of adaptive c a p a c i t i e s . - 1 ? -R e s i l i e n c y The l i t e r a t u r e on r e s i l i e n t c h i l d r e n , youth and a d u l t s ( R u t t e r , 1985), provides some focus to the i n d i c a t o r s which might be of s i g n i f i c a n c e i n examining developmental outcomes of abused a d o l e s c e n t s . Those who f a r e w e l l i n terms of developmental outcome d e s p i t e evidence of severe r i s k s and s t r e s s o r s i n t h e i r l i v e s are c h a r a c t e r i z e d by the f o l l o w i n g : a p o s i t i v e outlook, a f e e l i n g of r e s p o n s i b i l i t y / c o n t r o l over what happens to them, well-developed s o c i a l s k i l l s , good a b i l i t y to problem s o l v e , and the presence of a s i g n i f i c a n t c a r i n g human r e l a t i o n s h i p . Working ag a i n s t r e s i l i e n c e are the presence of f a c t o r s i n d i c a t i v e of a non-supportive environment i n c l u d i n g f a m i l y d y s f u n c t i o n and d i s r u p t i o n , and experience of m u l t i p l e placements i n care or i n treatment ( P a r r y , 1988, b u i l d i n g on Rutter, 1985). - 18 -R a t i o n a l e f o r S e l e c t i o n of Issues Given the background d i s c u s s e d i n t h i s l i t e r a t u r e review, a number of important i s s u e s a r i s e . As has been s t a t e d , the focus on p r o v i d i n g b e t t e r assessment, and thereby more a p p r o p r i a t e and d i f f e r e n t i a l i n t e r v e n t i o n s , f o r s e x u a l l y abused ad o l e s c e n t s who are i n treatment programs i s important, because while they may represent a r e l a t i v e l y small p r o p o r t i o n of the s e x u a l l y abused p o p u l a t i o n , they are heavy consumers of mental h e a l t h and other s p e c i a l i z e d r e s o u r c e s . This t h e s i s takes the viewpoint that sexual abuse i s one of s e v e r a l sources of i n d i v i d u a l s t r e s s . Therefore, data c o l l e c t i o n should i n c l u d e some open-ended formats to i n c l u d e more than i n f o r m a t i o n s p e c i f i c only to the sexual abuse area. A l s o , the ambiguity i n e x i s t i n g sexual abuse l i t e r a t u r e r e g a r d i n g the i n f l u e n c e of i n d i v i d u a l f a c t o r s may i n d i c a t e that i t i s a combination of f a c t o r s , not the i n f l u e n c e of any i n d i v i d u a l one, which i s important. T h i s view i s c o n s i s t e n t with the i n t e r a c t i v e nature of the e c o l o g i c a l model of t h i s t h e s i s . Another i s s u e which makes t h i s r e s e a r c h somewhat unique i s that a c c o r d i n g to the l i t e r a t u r e review, most sexual abuse s t u d i e s to date have i n v o l v e d a d u l t s u r v i v o r s . There i s a s c a r c i t y of s t u d i e s f o c u s i n g on e a r l i e r developmental stages. Yet normal development and changes i n l i f e tasks are known to be s i g n i f i c a n t i n determining the impact of s t r e s s on coping a b i l i t y . Therefore, r e s e a r c h s t u d i e s should begin to measure s t r e s s impact i n terms of developmental coping, - 19 -d e l a y s , d i s t o r t i o n s and r e c u r r i n g impact. Developmental theory r e c o g n i z e s change over time. As c o g n i t i v e and emotional growth occur, p e r c e p t i o n s or s u b j e c t i v e experiences a l t e r . Therefore i t i s important to look at both s u b j e c t i v e experiences, as w e l l as the " f a c t u a l " elements. In summary, resea r c h should look at both the i n d i v i d u a l and the environment and study p o s i t i v e and negative f a c t o r s which strengthen or weaken the i n d i v i d u a l ' s coping a b i l i t y . Since assessment i s most commonly undertaken to determine problem areas, many of the popular t e s t s tend to be formatted f o r d e s c r i p t i o n of d e f i c i t s . Therefore, open-ended format instruments (e.g. s t r u c t u r e d i n t e r v i e w s ) and modified v e r s i o n s of e x i s t i n g measures need to be i n c l u d e d to assess s t r e n g t h s as w e l l as d e f i c i t s . The r e s e a r c h questions proposed by t h i s t h e s i s i n c l u d e d the f o l l o w i n g : 1. What would c o n s t i t u t e a comprehensive assessment p r o t o c o l f o r use with s e x u a l l y abused adolescents? Which instruments would provide the most c r u c i a l i n formation? The o b j e c t i v e was to more e f f i c i e n t l y assess the w e l l being and needs of s e x u a l l y abused a d o l e s c e n t s i n treatment programs so that h e l p i n g p r o f e s s i o n a l s can b e t t e r plan f o r them and t h e i r emotional h e a l t h ( p r o v i d e b e t t e r d i f f e r e n t i a l treatment based on sound assessment). 2 . What are the p r a c t i c a l and c l i n i c a l s t r e n g t h s and weaknesses of the measures used? Where are the unnecessary o v e r l a p s between measures? - 20 -CHAPTER THREE: METHOD Conceptual Model In chapter one, e c o l o g i c a l theory, developmental theory, and r e s i l i e n c y were d i s c u s s e d . Measurement instruments and areas of measurement focus have been determined w i t h i n t h i s framework, and from w i t h i n a core of s t a n d a r d i z e d measures. A c e n t r a l i s s u e which has been kept i n mind throughout has been the importance of i d e n t i f y i n g f a c t o r s p e r t a i n i n g to coping a b i l i t i e s . The p a r t i c u l a r measures and s p e c i f i c i n f o r m a t i o n items f a l l i n t o three general c a t e g o r i e s : socio-demographics. (age, gender, f a m i l y c o n s t e l l a t i o n , e t c . ) , i n d i c a t o r s of developmental s t a t u s ( I - l e v e l Assessment), and i n d i c a t o r s of emotional h e a l t h ( s e l f - e s t e e m , d e p r e s s i o n , sense of c o n t r o l , s o c i a l s k i l l , i n t e r p e r s o n a l m a t u r i t y ) . A range of assessment s t r a t e g i e s have been used ( i e . s t r u c t u r e d i n t e r v i e w s , psychometric t e s t s , o b s e r v a t i o n , f i l e review) . Based on the l i t e r a t u r e review, and as o u t l i n e d above, the assessment package chosen during the process of t h i s r e s e a r c h i n c l u d e s measures to assess the i n d i v i d u a l , the f a m i l y , the environment, and s t r e n g t h s w i t h i n these systems. This measurement package was then t e s t e d i n a s i n g l e case study. The relevance of s i n g l e case s t u d i e s i s d i s c u s s e d i n the f o l l o w i n g s e c t i o n . - 21 -S i n g l e C a s e D e s i g n A m a j o r c o n c e r n f o r b o t h r e s e a r c h e r s a n d c l i n i c i a n s i s t h e g e n e r a l i z a b i l i t y o f r e s e a r c h f i n d i n g s i n t o t h e c l i n i c a l s e t t i n g . P s y c h o l o g y h a s t r a d i t i o n a l l y p r e f e r r e d q u a n t i t a t i v e r e s e a r c h f o r t h i s r e a s o n . H o w e v e r , t h e r e i s a l s o a p l a c e f o r s i n g l e c a s e r e s e a r c h , p a r t i c u l a r l y i n c l i n i c a l s e t t i n g s . C a s e s t u d i e s p r o v i d e a n i m p o r t a n t K n o w l e g e b a s e t h a t i s u n o b t a i n a b l e t h r o u g h t r a d i t i o n a l q u a n t i t a t i v e r e s e a r c h . A l t h o u g h t h e r e a r e m a n y a d v a n t a g e s t o q u a n t i t a t i v e r e s e a r c h , s o m e o f t h e l i m i t a t i o n s a s n o t e d b y H e r s e n a n d B a r l o w ( 1 9 7 6 ) i n c l u d e : e t h i c a l o b j e c t i o n s t o w a i t i n g l i s t s o r n o i n t e r v e n t i o n c o n t r o l g r o u p s ; d i f f i c u l t i e s i n c o l l e c t i n g h o m o g e n e o u s g r o u p s ; t h e o b s c u r i n g o f i n d i v i d u a l o u t c o m e s i n g r o u p a v e r a g e s ; a n d t h e u s e o f p r e t e s t a n d p o s t t e s t o n l y m e a s u r e m e n t s , w h i c h o b s c u r e p r o g r e s s o r d e t e r i o r a t i o n d u r i n g t r e a t m e n t . O n e m a j o r a d v a n t a g e o f s i n g l e c a s e d e s i g n s i s t h a t t h e y p r o v i d e a n a l t e r n a t i v e t o t r a d i t i o n a l l a r g e d e s i g n s a b o u t w h i c h v a r i o u s e t h i c a l a n d l e g a l c o n s i d e r a t i o n s a r e o f t e n r a i s e d ( H e r s e n C B a r l o w , 1 9 7 6 ) . S i n g l e c a s e d e s i g n s a l s o m a k e i t m o r e f e a s i b l e t o i n v o l v e p r a c t i t i o n e r s i n r e s e a r c h . T h e a d v a n t a g e s o f t h i s a r e o b v i o u s . R e s e a r c h o f t e n d o e s n o t u t i l i z e t h e c o m m o n s e n s e k n o w l e d g e o f t h e p r a c t i t i o n e r , a n d t h e p r a c t i t i o n e r may n o t b e a s i n f l u e n c e d b y p r e c o n c e i v e d t h e o r e t i c a l h y p o t h e s e s ( O l s e n , 1 9 7 6 ) . P r a c t i t i o n e r s a r e a l s o i n a p o s i t i o n t o o b t a i n i n f o r m a t i o n o r d a t a t h a t c a n n o r m a l l y o n l y b e o b t a i n e d - 22 -i n the context of a r e l a t i o n s h i p . Another p o s i t i v e f e a t u r e of s i n g l e case r e s e a r c h i s i t s f l e x i b i l i t y of design i n response to ongoing change and c l i e n t needs. A case study approach i s a l s o u s e f u l when the subject i s s t u d i e d i n i t s r e a l l i f e context; where boundaries between the phenomena and the context are not c l e a r ; and where m u l t i p l e sources of data are used ( Y i n , 1986). By f a r the most common case study methods are those used to evaluate the e f f e c t i v e n e s s of treatment. In the circumstance of t h i s t h e s i s , a case study method was used to evaluate an assessment p r o t o c o l . In other words, t h i s i s a case study of an assessment process and not a case study of change over time. In terms of assessment case s t u d i e s , they "can be d i s t i n g u i s h e d from more t r a d i t i o n a l t h e r a p e u t i c i n t e r v e n t i o n s i n that t h e i r primary purpose i s to provide an example of the a p p l i c a t i o n of v a r i o u s psychometric instruments f o r e i t h e r d i a g n o s i s or d e s c r i p t i o n of c o g n i t i v e and s o c i a l b ehavior" (Kratochwi11, Mott, G Dodson, 1983). In the case of t h i s r e s e a r c h , such data i s gathered to a s s i s t i n understanding problems or s t r e n g t h s that may have important i m p l i c a t i o n s f o r i n t e r v e n t i o n . The important poi n t to keep i n mind i s that the the assessment r e s u l t s need to be t r a n s l a t e d i n t o i n t e r v e n t i o n s , and not j u s t diagnoses. In terms of v a l i d i t y . although i t i s g e n e r a l l y b e l i e v e d that the v a l i d i t y of s i n g l e case and other s t u d i e s can be improved by the use of o b j e c t i v e measures, t h i s does not exclude s u b j e c t i v e measures from c o n s i d e r a t i o n . Indeed, the d e s i r a b i l i t y of using s u b j e c t i v e measures of behavior or - 23 -experience i n a d d i t i o n to o b j e c t i v e assessment i s becoming i n c r e a s i n g l y recognized as a good check (Kazdin, 1977; Wolf, 1978). Due to t h e i r depth and unhurriedness, s i n g l e - c a s e s t u d i e s are p a r t i c u l a r l y conducive to being supplemented by s u b j e c t i v e data. Yin (1986) s t a t e s that the s t r e n g t h of case s t u d i e s l i e i n t h e i r a b i l i t y to use m u l t i p l e sources of data as evidence. He b e l i e v e s that t h i s technique adds to v a l i d i t y . In g e n e r a l , and i n t h i s s i t u a t i o n i n p a r t i c u l a r , the s i n g l e - c a s e design should not be viewed as a s u b s t i t u t e f o r group designs, but r a t h e r as a c a t a l y s t to s t a r t the process of checking hunches and a p p l y i n g notions from theory to c r e a t e new i n f o r m a t i o n bases. - 24 -R a t i o n a l e f o r the Measures S e l e c t e d Due to the m u l t i p l e t h e o r e t i c a l areas i n c l u d e d i n the comprehensive p e r s p e c t i v e taken w i t h i n t h i s t h e s i s , the l i t e r a t u r e review became a l a r g e and time consuming part of the a c t u a l design of t h i s study. Not only d i d the l i t e r a t u r e review cover the t h e o r e t i c a l frameworks i n c l u d e d i n the previous chapter, but i t a l s o i n c l u d e d reviewing i n d e t a i l many times more measures than were ever i n c l u d e d i n the assessment package decided on during the course of t h i s r e s e a r c h . Many of the measures were p i l o t e d as i t was e t h i c a l and u s e f u l to do so i n the course of the author's day to day p r a c t i c e . As w e l l , the author spoke with other p r o f e s s i o n a l s who were p i l o t i n g some of the measures elsewhere, such as at The Maples Adolescent Treatment Center i n Burnaby, B.C. Measures f o r the assessment p r o t o c o l were chosen keeping i n mind the o v e r a l l goal of g e t t i n g a c l e a r e r p i c t u r e of sexually-abused a d o l e s c e n t s i n treatment programs i n terms of developmental s t a t u s and emotional h e a l t h . An attempt was made to balance the use of measures which ere w e l l known and e s t a b l i s h e d i n the f i e l d , versus using measures which made the g r e a t e s t sense based on r e l i a b i l i t y , v a l i d i t y , c l a r i t y , b r e v i t y , norms, and c l i n i c a l experience of what would be acceptable and not too i n t r u s i v e to these a d o l e s c e n t s . These d e c i s i o n s were made a f t e r a l s o i n t e r v i e w i n g and t a k i n g i n t o account the experience of s e v e r a l s o c i a l workers and p s y c h o l o g i s t s who have f a m i l i a r i t y with s i m i l a r p o p u l a t i o n s C such as at The Maples Adolescent Treatment Centre) , and have - 25 -used some of the measures which were considered or i n c l u d e d . R e l i a b i l i t y R e l i a b i l i t y has been d e f i n e d as "the accuracy or p r e c i s i o n of an instrument" ( S e l l t i z , Wrightsman C Cook, 1976, p.580). In i t s broadest sense, "instrument r e l i a b i l i t y i n d i c a t e s the degree to which i n d i v i d u a l d i f f e r e n c e s i n scores are a t t r i b u t a b l e to true d i f f e r e n c e s i n the property or c h a r a c t e r i s t i c being measured and to e r r o r s of measurement" ( A n a s t a s i , 1968, p.8). One of the f u n c t i o n s of the " t r i a l run" w i t h i n t h i s t h e s i s was i n f a c t to begin to address f a c t o r s a f f e c t i n g r e l i a b i l i t y . For example i f an adolescent were not convinced that her answers would remain c o n f i d e n t i a l , or i f she f e l t uneasy about r e v e a l i n g her true f e e l i n g s (perhaps due to the s o c i a l d e s i r a b i l i t y f a c t o r ) , the i n t e r v i e w or measure would not provide a r e l i a b l e assessment of her experience. V a l i d i t y D e f i n i n g v a l i d i t y i n v o l v e s two a s p e c t s : "1) the instrument a c t u a l l y measures the concept i n q u e s t i o n , and 2) the concept i s measured a c c u r a t e l y " ( G r i n e l l , 1981, p. 104). Although a l l measures were s e l e c t e d keeping these two aspects i n mind, once again, one f u n c t i o n of the t r i a l run was to address the i s s u e of v a l i d i t y based on the c l i n i c a l experience of conducting the assessment. C l a r i t y A l l instuments were chosen based on the author's ten years of s o c i a l work experience with s e x u a l l y abused ad o l e s c e n t s , and by reading through each of the measures to - 26 -assess whether a l l of the items i n c l u d e d would make sense to such a p o p u l a t i o n . A l l p e n c i l and paper t e s t s were administered v e r b a l l y to allow f o r c l a r i f i c a t i o n i f needed. This a l s o meant that poor reading a b i l i t y would not compound the r e s u l t s . B r e v i t y B r e v i t y was balanced along with a l l other f a c t o r s mentioned. The assessment package used i n t h i s t h e s i s i s by no means a l l i n c l u s i v e . Many other v a r i a b l e s could be or were c o n s i d e r e d . However, i n the i n t e r e s t of not a l l o w i n g the assessment to become abusive i n l e n g t h , compromises and omissions had to be made. Norms A problem i s s u e kept i n mind i n the s e l e c t i o n of t h i s measurememt package was that many of the "norms" f o r American t e s t s seem as though they would not apply f o r Canadians ( f o r example, items p e r t a i n g to r e l i g o s i t y , or items which could be p e r c e i v e d d i f f e r e n t l y w i t h i n the Canadian Native c u l t u r e ) . Once again one of the purposes of the t r i a l run was to begin to address some of these i s s u e s as they arose. The general i s s u e of c u l t u r a l r e l a t i v i t y or u s e f u l n e s s of " t e s t s " i n a m u l t i c u l t u r a l s o c i e t y was a concern and i s f u r t h e r d i s c u s s e d i n the c o n c l u d i n g s e c t i o n . - 27 -The Measures Included i n the S i n g l e Case " T r i a l Run" Measures of a t t r i b u t e s of i n d i v i d u a l a d o l e s c e n t s cover: developmental s t a t u s ( I n t e r p e r s o n a l M a t u r i t y L e v e l Assessment), outlook (Beck Hopelessness S c a l e ; Kovacs Depression I n v e n t o r y ) , sense of c o n t r o l ( N o w i c k i - S t r i c k l a n d Locus of C o n t r o l S c a l e ) , s e l f - e s t e e m (Hare Self-Esteem S c a l e ; Rosenberg Self-Esteem S c a l e ) , and presence of a c r i t i c a l r e l a t i o n s h i p (Family Assessment Measure; I - L e v e l ) . Two s e l f - e s t e e m and two depression/hopelessness measures were i n c l u d e d i n t h i s study. The reason f o r t h i s was that a c l e a r c h o i c e could not be reached as to which measure seemed p r e f e r a b l e f o r a d o l e s c e n t s . One of the f u n c t i o n s of the " t r i a l run" was i n each case to s e l e c t one of the two measures as being s u p e r i o r f o r the t a r g e t group i n q u e s t i o n . Measures of the environment focused on s p e c i f i c s of supports such as s t a b i l i t y of home and surrounding environment (Family Inventory of L i f e Events; Adolescent Family Inventory of L i f e Events; placement h i s t o r y of the a d o l e s c e n t ) . Interviews (Harborview Sexual Abuse Impact C h e c k l i s t s ) and f i l e reviews were used to c o l l e c t data on i n d i c a t o r s of r e v i c t i m i z a t i o n such as ongoing p r o s t i t u t i o n , "unhealthy" r e l a t i o n s h i p s , end other s e l f - d e s t r u c t i v e b e h a viors. An Eco-Map was used to c o l l e c t data to assess f a m i l y r e s o u r c e s , connections, and the nature of connections. In terms of a s s e s s i n g school i s s u e s , an open ended short essay format was used with the adolescent who p a r t i c i p a t e d . The reason f o r t h i s was that a) she l i k e d the i d e a , and b) she had s t a r t e d but b a s i c a l l y not attended at - 28 -f o u r schools w i t h i n the past year. Thus teachers d i d not know her well enough to comment on t h e i r o b s e r v a t i o n s from s c h o o l . It i s the w r i t e r ' s experience that t h i s s o r t of school p a t t e r n i s t y p i c a l of s e x u a l l y abused ad o l e s c e n t s i n treatment programs, thus i t would l i k e l y be r a r e that a teacher could complete a meaningful assessment as part of an assessment package. On the f o l l o w i n g pages a r a t i o n a l e f o r each area s e l e c t e d w i l l be presented, and the a c t u a l measures used w i l l be d e s c r i b e d . The m u l t i p l e sources of data used were the adolescent h e r s e l f , her mother, the M i n i s t r y of S o c i a l S e r v i c e s s o c i a l worker, and f i l e review. - 29 -The Importance of A s s e s s i n g Self-Esteem The achievement of a f a v o r a b l e a t t i t u d e toward o n e s e l f has been regarded as important by a number of p e r s o n a l i t y t h e o r i s t s , i n c l u d i n g Murphy (1947), Horney (1945, 1950), and A d l e r (1917). The term " s e l f - e s t e e m " r e f e r s to the e v a l u a t i o n a person makes end c u s t o m a r i l y maintains with regard to her or h i m s e l f . "Self-esteem" expresses an a t t i t u d e of approval or d i s a p p r o v a l and i n d i c a t e s the extent to which a person b e l i e v e s her or h i m s e l f capable, s i g n i f i c a n t , s u c c e s s f u l , and worthy. It i s g e n e r a l l y b e l i e v e d that at some time preceding middle c h i l d h o o d , a person a r r i v e s at a general a p p r a i s a l of her or h i s worth, which remains r e l a t i v e l y s t a b l e and enduring over a p e r i o d of s e v e r a l years. This a p p r a i s a l can presumably be a f f e c t e d by s p e c i f i c i n c i d e n t s or by environmental changes but apparently i t r e v e r t s to i t s customary l e v e l when/if c o n d i t i o n s resume t h e i r "normal" course. Self-esteem may vary across d i f f e r e n t areas of experience and a c c o r d i n g to sex, age, and other r o l e - d e f i n i n g c o n d i t i o n s . For example, i t i s c o n c e i v a b l e that a person could regard s e l f as very worthy as a student, moderately worthy as a daughter/son, and not at a l l worthy as a b a s e b a l l p l a y e r . There are s e v e r a l l i n e s of evidence i n p s y c h o l o g i c a l l i t e r a t u r e p o i n t i n g to the importance of s e l f - e s t e e m . C l i n i c i a n s observe that persons who are plagued by doubts of - 30 -t h e i r worthiness can n e i t h e r give nor r e c e i v e love, apparently f e a r i n g that the exposure that comes with intimacy w i l l r e v e a l t h e i r inadequacies and cause them to be r e j e c t e d (Fromm, 1939}. As f a r back as 1954, J a n i s found that a person with low s e l f - e s t e e m i s l e s s capable of r e s i s t i n g p ressures to conform and i s l e s s able to p e r c e i v e t h r e a t e n i n g s t i m u l i . S t u d i e s of c r e a t i v e persons show that they rank q u i t e high i n s e l f - e s t e e m ( R u t t e r , 1985). Presumably, a b e l i e f i n one's p e r c e p t i o n s and the c o n v i c t i o n that one can impose order on a segment of the universe i s a b a s i c p r e r e q u i s i t e f o r s i g n i f i c a n t c r e a t i v i t y . Persons with high s e l f - e s t e e m are a l s o more l i k e l y to assume an a c t i v e r o l e i n s o c i a l groups and to express t h e i r views f r e q u e n t l y and e f f e c t i v e l y . Less t r o u b l e d by f e a r s and ambivalence, l e s s burdened by s e l f - d o u b t and minor p e r s o n a l i t y d i s t u r b a n c e s , the person with high s e l f - e s t e e m apparently moves more d i r e c t l y and r e a l i s t i c a l l y toward h i s or her personal g o a l s . In the next s e c t i o n two s e l f - e s t e e m measures w i l l be d e s c r i b e d . - 31 -Rosenberg Self-Esteem Scale (RSE) (See Appendix B) Author; Morris Rosenberg Purpose: This s c a l e measures the s e l f acceptance aspect of s e l f - e s t e e m . De s c r i p t i o n : The RSE i s a 10-item s c a l e . I t was o r i g i n a l l y designed (1962) to measure the s e l f - e s t e e m of high school students. The items were developed by reducing a l a r g e r pool of items and s e l e c t i n g items which d i f f e r e d s i g n i f i c a n t l y i n the numbers of people answering each way. The s c a l e has been used with many d i f f e r e n t groups i n c l u d i n g a d u l t s from v a r i o u s occupations. One of i t s g r e a t e s t s t r e n g t h s , and one of the reasons the RSE was chosen f o r purposes of t h i s r e s e a r c h , i s that i t i s w e l l known, and there has been a l a r g e amount of r e s e a r c h conducted with a wide range of groups on t h i s s c a l e over the years . A d m i n i s t r a t i o n and B r e v i t y : This s c a l e was designed s p e c i f i c a l l y with b r e v i t y and ease of a d m i n i s t r a t i o n i n mind. I t i s s u i t a b l e f o r o r a l or s e l f - a d m i n i s t r a t i o n , and r e q u i r e s approximately 5 to 10 minutes. Norms: The o r i g i n a l r e s e a r c h on the RSE was conducted on 5000 American high school students. Since that time f u r t h e r r e s e a r c h has i n v o l v e d thousands of a d u l t s and c o l l e g e students from a v a r i e t y of occupations and p r o f e s s i o n s . A high score i n d i c a t e s low s e l f - e s t e e m . Re 1 i a b i 1 i t y : The RSE has good i n t e r n a l c o n s i s t e n c y (a Guttman s c a l e c o e f f i c i e n t of r e p r o d u c i b i l i t y of .92). E x c e l l e n t s t a b i l i t y i s shown by two s t u d i e s of two-week t e s t - r e t e s t r e l i a b i l i t y ( c o r r e l a t i o n s were .85 and .88). - 32 -V a l i d i t y : T h i s t e s t c o r r e l a t e s s i g n i f i c a n t l y with s e l f - e s t e e m measures such as the Coopersmith Self-Esteem Inventory (a much l e n g t h i e r i n v e n t o r y ) . As w e l l , the RSE c o r r e l a t e s i n the p r e d i c t e d d i r e c t i o n with measures of dep r e s s i o n , a n x i e t y , and peer-group r e p u t a t i o n , showing good c o n s t r u c t v a l i d i t y by c o r r e l a t i n g with measures with which i t should t h e o r e t i c a l l y c o r r e l a t e and not c o r r e l a t i n g with those with which i t should not . Comment s: P o s i t i v e P o i n t s : The items are f a i r l y c l e a r and easy to understand, and the s c a l e i s b r i e f . I t has high r e l i a b i l i t y f o r such a short s c a l e . Negative P o i n t s : Not much rec e n t work has been done with the RSE. Primary Reference: Rosenberg, M. (1999). Conceiving the S e l f . New York: B a s i c Books. - 33 -Hare Self-Esteem Scale (HSS) CSee Appendix C) Author; Bruce R. Hare Purpose; To measure se l f - e s t e e m i n school age i n d i v i d u a l s . D e s c r i p t i o n : The HSS i s a 30-item measure of se l f - e s t e e m i n school age c h i l d r e n 10 years o l d and above. The HSS i s made up of three 10-item subscales (peer, s c h o o l , and home). The t o t a l score of a l l 30 items i s the o v e r a l l s e l f - e s t e e m measure. The reasoning behind c o n c l u d i n g that the t o t a l of the three subscales equates a general assessment of sel f - e s t e e m i s that peer, home, and school are the main areas of i n t e r a c t i o n i n which i n d i v i d u a l s develop a sense of s e l f - w o r t h . A d m i n i s t r a t i o n and B r e v i t y : The HSS can be administered i n d i v i d u a l l y or i n groups, o r a l l y or i n w r i t i n g . The t e s t i s s u i t a b l e f o r s e l f - a d m i n i s t r a t i o n , and r e q u i r e s approximately 10 minutes. Norms; The HSS was o r i g i n a l l y researched on 2S0 American high school and elementary school students. The mean ranges from 90.4 to 95 with a group mean of 91.1. A high score i n d i c a t e s high s e l f - e s t e e m . Re 1 i a b i 1 i t y : I n t e r n a l c o n s i s t e n c y i n f o r m a t i o n does not seem to e x i s t to date. T e s t - r e t e s t c o r r e l a t i o n s show f a i r s t a b i l i t y (a three-month c o r r e l a t i o n of .74 f o r the general sc a l e ) . V a l i d i t y : The HSS seems to have e x c e l l e n t concurrent v a l i d i t y (the general s c a l e c o r r e l a t e d .83 with both the Coopersmith Self-Esteem Inventory and the Rosenberg Self-Esteem Scale) . - 34 -Comment: This s c a l e i s appealing because i t allows an i n d i v i d u a l to show st r e n g t h i n one area without n e c e s s a r i l y s c o r i n g as having healthy self-esteem o v e r a l l . The obvious c l i n i c a l advantage i s that t h i s allows f o r b u i l d i n g on areas of s t r e n g t h . The P i e r s - H a r r i s and the Coopersmith s e l f - e s t e e m measures a l s o c o n t a i n subscales c o v e r i n g c e r t a i n areas of l i f e . However, the HSS was chosen f o r t h i s r e s e a r c h p r o j e c t because of i t s b r e v i t y and c l a r i t y of items. Primary Reference; Hare, B.R. (198S). The HARE general and a r e a - s p e c i f i c ( s c h o o l , peer, and home) se l f - e s t e e m s c a l e . Unpublished manuscript, Department of S o c i o l o g y , SUNY Stony Brook, Stony Brook, New York. - 35 -The Importance of As s e s s i n g Depression/Hopelessness According to Aaron Beck (1974), hopelessness i s a core c h a r a c t e r i s t i c of de p r e s s i o n , and serves as the l i n k between depression and s u i c i d e . Depression has been diagnosed i n approximately 20% of c h i l d and adolescent p s y c h i a t r i c c l i n i c r e f e r r a l s ( C o s t e l l o and Angold, 1988). Among s e x u a l l y abused ad o l e s c e n t s d e p r e s s i o n , s u i c i d e attempts, and r i s k t a k i n g behaviour i s much higher. There i s s t i l l c o n s i d e r a b l e u n c e r t a i n t y about the s t a t u s of depression as a syndrome i n childho o d and adolescence (Angold, 1988; Rutter, 1986). In these circumstances, and given that a d o l e s c e n t s , l i k e a d u l t s , may w e l l sometimes re p o r t normal unhappiness r a t h e r than p a t h o l o g i c a l symptoms i n response to a q u e s t i o n n a i r e , there i s no s u b s t i t u t e f o r the time-consuming task of making a c l i n i c a l assessment based upon the widest a v a i l a b l e range of i n f o r m a t i o n . Q u e s t i o n n a i r e s , however, can o f f e r u s e f u l i n s i g h t s i n t o an ado l e s c e n t ' s mental s t a t e , and a point of departure f o r d i s c u s s i o n s of f e e l i n g s and behaviour. A depression q u e s t i o n n a i r e can have uses with adolescents whose p r e s e n t i n g problems are not p r i m a r i l y a f f e c t i v e . Given c l i n i c i a n ' s tendency to focus on i n f o r m a t i o n l i k e l y to confirm t h e i r d i a g n o s i s ( C a n t w e l l , 1988), i t i s h e l p f u l to be reminded by q u e s t i o n n a i r e responses of the need to probe f o r a f f e c t i v e symptoms i n ad o l e s c e n t s p r e s e n t i n g with conduct, r e l a t i o n s h i p or l e a r n i n g problems. Such q u e s t i o n i n g can a l s o be u s e f u l i n f o r g i n g a treatment a l l i a n c e . - 36 -The Hopelessness Scale (HS) C See Appendix D) Author : Aaron Beck Purpose: To evaluate depression and negative e x p e c t a t i o n s about the f u t u r e . A d m i n i s t r a t i o n and B r e v i t y : This t e s t i s s u i t a b l e f o r o r a l or s e l f - a d m i n i s t r a t i o n , and r e q u i r e s approximately 5 to 10 minutes. C o n s t r u c t i o n of the HS: Two sources were u t i l i z e d i n s e l e c t i n g items f o r the 20-item t r u e - f a l s e Hopelessness S c a l e . Nine items were s e l e c t e d from a t e s t of a t t i t u d e s about the f u t u r e . The remaining 11 items were drawn from a pool of p e s s i m i s t i c statements made by p s y c h i a t r i c p a t i e n t s who were adjudged by c l i n i c i a n s to appear hopeless. Norms: The sample on which norms were based was made up of 47% men and 53% women. 62% were white and 37% were black. The mean age was 33 years, and the mean e d u c a t i o n a l attainment was grade 11. A high score i n d i c a t e s depression, and a score of 10 or more has been c o r r e l a t e d to s u i c i d e attempts. R e l i a b i l i t y : A p o p u l a t i o n of 294 h o s p i t a l i z e d a d u l t p a t i e n t s who had made recent s u i c i d e attempts provided the data f o r deter m i n a t i o n of the i n t e r n a l c o n s i s t e n c y of the HS. The i n t e r n a l c o n s i s t e n c y of the s c a l e was analyzed and y i e l d e d a r e l i a b i l i t y c o e f f i c i e n t of .93. The i t e m - t o t a l c o r r e l a t i o n c o e f f i c i e n t s ranged from .39 to .76. V a l i d i t y : Concurrent v a l i d i t y was determined by comparing HS scores with c l i n i c a l r a t i n g s of hopelessness and with other t e s t s designed to measure negative a t t i t u d e s about the - 3? -f u t u r e . C o r r e l a t i o n s of .60 to .86 have been obtained. The c o r r e l a t i o n with the pessimism item of the Beck Depression Inventory (DI) (Beck, 196?) was .63. The HS c o r r e l a t e d more h i g h l y with t h i s item than with any of the other items on the DI . Comments; This measure has been evaluated i n a number of s t u d i e s and has been found to be r e l i a b l e , s e n s i t i v e , and e a s i l y a dministered. The items are r e l a t i v e l y c l e a r , although they assume a c e r t a i n l e v e l of i n s i g h t and a b i l i t y to think about the f u t u r e (a developmental s k i l l ) . Thus the s c a l e may not be v a l i d f o r concrete t h i n k e r s who are developmentally "stuck". The Maples Adolescent Treatment Centre i s using the HS i n t h e i r assessment u n i t (a s i m i l a r p o p u l a t i o n to that f o r whom t h i s assessment p r o t o c o l i s intended) and they are f i n d i n g that they are o b t a i n i n g more c l i n i c a l l y v a l i d data than they were o b t a i n i n g from the Beck Depression Inventory with the same p o p u l a t i o n . It was f o r t h i s reason that the HS and not the w e l l known Beck Depression Inventory was t r i e d here. Both s c a l e s were developed with adul t p o p u l a t i o n s . Primary Reference: Beck, A.T., Weissman, A., L e s t e r , D., T r e x l e r , L. (1974). The Measurement of Pessimism: The Hopelessness S c a l e . J o u r n a l of C o n s u l t i n g and C l i n i c a l  Psychology. V o l . 42. 861-86S. - 38 -The C h i l d r e n ' s Depression Inventory (CDI) (See Appendix E) Author; Maria Kovacs Purpose: To assess depression i n c h i l d r e n ages 8 to 17 years. A d m i n i s t r a t i o n and B r e v i t y : The CDI i s a 27 item s c a l e r e q u i r i n g 10 to 15 minutes to complete. I t was o r i g i n a l l y designed to be administered to young people i n d i v i d u a l l y . The examiner may read the items aloud while the c h i l d / a d o l e s c e n t f o l l o w s along on h i s or her own copy. For o l d e r c h i l d r e n or c h i l d r e n who do not have reading d i f f i c u l t i e s , the c h i l d / a d o l e s c e n t may complete the i n v e n t o r y on h i s or her own. The examiner i s to remind the c h i l d or adolescent to answer about h i s or her f e e l i n g s during the past two weeks. It should take no more than 5 minutes to score the CDI. Scale C o n s t r u c t i o n : Dr. Kovacs i n i t i a l l y c o l l a b o r a t e d with Dr. Aaron Beck, the developer of the Beck Depression Inventory f o r a d u l t s . The Beck Depression Inventory served as a model f o r the development of the CDI (Kovacs G Beck, 1977). The CDI was intended as a r e s e a r c h instrument, and i t continues to undergo f u r t h e r e v a l u a t i o n s with v a r i o u s c h i l d h o o d p o p u l a t i o n s . Beginning i n 1975, 10- to 15-year-old youths were asked to help word the items on the Beck Depression Inventory so that they could be understood by c h i l d r e n t h e i r own age. As w e l l , the Beck item p e r t a i n i n g to sexual i n t e r e s t was r e p l a c e d by an item on l o n e l i n e s s , and f i v e items concerning school and peer f u n c t i o n i n g , and an item on self-blame were added. The f i n a l v e r s i o n of the CDI was p u b l i s h e d i n 1977 - 39 -f o l l o w i n g t e s t i n g with a group of 8- to 13-year-olds seen at a c h i l d guidance c l i n i c , a comparison group of "normal" c h i l d r e n , and a group of f i f t h and s i x t h grade c h i l d r e n . A review of the l i t e r a t u r e d i d not mention the s i z e of these samples. Each of the 27 items d e s c r i b e s a d i f f e r e n t symptom of c h i l d h o o d d e p r e s s i o n , i n c l u d i n g d i s t u r b a n c e s i n mood and hedonic c a p a c i t y , v e g e t a t i v e f u n c t i o n s , s e l f - e v a l u a t i o n , and i n t e r p e r s o n a l b e h a v i o r s . The CDI assesses a l l the d i a g n o s t i c c r i t e r i a i n DSM-III (American P s y c h i a t r i c A s s o c i a t i o n , 1980) except psychomotor a g i t a t i o n or r e t a r d a t i o n . Norms: At the present time, normative data p e r t a i n i n g to the scores y i e l d e d by the CDI and t h e i r r e l a t i o n s h i p to depression i n youth are s t i l l e v o l v i n g ( C a r l s o n C Cantwell, 1980; Esveldt-Dawson, 1983; Kovacs, 1980/1981/1983; Kovacs C Beck, 1977; M u l l i n s , S i e g e l , and Hodges, 198S) . This i s l a r g e l y due to the f a c t that c l i n i c i a n s and r e s e a r c h e r s have only r e c e n t l y reached general agreement r e g a r d i n g the c l a s s i f i c a t i o n of c h i l d h o o d depression as an a f f e c t i v e d i s o r d e r . Furthermore, there has only r e c e n t l y been concensus r e g a r d i n g the d i a g n o s t i c c r i t e r i a f o r depression i n t h i s p o p u l a t i o n (Swartz, 1986). Kovacs (1980/1981) i n i t i a l l y r eported that a CDI score of 9 was an average score i n n o n p s y c h i a t i c samples. She found that a score of 19 c l a s s i f i e d i n d i v i d u a l s w i t h i n the depressed range. This was reported to represent the 90th p e r c e n t i l e f o r normal c h i l d r e n and a d o l e s c e n t s . - 40 -R e l i a b i l i t y : The CDI has been evaluated through i n t e r n a l c o n s i s t e n c y and t e s t - r e t e s t methods. Kovacs (1983) r e p o r t s an acceptable i n t e r n a l c o n s i s t e n c y ( c o e f f i c i e n t alpha = .86) i n a sample of c h i l d r e n and a d o l e s c e n t s with d i v e r s e p s y c h i a t r i c diagnoses. S i m i l a r alpha c o e f f i c i e n t s are r e p o r t e d by numerous other i n v e s t i g a t o r s . Kovacs r e p o r t s a moderately high t e s t - r e t e s t c o r r e l a t i o n c o e f f i c i e n t of .82 over a one-month i n t e r v a l . Again s i m i l a r r e s u l t s are r e p o r t e d by other i n v e s t i g a t o r s . Content V a l i d i t y : The CDI has good content v a l i d i t y i f the DSM-III d i a g n o s t i c c r i t e r i a f o r Major Depressive D i s o r d e r are used as the a p p r o p r i a t e content domain to be assessed. Concurrent V a l i d i t y : Kovacs (1983) r e p o r t s a s i g n i f i c a n t c o r r e l a t i o n between d e p r e s s i v e CDI scores and low s e l f - e s t e e m as measured by the Coopersmith Self-Esteem Inventory ( r = - . 59) . Comment; The CDI's appeal f o r t h i s assessment package i s that i t i s c u r r e n t l y thought to be the most commonly used measure of c h i l d and adolescent d e p r e s s i o n , and that i t s items are c o n c e p t u a l l y c l e a r and simple. Primary Reference: Kovacs, M. (1983). The C h i l d r e n ' s Depression Inventory. Unpublished Manuscript, U n i v e r s i t y of P i t t sburgh. - 41 -The C h i l d r e n ' s N o w i c k i - S t r i c k l a n d Locus of C o n t r o l Scale (N-SLCS) (See Appendix F) Authors; Stephen Nowicki, J r . , and B. S t r i c k l a n d Purpose: To measure whether an i n d i v i d u a l b e l i e v e s i n an i n t e r n a l or an e x t e r n a l c o n t r o l of h i s or her l i f e . A d m i n i s t r a t i o n and B r e v i t y ; The N-SLCS i s a paper and p e n c i l assessment of the locus of c o n t r o l . The s c a l e c o n s i s t s of 40 questions that are answered by marking e i t h e r yes or no. This s c a l e r e q u i r e s approximately 15 to 20 minutes to complete. Test C o n s t r u c t i o n and Norms; The s c a l e d e r i v e d from 102 items based on R o t t e r ' s (1966) d e f i n i t i o n of i n t e r n a l - e x t e r n a l c o n t r o l . The items d e s c r i b e d reinforcement s i t u a t i o n s across areas such as a f f i l i a t i o n , achievement, and dependency. School teachers helped i n the c o n s t r u c t i o n of the items. The 102 items along with R o t t e r ' s d e f i n i t i o n of the locus of c o n t r o l were given to a group of nine c l i n i c a l psychology s t a f f who were asked to answer the items i n an e x t e r n a l d i r e c t i o n . Items on which there was not complete agreement among the judges were dropped. This l e f t 59 items. The 59 item form of the t e s t was then given to a sample 152 American high school and elementary school c h i l d r e n . C o n t r o l l i n g f o r IQ, i n t e r n a l s performed s i g n i f i c a n t l y b e t t e r than e x t e r n a l s on achievement t e s t s c o res. T e s t - r e t e s t r e l i a b i l i t i e s f o r a s i x week p e r i o d were .75 f o r those i n the 12 to 15 year o l d i group. Item a n a l y s i s was computed to make a somewhat more homogeneous s c a l e and to examine the d i s c r i m i n a t i v e performance of the items. The r e s u l t s of t h i s a n a l y s i s , as - 42 -well as comments from teachers and p u p i l s i n the sample led to the present form of the s c a l e c o n s i s t i n g of 40 items. The 40 item s c a l e was given to 1,017 American t h i r d through 12th graders to gather r e l i a b i l i t y data, demographic measures and c o n s t r u c t v a l i d i t y i n f o r m a t i o n . A l l schools were i n a county b o r d e r i n g a l a r g e m e t r o p o l i t a n school system, and most of the students were C a u c a s i a n . Socioeconomic i n f o r m a t i o n o b t a i n e d from school records and H o l l i n g s h e a d Index of S o c i a l P o s i t i o n (1957) rankings i n d i c a t e d that although the lower l e v e l o c c u p a t i o n s were somewhat over represented, a l l l e v e l s , except the very highest one, were w e l l represented. I n t e l l i g e n c e t e s t scores f o r males and females ranged from means of 101 to 106 as measured by O t i s Lennon s c a l e s . There were no s i g n i f i c a n t d i f f e r e n c e s across groups. Means range from 11.01 to 18.60, and responses tended to become more i n t e r n a l with age. R e l i a b i l i t y : The N-SLCS has f a i r i n t e r n a l c o n s i s t e n c y of .68. D i s c r i m i n a t i v e V a l i d i t y : Nowicki and S t r i c k l a n d (1973) repor t e d n o n s i g n i f i c a n t c o r r e l a t i o n s between locus of c o n t r o l scores and s o c i a l d e s i r a b i l i t y i n grades three to twelve. I n t e l l i g e n c e i s another v a r i a b l e that should be u n r e l a t e d to L0C scores. Nowicki and S t r i c k l a n d C1973) and Nowicki and Roundtree (1971) r e p o r t n o n s i g n i f i c a n t c o r r e l a t i o n s between the N-SLCS scores and IQ scores. It a l s o seems that sex of the subject does not lead to d i f f e r e n t locus of c o n t r o l s c o res. The mean score of males and females i s e s s e n t i a l l y the same when compared to - 43 -e q u i v a l e n t age l e v e l s (Nowicki and Duke, 1983). Construct V a l i d i t y ; Nowicki and S t r i c k l a n d (1973) repo r t e d moderate r e l a t i o n s between the N-SLCS and other measures of, locus of c o n t r o l . S o c i a l C l a s s : Nowicki and S t r i c k l a n d (1973) r e p o r t e d a s i g n i f i c a n t r e l a t i o n between N-SLCS scores and s o c i a l c l a s s , with i n t e r n a l i t y being moderately but s i g n i f i c a n t l y r e l a t e d to higher s o c i a l c l a s s . T h i s r e l a t i o n was a l s o found by s e v e r a l others (e.g. Ludwigsen & R o l l i n s , 1970). Race: In terms of race, i t has been found that blacks score more e x t e r n a l l y than whites (Marcus, 1975; Nowicki, 1976; Fry r e G C a r l son, 1976). The expected movement of scores toward a more i n t e r n a l o r i e n t a t i o n with age i s not f o l l o w e d by the black s u b j e c t s . In f a c t , i n most cases black s u b j e c t s became more e x t e r n a l with age. It i s d i f f i c u l t to separate the impact of lower s o c i a l c l a s s on these race f i n d i n g s . Indians have a l s o been found to score more e x t e r n a l l y than whites ( T y l e r G H o l s i n g e r , 1975; Hawk G Parsons, 1976). This makes sense i n that i t would be somewhat of an i l l u s i o n f o r suppressed or powerless groups to score i n t e r n a l l y . Gender; Males and females do not d i f f e r i n any c o n s i s t e n t f a s h i o n i n mean response to the N-SLCS r e g a r d l e s s of age or race (Nowicki and S t r i c k l a n d , 1973). Achievement: I n t e r n a l i t y has been a s s o c i a t e d with academic achievement as w e l l as with those behaviors a s s o c i a t e d with academic achievement, such as p e r s i s t e n c e (Nowicki and S t r i c k l a n d , 1973; Wyner and Blachare, 1976). The p r e d i c t e d r e l a t i o n s h i p between i n t e r n a l i t y and g r e a t e r academic - 44 -a c h i e v e m e n t h o l d s not o n l y f o r A m e r i c a n c h i l d r e n but a l s o f o r D a n i s h c h i l d r e n ( A f e d o G F o n s b o l , 1975), H u n g a r i a n c h i l d r e n (Rupp G N o w i c k i , 1976), and M e x i c a n A m e r i c a n s [ C e r v a n t e s , 1976a, b ) . H e l p l e s s n e s s : Mount (197S) i n a s t u d y o f h e l p l e s s n e s s and l o c u s o f c o n t r o l o r i e n t a t i o n r e p o r t e d c o r r e l a t i o n s r a n g i n g f r o m .35 t o .47. C o n s t i t u t i o n a l : In a d d i t i o n t o d e m o g r a p h i c and a c h i e v e m e n t d a t a , c o n s t i t u t i o n a l d i f f e r e n c e s a r e a n o t h e r s o u r c e o f d a t a u s e f u l i n a s s e s s i n g t h e v a l i d i t y o f t h e N-SLCS. E m o t i o n a l l y d i s t u r b e d a d o l e s c e n t s were f o u n d t o be more e x t e r n a l ( K e n d a l l , F i n c h , L i t t l e , G O l l e n d i c k , 1976). A l s o , d e l i n q u e n t y o u t h have been f o u n d t o be more e x t e r n a l t h a n y o u t h who a r e not i n t r o u b l e w i t h th e law ( K e n d a l l e t . a l . , 1976; H e n d r i x , 1975; E l e n e w s k i , 1974; Fenhagen, 1973; S t e i n , 1974; L u d w i g s e n G H a s k i n s , 1976). P s y c h o l o g i c a l m a l a d j u s t m e n t has a l s o been r e l a t e d t o e x t e r n a l i t y ( M c C l a n a h a n , 1975). The most m a s s i v e c o n f i r m a t i o n o f t h i s f a c t were r e s u l t s f r o m a y e a r l o n g s t u d y o f a l l i n s t i t u t i o n a l i z e d c h i l d r e n i n the s t a t e o f G e o r g i a (Thomas, 1974). A somewhat s h o r t e n e d f o r m o f t h e N-SLCS was g i v e n t o 2000 i n s t i t u t i o n a l i z e d and 1500 n o n i n s t i t u t i o n a l i z e d c h i l d r e n and a d o e s c e n t s . Those who were i n s t i t u t i o n a l i z e d were more e x t e r n a l t h a n t h e i r c o n t r o l s . P e r s o n a l i t y : L o c u s o f c o n t r o l has been r e l a t e d t o o t h e r p e r s o n a l i t y v a r i a b l e s i n a t h e o r e t i c a l l y c o n s i s t e n t f a s h i o n . F o r example, i n t e r n a l i t y has been r e l a t e d t o h i g h e r s e l f - e s t e e m ( G o r d o n G W i l b u r , 1973; Gordon, 1976; R o b e r t s , - 45 -1971), higher s e l f - c o n c e p t (Cervantes, 1976; M o r r i s , 1976; Gordon, 1976), higher moral development (Grotsky, 1973), lower a n x i e t y CKendall, K e e r d o r f f , F i n c h G Graham, 1976), and l e s s i n t e r p e r s o n a l d i s t a n c e (Duke G Nowicki, 1974; M o r r i s , 1975; Ude, 1975). Primary Reference: Nowicki, S. G S t r i c k l a n d , B. (1973). A Locus of C o n t r o l Scale f o r C h i l d r e n . J o u r n a l of C o n s u l t i n g  and C l i n i c a l Psychology. 40. 148-154. - 46 -The I n t e r p e r s o n a l M a t u r i t y L e v e l A s s e s s m e n t ( I - L e v e l ) ( S e e A p p e n d i x G) A u t h o r s : The I - l e v e l was d e v e l o p e d o v e r t h e e a r l y 1960's by Dr. M a r g u e r i t e Warren and h e r c o l l e a g u e s at t h e C a l i f o r n i a Youth A u t h o r i t y (CYA) f o r use i n t h e Community T r e a t m e n t P r o j e c t f u n d e d by the N a t i o n a l I n s t i t u t e o f M e n t a l H e a l t h . P u r p o s e ; To a s s e s s t h e c o g n i t i v e and m o r a l d e v e l o p m e n t o f a d o l e s c e n t s ( d e v e l o p m e n t a l c o p i n g , d e l a y s , d i s t o r t i o n s ) . I - l e v e l a t t e m p t s t o e x p l a i n how t h e s t a g e o f d e v e l o p m e n t a l growth a t wh i c h a y o u t h i s f u n c t i o n i n g may i n f l u e n c e o r d e t e r m i n e h i s o r h e r b e h a v i o r s . The two b a s i c g o a l s o f an I - l e v e l A s s e s s m e n t a r e t o o b t a i n : (1) The i n t e r v i e w e e ' s p e r c e p t i o n o f t h e w o r l d - h i s o r h e r view o f s e l f , o t h e r s and o f r e l a t i o n s h i p s among t h e s e p e r c e p t i o n s ( i . e . , I n t e r p e r s o n a l M a t u r i t y L e v e l ) ; and (2) t h e i n t e r v i e w e e ' s way o f r e s p o n d i n g t o h i s o r h e r p e r c e p t i o n s o f t h e w o r l d - t y p i c a l p a t t e r n s o f a d j u s t m e n t / c o p i n g ( i . e . , s u b t y p e w i t h i n I n t e r p e r s o n a l M a t u r i t y L e v e l ) . (3) Based on t h e above, t o make rec o m m e n d a t i o n s about w o r k e r - c l i e n t m a t c h i n g and a t r e a t m e n t p l a n t h a t w i l l make s e n s e t o t h e c l i e n t , g i v e n t h e i r l e v e l o f d e v e l o p m e n t a l m a t u r i t y and g i v e n t h e i r a d j u s t m e n t / c o p i n g / s u r v i v a 1 p a t t e r n s . I - l e v e l t r i e s t o e x p l a i n " n o r m a l " and a n t i - s o c i a l b e h a v i o r f o r t h e p u r p o s e o f p r e d i c t i o n , p r e v e n t i o n and t r e a t m e n t . O r i g i n and De v e l o p m e n t : I - l e v e l ( s h o r t f o r I n t e g r a t i o n L e v e l ) began as a g e n e r a l t h e o r y o f p e r s o n a l i t y d e v e l o p m e n t . The - 47 -t h e o r y was d e v e l o p e d by a group o f p s y c h o l o g y s t u d e n t s at B e r k l e y d u r i n g t h e l a t e 1950s. I t s a u t h o r s s o u g h t t o i n t e g r a t e d e v e l o p m e n t a l , p s y c h o a n a l y t i c , L e w i n i a n , and s o c i a l p e r c e p t u a l p e r s p e c t i v e s i n t o a s i n g l e d i m e n s i o n o f p e r s o n a l i t y d e v e l o p m e n t t h a t d e s c r i b e d p e r s o n a l d e v e l o p m e n t i n terms o f i n c r e a s i n g p e r c e p t u a l c o m p l e x i t y and i n t e r p e r s o n a l m a t u r i t y . Seven s u c c e s s i v e s t a g e s o f dev e l o p m e n t were s p e c i f i e d , r a n g i n g f r o m t h e l e a s t mature, t h a t common t o t h e new-born i n f a n t , t o S t a g e 7, a h y p o t h e t i c a l s t a g e o f d e v e l o p m e n t u n l i k e l y t o be a c h i e v e d by anyone. I - L e v e l i n B r i e f V e ry r o u g h l y , s u c c e s s f u l e l e m e n t a r y s c h o o l f u n c t i o n i n g r e q u i r e s S t a g e 3 d e v e l o p m e n t , s u c c e s s f u l h i g h s c h o o l f u n c t i o n i n g r e q u i r e s S t a g e 4 d e v e l o p m e n t , and s u c c e s s f u l / h e a l t h y / m a t u r e a d u l t f u n c t i o n i n g r e q u i r e s S t a g e 5 d e v e l o p m e n t . The f o u r s t a g e s o f d e v e l o p m e n t common t o a d o l e s c e n t s i n t r e a t m e n t propgrams a r e as f o l l o w s : I 2 i s a s t a g e o f v e r y young c h i l d r e n . O t h e r p e o p l e a r e viewed s o l e l y as s o u r c e s o f g r a t i f i c a t i o n . G r a t i f i c a t i o n can not be d e l a y e d . Our s o c i e t y does not t o l e r a t e t h i s k i n d o f b e h a v i o r i n a d o l e s c e n t s and t h e r e f o r e s u c h y o u t h a r e u n s u a l l y i n j u v e n i l e d e t e n t i o n o r t r e a t m e n t c e n t r e s . I 3 y o u t h s have l e a r n e d t h a t t h e y have power. T h e i r b e h a v i o u r s a f f e c t t h e r e s p o n s e t h e y r e c e i v e f r o m o t h e r s . They a r e k e e n l y i n t e r e s t e d i n who has t h e power and what a r e th e f o r m u l a e t h e y need t o a p p l y i n o r d e r t o g e t what t h e y - 48 -want. T h i s i s a v e r y c o n c r e t e s t a g e , and v a l u e s have not y e t been i n t e r n a l i z e d . Our s o c i e t y does not t o l e r a t e l e v e l 3 b e h a v i o r i n a d u l t s , and as one V a n c o u v e r I - l e v e l t r a i n e r s u g g e s t e d , most l e v e l 3 a d u l t s would end up i n j a i l . I 4 y o u t h a r e more aware o f f e e l i n g s and m o t i v e s . They a l s o o p e r a t e f r o m i n t e r n a l i z e d v a l u e s and m o r a l s w h i c h t h e y a p p l y i n a r i g i d b l a c k and w h i t e manner. T h i s i s t h e phase o f a d o l e s c e n c e when one f e e l s t h a t one knows i t a l l . Some a d u l t s n e v e r grow beyond t h i s l e v e l , A r c h i e Bunker b e i n g a c l a s s i c f i c t i t i o u s TV example. J: 5 i s a s t a g e o f d e v e l o p m e n t uncommon among a d o l e s c e n t s i n t r e a t m e n t p r o g r a m s . At l e v e l S one t e n d s t o see g r e y a r e a s and i s t o l e r a n t o f v i e w p o i n t s t h a t d i f f e r f r o m one's own. Warren ( p r e v i o u s l y G r a n t ) (1961) f u r t h e r d e v e l o p e d t h e c l a s s i f i c a t i o n s y s t e m by a d d i n g t o t h e t h e o r e t i c a l model a s e t o f n i n e " d e v e l o p m e n t a l l y s t u c k " o r a n t i - s o c i a l s u b t y p e s . A l t h o u g h t h e I - l e v e l s t a g e s f i t f o r t h e p o p u l a t i o n i n g e n e r a l , not e v e r y o n e p a s s e s t h r o u g h t h e s u b t y p e s . F i t t i n g t h e d e s c r i p t i o n o f one o f t h e s u b t y p e s i s i n d i c a t i v e o f u n h e a l t h y e m o t i o n a l f u n c t i o n i n g . The s u b t y p e s d e f i n e ways i n which i n d i v i d u a l s r e s p o n d t o t h e i r p e r c e i v e d w o r l d s , e a c h c o n t a i n i n g c l u s t e r s o f t r a i t s d e r i v e d f r o m c l i n i c a l d e s c r i p t i o n s o f d e l i n q u e n t o r t r o u b l e d y o u t h s . K e e p i n g b r e v i t y i n mind, t h e t h r e e most common s u b t y p e s f o u n d among V a n c o u v e r p o p u l a t i o n s o f a d o l e s c e n t s i n t r e a t m e n t programs w i l l be d e s c r i b e d below. These s u b t y p e s a r e not d e v e l o p m e n t a l . They d e s c r i b e p a t t e r n s o f r e s p o n s e o r a d a p t a t i o n s t o p e r c e i v e d w o r l d s . - 49 -I 3 Immature C o n f o r m i s t s , i n an e f f o r t t o seek a p p r o v a l , c o n f o r m t o whomever has t h e power at the moment. Thus commitments o r p r o m i s e s a r e s i n c e r e , but mean n o t h i n g . I 4 N e u r o t i c A c t i n g - o u t y o u t h a r e i n t e r n a l l y c o n f l i c t e d due t o n e g a t i v e s e l f - i m a g e . They put on a f a c a d e o f s u p e r a d e q u a c y . They have done e v e r y t h i n g b i g g e r and b e t t e r , and no wrong d o i n g s a r e e v e r t h e i r f a u l t . These i n d i v i d u a l s a r e a l w a y s on t h e go i n an e f f o r t not t o f o c u s on t h e d i f f i c u l t i n n e r f e e l i n g s . They may become a g g r e s s i v e i n one o f t h e i r c o n s t a n t a t t e m p t s t o keep o t h e r s at a d i s t a n c e . T h i s need f o r d i s t a n c e s h o u l d t o be r e s p e c t e d . I 4 N e u r o t i c A n x i o u s i n d i v i d u a l s a r e a l s o i n t e r n a l l y c o n f l i c t e d due t o a n e g a t i v e s e l f - i m a g e . Y e t , r a t h e r t h a n b l a m i n g o t h e r s f o r a l l t h e p r o b l e m s t h a t come t h e i r way, t h e y t e n d t o blame t h e m s e l v e s . These i n d i v i d u a l s t e n d t o be i n t r o s p e c t i v e . They f r e q u e n t l y t r y t o engage s e v e r a l o t h e r s i n t h e i r s e l f - a n a l y t i c a l a t t e m p t s . The v a l u e o f e n g a g i n g s e v e r a l o t h e r s i s t h a t i f anyone g e t s t o o c l o s e t o t h e " t r u t h " , t h e i n d i v i d u a l can move o n t o a s a f e r c o n f i d a n t o r c o u n s e l l o r who i s more d i s t a n t . I l e v e l b a s i c a l l y c o m p r i s e s f o u r p a r t s : 1 . D e v e l o p m e n t a l T h e o r y : As n o t e d , I - l e v e l i s r o o t e d i n c o g n i t i v e d e v e l o p m e n t a l t h e o r y . C o n c e p t s f r o m d e v e l o p m e n t a l t h e o r i e s a r e used t o f a c i l i t a t e t h e u n d e r s t a n d i n g and e x p l a n a t i o n o f " n o r m a l " and p r o b l e m b e h a v i o r . 2. D i a g n o s i s ; I - l e v e l d i a g n o s i s , as n o t e d , a s s e s s e s t h e a d o l e s c e n t ' s d e v e l o p m e n t a l p e r c e p t i o n / u n d e r s t a n d i n g o f s e l f , - 5 0 -others , and the world around him or her. I - l e v e l d i a g n o s i s d e s c r i b e s each youth as a unique i n d i v i d u a l with both s t r e n g t h s and v u l n e r a b i l i t i e s . The v u l n e r a b i l i t i e s were o f t e n previous s t r e n g t h s or ways of coping which the youth had to l e a r n i n order to get through a d i f f i c u l t l i f e s i t u t a t i o n . D i f f e r e n t t h i n g s are going to be important and make sense to d i f f e r e n t youth. I f s o c i e t y i s going to i n t e r v e n e , I - l e v e l recommends i n t e r v e n i n g i n a way that makes sense to the youth. D e s c r i b i n g what makes sense i s the whole point of the d i a g n o s t i c l a b e l . 3- Treatment: The reason that I - l e v e l has become so popular i n c h i l d welfare and j u v e n i l e p r o b a t i o n i s that i t provides more than j u s t another assessment. I - l e v e l a l s o provides p r a c t i c a l d i f f e r e n t i a l treatment recommendations - that i s , d i f f e r e n t ways of meeting the i n d i v i d u a l needs of each youth and i n t e r v e n i n g so that the youth w i l l not get deeper and deeper i n t o a c y c l e of a n t i - s o c i a l behavior and be r e p e t i t i v e l y i n s t i t u t i o n a l i z e d . Since treatment program design emphasizes the uniqueness of each youth, the I - l e v e l treatment program provides a general framework and the i n d i v i d u a l i t y of the i n v o l v e d youth d i c t a t e s the s p e c i f i c s . 4. Worker-Client Matching: I - l e v e l suggests that the r e l a t i o n s h i p between a youth and h i s or her workers i s a h i g h l y s i g n i f i c a n t part of treatment. Thus, I - l e v e l d e s c r i b e s d i f f e r e n t kinds of worker s t y l e s and has developed a method of c l a s s i f y i n g the worker f o r the purpose of matching youths and workers who have s i m i l a r approaches to i n t e r p e r s o n a l i n t e r a c t i o n and can t h e r e f o r e more r e a d i l y - 51 -develop a working c o m p a t i b i l i t y . Just as a w o r k e r - c l i e n t mismatch may lead to i n e f f e c t i v e i n t e r v e n t i o n with the youth, so i t may a l s o be harmful f o r the worker, making him or her f e e l a f a i l u r e when i t i s a c t u a l l y h i s or her c h a r a c t e r i s t i c s t y l e of i n t e r a c t i o n that i s not compatible with the youth's p r e f e r r e d way of r e l a t i n g to people, and the worker may be very e f f e c t i v e With matched c l i e n t s . I - l e v e l a l s o recommends worker r o l e s (e.g. t h e r a p i s t , tough b i g b r o t h e r / s i s t e r , teacher, concerned peer) which can enhance the worker-youth r e l a t i o n s h i p f o r the purpose of maximizing e f f e c t i v e i n t e r v e n t i o n . For example, an I 4 Na would f e e l most comfortable with a worker who can have a b u s i n e s s - l i k e approach to t h e i r r e l a t i o n s h i p , and who can be a c t i v e and presents as " c o o l " i n the popular slang sense of the word. An I 4 Nx would f e e l more comfortable with a worker who l i k e s to s i t around and l i s t e n and be the c o u n s e l l o r . An I 3 cfm i s best matched to a very n u r t u r i n g , g i v i n g , c l e a r , p a t i e n t worker. A d m i n i s t r a t i o n and B r e v i t y : A c l i n i c a l s e m i - s t r u c t u r e d i n t e r v i e w of about one hour i n length i s the o r i g i n a l method by which an I - l e v e l c l a s s i f i c a t i o n i s reached. (See sample i n t e r v i e w q u e s t i o n s i n Appendix G.) A l l i n t e r v i e w s are tape recorded to allow f o r l a t e r r a t i n g of the i n t e r v i e w . D i a g n o s t i c r a t i n g s are obtained from the i n t e r v i e w e r and an a d d i t i o n a l d i a g n o s t i c i a n . The purpose of the second r a t i n g i s to determine the l e v e l of r e l i a b i l i t y being obtained and to c o n t r o l f o r s e l e c t i v e h e aring. This i n t e r v i e w method i s o b v i o u s l y very c o s t l y . F i r s t , t r a i n i n g of a c l a s s i f i e r - 52 -r e q u i r e s three weeks of i n t e n s e t r a i n i n g . Secondly, the i n t e r v i e w and second r a t i n g takes a minimum of f o u r hours. Much more time i s i n v o l v e d i f a w r i t t e n I - l e v e l r e p o r t i s produced. The Jesness Inventory (Jesness & Wedge, 1983} paper and p e n c i l method of c l a s s i f i c a t i o n o f f e r s a l e s s expensive or l e s s time consuming a l t e r n a t i v e of I - l e v e l c l a s s i f i c a t i o n , s o l v i n g both the t r a i n i n g and i n t e r r a t e r r e l i a b i l i t y problems. However u s u a l l y agency personnel are i n t e r e s t e d i n o b t a i n i n g the f a r r i c h e r set of data and themes a r i s i n g out of the i n t e r v i e w method. R e l i a b i l i t y : R e l i a b i l i t y of I - l e v e l c l a s s i f i c a t i o n s has been t e s t e d i n terms of i n t e r r a t e r and t e s t - r e t e s t r e l i a b i l i t y . R e l i a b i l i t y s t u d i e s have produced v a r y i n g r e s u l t s ranging from 67% to 92% i n t e r r a t e r agreement (Palmer and Wernner, 1972; Jesness, 1974; H a r r i s , 1983, 1986). This variance i s not s u r p r i s i n g given that proper c l a s s i f i c a t i o n r e l i e s on t r a i n i n g and experience. H a r r i s (1988) w r i t e s that "problems i n t h i s area are well-known and the p o t e n t i a l f o r c o r r e c t i n g t hem e x i s t s . " V a l i d i t y ; V a l i d i t y of the i n t e r v i e w c l a s s i f i c a t i o n method has been addressed only i n terms of c o n s t r u c t v a l i d i t y . I - l e v e l theory c l o s e l y resembles other t h e o r i e s of p e r s o n a l i t y development such as Moral Development (Kohlberg, 1966), Conceptual L e v e l (Hunt, 1971), and Ego Development (Lo e v i n g e r , 1976). Jesness found that I - l e v e l was s t r o n g l y r e l a t e d to Loevinger's (1976) ego-development continuum ( r = .47). Werner (1975) t e s t e d the c o n s t r u c t v a l i d i t y of I - l e v e l - S3 -i n terms of c l u s t e r s of p r o f i l e s on the C a l i f o r n i a P e r s o n a l i t y Inventory. He found higher I - l e v e l r a t i n g s ( h i g h e r l e v e l s of developmental maturity) to be r e l a t e d to such p e r s o n a l i t y c h a r a c t e r i s t i c s as i n t e r n a l i z a t i o n of values, t o l e r a n c e , independence, and f l e x i b i t i t y . Norms: Although I - l e v e l l a t e r became a system f o r d i f f e r e n t i a t i o n g among delinquent youths, i t was i n i t i a l l y a theory of normal p e r s o n a l i t y development designed as a means of c o n c e p t u a l i z i n g the extent of a person's ego development. H a r r i s (1983) found that only 35% of a sample of males drawn from a general student p o p u l a t i o n f i t any of the I - l e v e l subtypes. This lends support to the p r e d i c t a b l e concept that the subtypes d e s c r i b e only a p o r t i o n of the p o p u l a t i o n , a n t i - s o c i a l or t r o u b l e d youths, and that the subtypes are not g e n e r l i z a b l e to the o v e r a l l p o p u l a t i o n . T h i s i s not s u r p r i s i n g given that I - l e v e l theory has evolved to i t s c u r r e n t form as a treatment planning and e v a l u a t i o n t o o l f o r t r o u b l e d youth. The l e v e l s or stages, however, were c o n c e p t u a l i z e d to hold true developmentally f o r the general p o p u l a t i o n i n c l u d i n g a l l ages. No data i s a v a i l a b l e r e g a r d i n g the extent to which t h i s i s t r u e . Comment s: I - l e v e l i s c l e a r l y very complex. I t takes i n t o account both p e r s o n a l i t y development and p e r s o n a l i t y type. As noted, I - l e v e l i s p r i m a r i l y u s e f u l as a treatment planning t o o l . I t provides a wealth of i n f o r m a t i o n p e r t a i n i n g to treatment goals, p r e d i c t a b l e e x p e c t a t i o n s w i t h i n the treatment process, and h e l p f u l methods. - 54 -P r i m a r y R e f e r e n c e ; Warren, M. G t h e Community T r e a t m e n t P r o j e c t S t a f f . ( 1 9 6 6 ) . I n t e r p e r s o n a l M a t u r i t y L e v e l C l a s s i f i c a t i o n : J u v e n i l e D i a g n o s i s and T r e a t m e n t o f Low,  M i d d l e and H i g h M a t u r i t y D e l i n q u e n t s . S a c r a m e n t o : C a l i f o r n i a Y outh A u t h o r i t y . - 55 -The Sexual Abuse Impact C h e c k l i s t s (See Appedix I) Developed by; The Sexual A s s a u l t Center at Harborview Medical Center, S e a t t l e , Washington. Purpose: To i d e n t i f y some of the e f f e c t s of sexual abuse on c h i l d r e n and a d o l e s c e n t s . A d m i n i s t r a t i o n and B r e v i t y : The c h e c k l s i t s can be administered v e r b a l l y or can be s e l f - a d m i n i s t e r e d . Approximately 20 minutes per c h e c k l i s t i s r e q u i r e d , or longer i f p r e s s i n g c l i n i c a l i s s u e s a r i s e (e.g. s u i c i d a l i d e a t i o n , v i o l e n t f a n t a s i e s , p l a c i n g s e l f i n dangerous s i t u a t i o n s , overwhelming g u i l t ) . There are three separate c h e c k l i s t s , one to be answered by a nonoffending parent, one to be answered by the c h i l d ' s s o c i a l worker, and one to be answered by the c h i l d . NIMH Study (Norms): Conte, B e r l i n e r , and Schuerman (1986), used and r e v i s e d the Impact C h e c k l i s t s i n a la r g e study funded by the N a t i o n a l I n s t i t u t e of Mental Health. The study d e s c r i b e s the e f f e c t s of sexual abuse on a sample of 369 s e x u a l l y abused c h i l d r e n seen by the Sexual A s s a u l t Center at Harborview Medical Center i n S e a t t l e between September 1983 and May 1985. The age range was from 4 to 1? years. 96% were female and 24% were male. 82% were white. Construct V a l i d i t y : The items f o r the three impact c h e c k l i s t s were d e r i v e d from sexual abuse l i t e r a t u r e and a survey of experienced s p e c i a l i z e d t h e r a p i s t s . When the c h e c k l i s t s were t e s t e d with abused and nonabused p o p u l a t i o n s , many items were dropped from the o r i g i n a l c h e c k l i s t s due to i n s i g n i f i c a n t v a r i a t i o n between groups. The items from the parent - 56 -c o m p l e t e d c h e c k l i s t were f a c t o r a n a l y z e d r e s u l t i n g i n e i g h t f a c t o r s : p o o r s e l f - e s t e e m , a g g r e s s i o n , f e a r f u l n e s s , c o n s c i e n t i o u s n e s s , d i f f i c u l t y i n c o n c e n t r a t i o n , w i t h d r a w a l , a c t i n g o u t , and a n x i o u s n e s s t o p l e a s e / t r i e s t o o h a r d . D i f f e r e n c e s between a b u s e d and c o m p a r i s o n c h i l d r e n on t h e s e f e t o r s a r e a l l s t a t i s t i c a l l y s i g n i f i c a n t . The 65 v a r i a b l e s p o t e n t i a l l y a s s o c i a t e d w i t h v a r i a t i o n i n t h e e f f e c t s o f s e x u a l abuse on c h l d r e n and a d o l e s c e n t s were r e d u c e d t o 35 on t h e b a s i s o f low i t e m c o r r e l a t i o n s between c h i l d and p a r e n t s c o r e s , o r between c h i l d and s o c i a l w o r k e r s c o r e s , o r C e n t e r e d ) b e c a u s e o f c l i n i c a l o r t h e o r e t i c a l i n t e r e s t . H i g h s c o r e s on t h e s o c i a l w o rker c o m p l e t e d Impact C h e c k l i s t were p o s i t i v e l y a s s o c i a t e d w i t h p o o r f a m i l y f u n c t i o n i n g , e x p o s u r e t o more t y p e s o f s e x u a l b e h a v i o r , p h y s i c a l r e s t r a i n t as p a r t o f t h e a b u s e, th e v i c t i m f e a r i n g n e g a t i v e c o n s e q u e n c e s t o s e l f , and t h e o f f e n d e r ' s d e n y i n g t h a t t h e abuse took p l a c e . H i g h s o c i a l w o rker s c o r e s were i n v e r s e l y r e l a t e d t o a v i c t i m ' s h a v i n g a s u p p o r t i v e r e l a t i o n s h i p w i t h an a d u l t o r s i b l i n g . The v i c t i m ' s h a v i n g a s u p p o r t i v e r e l a t i o n s h i p w i t h an a d u l t was a l s o n e g a t i v e l y a s s o c i a t e d w i t h h i g h s c o r e s on p a r e n t c o m p l e t e d c h e c k l i s t s . The number o f p r o b l e m s i n l i v i n g e x p e r i e n c e d by t h e v i c t i m ' s f a m i l y and t h e d e g r e e t o which th e v i c t i m s e e s s e l f as r e s p o n s i b l e f o r the abuse were p o s i t i v e l y a s s o c i a t e d w i t h h i g h p a r e n t s c o r e s . These c o r r e l a t i o n s a r e i n k e e p i n g w i t h s e x u a l abuse l i t e r a t u r e and r e s i l i e n c y l i t e r a t u r e , l e n d i n g s u p p o r t t o the v a l i d i t y o f t h e c h e c k l i s t s . However, the - 5? -c h e c k l i s t s are s t i l l i n the process of being f u r t h e r developed and changed. No comparative data i s a v a i l a b l e r e g a r d i n g the p a t t e r n s of symptoms i n other groups of traumatized or s t r e s s e d c h i l d r e n . This would be very h e l p f u l to understand the d i f f e r e n t i a l e f f e c t s of other types of trauma. R e l i a b i l i t y ; The r e l i a b i l i t y s t u d i e s (Conte, B e r l i n e r , & Schuerman, 1966) conducted, as small as they are, seem to suggest that both s o c i a l workers and parents are c o n s i s t e n t i n how they d e s c r i b e the c h i l d on t h e i r r e s p e c t i v e measures. At the same time i t i s g e n e r a l l y recognized that d i f f e r e n t data sources, e s p e c i a l l y parent and p r o f e s s i o n a l s , are l i k e l y to view events and behavior d i f f e r e n t l y i n part because they use d i f f e r e n t p e r s p e c t i v e s ,to view behavior and i n part because they see the c h i l d i n very d i f f e r e n t environments and under d i f f e r e n t c o n d i t i o n s . Comment: The Harborview Impact C h e c k l i s t s are s t i l l e v o l v i n g and more resea r c h i s needed. However, these c h e c k l i s t s are the most w e l l researched and comprehensive measures of the e f f e c t s of sexual abuse on c h i l d r e n and a d o l e s c e n t s to date. Primary References: Conte, J . C B e r l i n e r , L. (1988). The impact of sexual abuse on c h i l d r e n : e m p i r i c a l f i n d i n g s . In L. Walker, ( E d . ) , Handbook of Sexual Abuse of C h i l d r e n . New York: S p r i n g e r P u b l i s h i n g Co. - 58 -Family Assessment The assessment of f a m i l y f u n c t i o n i n g presents many c h a l l e n g e s . For i n s t a n c e , how much emphasis should be placed on examining the c h a r a c t e r i s t i c s of i n d i v i d u a l members, t h e i r v a r i o u s i n t e r a c t i o n s , or the f a m i l y system as a whole? (Bodin, 1968) Another c o n s i d e r a t i o n i s the extent of focus on past events versus ongoing f a m i l y behavior. Since each p e r s p e c t i v e may provide unique as w e l l as c o r r o b o r a t i n g i n f o r m a t i o n on areas of health-pathology i n the f a m i l y , there are obvious advantages i n attempts to i n t e g r a t e these viewpoints. However, p r a c t i c a l c o n s t r a i n t s and d i f f e r e n t t h e o r e t i c a l o r i e n t a t i o n s of s t a f f o f t e n r e s u l t i n a more c i r c u m s c r i b e d approach being used f o r f a m i l y assessments i n a given s e t t i n g ( F i s h e r , 1982). For the purposes of d e s i g n i n g t h i s assessment package, many known f a m i l y measures were reviewed. However, v i r t u a l l y none were found to be s a t i s f a c t o r y i n terms of addressing known major f a m i l y s t r e s s o r s such as v i o l e n c e , substance abuse, sexual r e l a t i o n s h i p s or socio-economic f a c t o r s . The m a j o r i t y of the f a m i l y measures reviewed a l s o seem to be c u l t u r a l l y or economically b i a s e d . In order to overcome some of the above mentioned concerns, a combination of three f a m i l y measures was decided on f o r t h i s p r o j e c t : the FAM (chosen i n part because i t i s based on Canadian norms, and because i t assesses str e n g t h s as well as j u s t pathology); the FILE/A-FILE (chosen because i t i s a c h e c k l i s t of l i f e and f a m i l y s t r e s s o r s , and would t h e r e f o r e address the gaps not - 59 -addressed by the FAM); and the Morrison Center Family Problem C h e c k l i s t (chosen because, although i t i s not one of the st a n d a r d i z e d " b i g name" f a m i l y measures which are f a m i l i a r i n the l i t e r a t u r e w i t h i n the f i e l d , the problem c h e c k l i s t does a good job of addressing very r e a l common f a m i l y strengths and problems). - 60 -The Family Assessment Measure (FAM) (See Appendix J) Aut h o r s : Skinner, H.A., Steinhauer, P.D. G Santa-Barbara, J . Purpose: To assess f a m i l y f u n c t i o n i n g , i n c l u d i n g f a m i l y s t r e n g t h s and weaknesses. The FAM i s designed to be used i n c l i n i c a l and resea r c h s e t t i n g s as a d i a g n o s t i c t o o l , as a measure of therapy process and outcome, and as an instrument f o r b a s i c r e s e a r c h on f a m i l y processes. B r e v i t y and A d m i n i s t r a t i o n ; The General s c a l e c o n t a i n s SO items and takes a p p r o o x i m a t e l l y 20 to 26 minutes to complete. The FAM may be completed by f a m i l y members who are at l e a s t 10-12 years o l d . D e s c r i p t i o n : The FAM i s a f a m i l y i n v e n t o r y based on Canadian norms f o r c l i n i c a l and n o n - c l i n i c a l p o p u l a t i o n s . This i n v e n t o r y provides i n f o r m a t i o n on seven b a s i c f a c t o r s i n f a m i l y f u n c t i o n i n g : task accomplishment, r o l e performance, communication, a f f e c t i v e e x p r e s s i o n , involvement, c o n t r o l , and values and norms. Also i n c l u d e d are response s t y l e b i a s measures of s o c i a l d e s i r a b i l i t y and de f e n s i v e n e s s . The f o l l o w i n g i s a d e s c r i p t i o n of the seven f a c t o r s of f a m i l y f u n c t i o n i n g which are assessed by the FAM: 1) Task Accomplishment ( o r problem s o l v i n g a b i l i t y ) : A major f u n c t i o n of the f a m i l y i s the s u c c e s s f u l achievement of a v a r i e t y of b a s i c , developmental and c r i s i s t a s k s . T h i s i n c l u d e s a l l o w i n g f o r the continued development of a l l f a m i l y members, p r o v i d i n g reasonable s e c u r i t y , and f u n c t i o n i n g e f f e c t i v e l y as part of s o c i e t y . The process by which tasks are accomplished i n c l u d e s : (1) task or problem i d e n t i f i c a t i o n , (2) e x p l o r a t i o n of a l t e r n a t i v e s o l u t i o n s , - 61 -(3) implementation of s e l e c t e d approaches, and (4) e v a l u a t i o n of e f f e c t s . 2) Role Performance r e q u i r e s three v a r i o u s o p e r a t i o n s : (1) the assignment of s p e c i f i e d a c t i v i t i e s to each f a m i l y member; C2) the agreement or w i l l i n g n e s s of f a m i l y members to assume the assigned r o l e s ; and (3) the a c t u a l c a r r y i n g out of p r e s c r i b e d behaviors. 3) Communication: C e n t r a l to the performance of these r o l e s i s the process of communciation, by which i n f o r m a t i o n e s s e n t i a l to tasks and r o l e s i s exchanged. The goal of e f f e c t i v e communication i s mutual understanding, so that the message r e c e i v e d i s the same as the message intended. I f the message sent i s c l e a r , d i r e c t and s u f f i c i e n t , then mutual understanding i s l i k e l y to occur. However, the process of communication may be avoided or d i s t o r t e d by the r e c e i v e r . Thus, c r i t i c a l aspects of the r e c e p t i o n phase of communication i n c l u d e the a v a i l a b i l i t y and openness of the r e c e i v e r to the message. 4) A f f e c t i v e E x p r e s s i o n i n c l u d e s the content, i n t e n s i t y and timing of f e e l i n g s . B) Involvement r e f e r s to both the degree and q u a l i t y of f a m i l y members' i n t e r e s t i n one another. Other important elements of a f f e c t i v e involvement i n c l u d e the a b i l i t y of the f a m i l y to meet the emotional and s e c u r i t y needs of f a m i l y members, and the f l e x i b i t y to provide support f o r f a m i l y members' autonomy. ^) C o n t r o l i s the process by which f a m i l y members i n f l u e n c e each other (e.g. i s the f a m i l y p r e d i c t a b l e , i n c o n s i s t e n t , - 62 -r e s p o n s i b l e , c o n s t r u c t i v e , r i g i d , f l e x i b l e , l a i s s e z - f a i r e , c h a o t i c ? ) . 7) Values and norms i n c l u d e how tasks are d e f i n e d and how the f a m i l y proceeds to accomplish them. This may be g r e a t l y i n f l u e n c e d by norms and values of the cu11ure i n ge n e r a l , and the f a m i l y background i n p a r t i c u l a r . FAM Norms; Scores i n the FAM p r o f i l e s are normalized with each subscale having a mean of 50 and a standard d e v i a t i o n of 10. The m a j o r i t y of scores f o r n o n c l i n i c a l f a m i l i e s should f a l l between 40 and 60. Scores o u t s i d e t h i s range are i n d i c a t i v e of very healthy f u n c t i o n i n g (below 40) or c o n s i d e r a b l e d i s t u r b a n c e (above 60). Separate norms have been developed f o r ado l e s c e n t s which a l s o have a mean of 50. P r e l i m i n a r y a n a l y s i s of. the FAM was conducted with 475 f a m i l i e s i n the Toronto area. R e l i a b i l i t y : I n t e r n a l c o n s i s t e n c y r e l i a b i l i t y estimates f o r the o v e r a l l r a t i n g on 'the General Scale i s e x c e l l e n t ( .93 f o r a d u l t s ; .94 f o r c h i l d r e n ) . V a l i d i t y : V a l i d a t i o n s t u d i e s are i n progress. Primary Reference: Skinner, H. & Steinhauer, P.O. (1983). The Family Assessment Measure, Canadian J o u r n a l of Community  Mental Health. 2 ( 2 ) , 91-10S. - 63 -The Concept of L i f e S t r e s s In the l a s t 25 years, there has been a p r o l i f e r a t i o n of res e a r c h based on the hypothesis that s t r e s s a r i s i n g from an accumulation of l i f e events p l a y s a r o l e i n the e t i o l o g y of v a r i o u s somatic and p s y c h i a t r i c d i s o r d e r s (Holmes S Rahe; 1967, Holmes G Masuda, 1974; McCubbin and P a t t e r s o n , 1982). McCubbin and P a t t e r s o n (1982) promote the concept that f a m i l y l i f e changes are a d d i t i v e and at some p o i n t , reach a f a m i l y ' s l i m i t to adjust to them.. At t h i s p o i n t , one would a n t i c i p a t e some negative consequence i n the f a m i l y system and/or i t s member( s) . Family Inventory of L i f e Events and Changes (FILE) (See Appendix K) Authors: McCubbin, H., P a t t e r s o n , J . & Wilson, L. Purpose: The purpose of the FILE i s to assess the above concept of the p i l e - u p of normative and non-normative l i f e events and changes experienced i n the f a m i l y u n i t ( s i n g l e parent, two parent, r e c o n s t i t u t e d , etc.) i n the past year. F a m i l i e s u s u a l l y are d e a l i n g with s e v e r a l s t r e s s o r s s imultaneously and FILE provides an index of a f a m i l y ' s v u l n e r a b i l i t y as a r e s u l t of t h i s p i l e - u p . Conceptual O r g a n i z a t i o n : A l l events experienced by any member of the f a m i l y are recorded s i n c e , from a f a m i l y systems p e r s p e c t i v e , what happens to any one member a f f e c t s the other members to some degree. B r e v i t y and A d m i n i s t r a t i o n : The FILE i s a 72-item s e l f - r e p o r t instrument r e q u i r i n g approximately 20 minutes to complete. - 64 -R e l i a b i l i t y : The o v e r a l l s c a l e r e l i a b i l i t y (Cronbach's Alpha) f o r the FILE i s .81. T e s t - r e t e s t r e l i a b i l i t y over a four week time lapse was computed as ranging between.72 and .77. This i n d i c a t e s acceptable r e l i a b i l i t y over time. V a l i d i t y : V a l i d i t y assessments of FILE were made by c o r r e l a t i n g the FILE with a measure of f a m i l y f u n c t i o n i n g , the Family Environment Scales (Moos, 1976). The hypothesis was that a p i l e - u p of l i f e changes would be n e g a t i v e l y c o r r e l a t e d with d e s i r a b l e dimensions of the f a m i l y environment and p o s i t i v e l y c o r r e l a t e d .with u n d e s i r a b l e c h a r a c t e r i s t i c s of the f a m i l y environment. As p r e d i c t e d , a moderately high c o r r e l a t i o n supported the c o n s t r u c t v a l i d i t y of FILE i n that s t r a i n s w i t h i n the f a m i l y would be expected to impact upon the way the f a m i l y u n i t f u n c t i o n s together. Norms are based on approximately 980 American couples (1,960 i n d i v i d u a l s ) i n c l u d i n g couples across the f a m i l y l i f e c y c l e from young married couples to those r e t i r e d . Conceptual Dimensions of the FILE: 1) I n t r a - F a m i l y S t r a i n s combine two dimensions: - C o n f l i c t - sources of t e n s i o n and c o n f l i c t between f a m i l y members, i n c l u d i n g i n c r e a s e s i n normative sources of i n t r a - f a m i l y s t r a i n . P a r e n t i n g S t r a i n s - in c r e a s e d d i f f i c u l t i e s i n enacting the pare n t i n g r o l e . 2) M a r i t a l S t r a i n s a r i s i n g from sexual or s e p a r a t i o n i s s u e s . 3) Pregnancy and C h i l d b e a r i n g S t r a i n s : Pregnancy d i f f i c u l t i e s or the a d d i t i o n of a new f a m i l y member. - 65 -4) Finance and Business S t r a i n s ; Family Finances - i n c r e a s e d s t r a i n on a f a m i l y ' s money supply. ~ Family Business - s t r a i n s a r i s i n g from a family-owned business or investments. 5} Work-Family T r a n s i t i o n s and S t r a i n s ; Work T r a n s i t i o n s - moving i n or out of the work f o r c e . - Family T r a n s i s t i o n s and Work S t r a i n s - changes o c c u r r i n g at work or moves made by the f a m i l y or one of i t s members. 6) I l l n e s s and Family "Care" S t r a i n s : I l l n e s s On set and C h i l d Care — dependency needs a r i s i n g from i n j u r y or i l l n e s s to a f a m i l y member or f r i e n d . This s e c t i o n a l s o i n c l u d e s problems with c h i l d care, although normally c h i l d care i s considered j u s t to be a part of day to day f a m i l y l i f e . - Chronic I l l n e s s S t r a i n s - the onset of or i n c r e a s e d d i f f i c u l t y with c h r o n i c i l l n e s s . Dependency S t r a i n s - a member or f r i e n d r e q u i r i n g more help or care. ?) Losses due to the death of a member or f r i e n d and due to broken r e l a t i o n s h i p s . B) T r a n s i t i o n s "In end Out" - a member's moving out or moving back home or beginning a major involvement o u t s i d e the f a m i l y . 9) Legal - a member breaking s o c i e t y ' s laws or mores. Primary Reference: McCubbin, H., P a t t e r s o n , J . G Wilson, L. (1980). Family Inventory of L i f e Events and Changes ( F I L E ) . St. P a u l : Family S o c i a l S cience. - 66 -Adolescent-Family Inventory of L i f e Events and Changes (A-FILE) (See Appendix L) Authors: McCubbin, H., P a t t e r s o n , J . , Bauman E. S H a r r i s , L. Purpose: To rec o r d normative and non-normative l i f e events and changes an adolescent p e r c e i v e s h i s or her f a m i l y has experienced during the past 12 months. The A-FILE provides an index of an ad o l e s c e n t ' s v u l n e r a b i l i t y as a r e s u l t of the f a m i l y p i l e - u p of s t r e s s f u l l i f e events. Conceptual O r g a n i z a t i o n : As with the FILE, a l l events experienced by any member of the f a m i l y are recorded s i n c e , from a f a m i l y systems p e r s p e c t i v e , what happens to any member a f f e c t s the others to some degree. Items on the A-FILE are grouped i n t o s i x conceptual dimensions: 1) t r a n s i t i o n s ( r o l e or s t a t u s t r a n s i t i o n s , geographic m o b i l i t y ) , 2) s e x u a l i t y (pregnancy, c h i l d b e a r i n g , onset of sexual a c t i v i t y ) , 3) l o s s e s (death, l o s s of property or income), 4) r e s p o n s i b i l i t i e s and s t r a i n s ( i n t e r p e r s o n a l t e n s i o n s and s t r a i n s r e l a t e d to h e a l t h care and f i n a n c e s ) , 5) substance use (use of drugs or a l c o h o l , c o n f l i c t about substance use, or a premature e x i t from s c h o o l ) , 6) l e g a l c o n f l i c t ( a r r e s t or a s s a u l t of a f a m i l y member). B r e v i t y and A d m i n i s t r a t i o n : The A-FILE i s a SO-item s e l f - r e p o r t instrument r e q u i r i n g approximately 15-20 minutes to complete. Norms are based on a sample of 500 American high school student s. - 6 ? -R e l i a b i l i t y : The t o t a l s c a l e r e l i a b i l i t i e s . a r e .83 and .80, i n d i c a t i n g a c c e p t a b l e i n t e r n a l c o n s i s t e n c y . The t e s t - r e t e s t r e l i a b i l i t y i s .82. C o n s t r u c t V a l i d i t y : T h r e e p r o c e d u r e s were used t o r e d u c e the A - F I L E t o SO i t e m s : ( a ) an a n a l y s i s o f t h e f r e q u e n c i e s o f o c c u r r e n c e o f a l l t h e i t e m s , (b) f a c t o r a n a l y s i s f o l l o w e d by t e s t s o f i n t e r n a l r e l i a b i l i t y and t e s t - r e t e s t r e l i a b i l i t y , end ( c) r e f e r e n c e t o p r i o r r e s e a r c h and t h e o r i e s r e g a r d i n g f a m i l y l i f e c h a n g e s . S e v e r a l i n f r e q u e n t l y o c c u r r i n g i t e m s were r e t a i n e d i f t h e y were c o n s i d e r e d m a j o r s t r e s s o r s ( e . g . d e a t h o f a p a r e n t ) . C a u t i o n must be u s e d i n t h i s a p p r o a c h t o d a t a a n a l y s i s and i n s t r u m e n t c o n s t r u c t i o n i n view o f t h e f a c t t h a t o c c u r r e n c e s o f e a c h f a m i l y l i f e change a r e not u n i f o r m . P e r h a p s c e r t a i n s t r e s s o r s s h o u l d be g i v e n more w e i g h t o r i m p o r t a n c e t h a n o t h e r s . A d d i t i o n a l V a l i d i t y C h e c k s : I t was h y p o t h e s i z e d t h a t a p i l e - u p o f f a m i l y l i f e e v e n t s would be p o s i t i v e l y a s s o c i a t e d w i t h t h e use o f c i g a r e t t e s and a l c o h o l a n d / o r m a r i j u a n a . F u r t h e r r e s e a r c h i n d i c a t e d s u p p o r t f o r t h i s h y p o t h e s i s . A s e c o n d v a l i d i t y c heck on the A - F I L E was made by h y p o t h e s i z i n g t h a t t h e g r e a t e r t h e p i l e - u p o f r e c e n t f a m i l y l i f e c h a n g e s , the l e s s t h e a d o l e s c e n t s b e l i e v e t h e i r h e a l t h b e h a v i o r s a r e u nder t h e i r own c o n t r o l . T h i s h y p o t h e s i s was s u p p o r t e d as measured by t h e M u l t i d i m e n s i o n a l H e a l t h L o c u s o f C o n t r o l S c a l e s ( W a l l s t o n , W a l l s t o n G D e V e l l u , 1978). P r i m a r y R e f e r e n c e : McCubbin, H., P a t t e r s o n , J . , Bauman, E. G H a r r i s , L. ( 1981) . A d o l e s c e n t - F a m i l y I n v e n t o r y o f L i f e  E v e n t s and Changes ( A - F I L E ) . S t . P a u l : F a m i l y S c i e n c e . - 68 -The Family Problem C h e c k l i s t (See Appendix L) D r a f t e d by; The 1980 s t a f f group, c o n s i s t i n g of c l i n i c a l p s y c h o l o g i s t s and s o c i a l workers, at the Morrison Center f o r Youth and Family S e r v i c e , P o r t l a n d , Oregon. Purpose: to assess how s a t i s f i e d or d i s s a t i s f i e d each f a m i l y member i s with how t h e i r f a m i l y i s doing i n common areas of f a m i l y s t r e n g t h or weakness (such as the use of p h y s i c a l f o r c e , r e l a t i o n s h i p s between parents, making of s e n s i b l e r u l e s , and methods of d e a l i n g with matters concerning sex). B r e v i t y and A d m i n i s t r a t i o n : The Family Problem C h e c k l i s t i s a 22-item s e l f - r e p o r t r e q u i r i n g approximately 10 minutes to complete. It i s a p p r o p r i a t e f o r parents and c h i l d r e n from the ages of 9/10 up. Content: The c h e c k l i s t r e f l e c t s the most common themes addressed by f a m i l y p r a c t i t i o n e r s at the Morrison Center i n Oregon. Of a l l the f a m i l y measures reviewed f o r t h i s assessment package, these themes most c l o s e l y address the " r e a l " or r e l e v a n t concerns/themes of the f a m i l i e s who present f o r c o u n s e l l i n g at Nisha's Family C o u n s e l l i n g Program i n Vancouver. Strengths: The c h e c k l i s t i s c l i n i c a l l y u s e f u l i n i d e n t i f y i n g important f a m i l y concerns or "red f l a g " items that may r e q u i r e quick a t t e n t i o n , and that f a m i l y members may not otherwise i d e n t i f y on t h e i r own i n i t i a t i v e at the onset of c o u n s e l l i n g , such as matters p e r t a i n i n g to p h y s i c a l f o r c e or sex. Drawback: Norms, r e l i a b i l i t y , and v a l i d i t y i n f o r m a t i o n have not yet been developed f o r the f a m i l y problem c h e c k l i s t . A l s o , i n f a m i l i e s where d e n i a l e x i s t s , the a c t u a l b a s e l i n e may not come u n t i l l a t e r on i n treatment. - 69 -Primary Reference; Trute, B. [1985). E v a l u a t i n g C l i n i c a l S e r v i c e i n Family P r a c t i c e S e t t i n g s : B a s i c Issues and Beginning Steps, Canadian S o c i a l Work Review. A v a i l a b i l i t y : The Morrison Center f o r Youth and Family S e r v i c e , 3355 S.E. Powell Blvd., P o r t l a n d , Oregon, 97202, U.S.A. - 70 -Other E c o l o g i c a l Measures An Eco-Map was completed based on the format of Hartman and L a i r d (1983). T h i s eco-map was completed v i a i n t e r v i e w s with the f a m i l y and s o c i a l worker (see appendix M). Purpose: to assess f a m i l y resources, connections, and the nature of these connections. B r e v i t y and A d m i n i s t r a t i o n ; The eco-map took approximately an hour to complete. There are other s i m i l a r formats f o r completing eco-maps. For example, f a m i l y members could be asked to complete t h e i r own maps. Some f a m i l i e s could do t h i s very w e l l , while other f a m i l i e s might not be aware of t h e i r resources and connections. De s c r i p t i o n : An eco-map i s a d e s c r i p t i v e c l i n i c a l t o o l ( r a t h e r than a r e s e a r c h t o o l ) which can h i g h l i g h t s i g n i f i c a n t r e sources and connections ( p o s i t i v e or negative) w i t h i n a f a m i l y . U n l i k e any of the other measures i n c l u d e d , the eco-map i s a v i s u a l t o o l which presents a p i c t u r e . T h i s can be q u i t e r e v e a l i n g f o r i n d i v i d u a l s , f a m i l i e s and c l i n i c i a n s . The eco-map w i l l be d i s c u s s e d f u r t h e r i n the " f i n d i n g s " s e c t i o n of t h i s t h e s i s . Reference: Hartman, A. G L a i r d , J . (1983). The Family i n Space: E c o l o g i c a l Assessment. In Family-Centered S o c i a l Work  P r a c t i c e . New York: The Free Press. - 71 -The "School Essay" As has a l r e a d y been mentioned on page 13, no s t a n d a r d i z e d teacher completed measure could be used as the adolescent who p a r t i c i p a t e d had not been i n school f o r over a year. The adolescent i n v o l v e d l i k e d the idea of w r i t i n g a short essay t e l l i n g how i t came to be that she was r e f u s i n g to attend school at t h i s time. The f i n d i n g s or themes of t h i s essay w i l l be d i s c u s s e d i n the f o l l o w i n g s e c t i o n . A l s o , a copy of the essay can be found i n Appendix N. - 72 -CHAPTER FOUR: PRESENTATION OF FINDINGS This s e c t i o n w i l l d e s c r i b e the process and f i n d i n g s of having run one time through the p r e v i o u s l y o u t l i n e d assessment p r o t o c o l . For the purposes of t h i s p r a c t i c e - t h e s i s combination, time has not allowed f o r more date c o l l e c t i o n (a l a r g e r sample group) due to the complexity of the re s e a r c h t o p i c , the l a r g e number of measures being used, and the enormous amount of time that went i n t o r e s e a r c h i n g a much l a r g e r pool of measures from which the i n c l u d e d s e l e c t i o n s were made. Case H i s t o r y The adolescent who p a r t i c i p a t e d i n t h i s r e s e a r c h i s a 14-year-old part Native g i r l who w i l l be r e f e r r e d to as L. She i s the o l d e s t of three c h i l d r e n . Her brother i s 8 years o l d , and her s i s t e r i s S years o l d . The brother i s a l a r g e , tough, a c t i v e boy. He i s i n a s p e c i a l c l a s s f o r behavior and l e a r n i n g problems. L a t e l y he has been b u l l y i n g and s t e a l i n g i n the neighbourhood. The 5 year o l d s i s t e r i s the "good" c h i l d i n the f a m i l y . L o f t e n looks uncared f o r . She i s somewhat overweight, and more o f t e n than not she wears torn or s t a i n e d black c l o t h e s which p o r t r a y a "tough" image. She o f t e n smells as though she or her c l o t h e s need a wash. L a l s o has many l o v e l y q u a l i t i e s . She can be fun l o v i n g , can have a good sense of humor, i s a r t i s t i c , can be s k i l l f u l with small c h i l d r e n and animals, i s s k i l l e d with computers, and i s a - 73 -good cook. Her weaknesses are that she i s very s k i l l e d at power s t r u g g l e s , l i k e s to think she i s more s t r e e t w i s e than she a c t u a l l y i s , i s very "mouthy" and moody, has a v o l a t i l e temper (something she no doubt witnessed i n her p a s t ) , and can be very good at ma i n t a i n i n g a stubborn c o n t r a r y stand. For example, when L does not want to do something such as going back to sc h o o l , her suggestions f o r a l t e r n a t i v e s tend to be ideas such as k i l l i n g h e r s e l f , or supporting h e r s e l f by d e a l i n g drugs as some of her r e l a t i v e s have done. L has grown up with her mother who had been a s i n g l e parent most of the time. They l i v e i n a very c h a o t i c , run down, d i r t y East Vancouver house. Perhaps the home i s symbolic of the chaos i n t h i s f a m i l y ' s l i f e . R ecently, L's f a t h e r has r e j o i n e d the f a m i l y . This s i t u a t i o n was shaky at best as he was an a l c o h o l i c who had r e c e n t l y been r e l e a s e d from j a i l . His r e l a t i o n s h i p with L has been very i n c o n s i s t e n t . L seeks h i s approval and a t t e n t i o n , however, t h i s has never been c o n s i s t e n t l y forthcoming. Thus, L's f e e l i n g s f o r her f a t h e r r o l l e r c o a s t e r between love and anger. The brother and s i s t e r each have d i f f e r e n t f a t h e r s . The s i s t e r ' s f a t h e r had been a b r i e f b o y f r i e n d of the mother's. The b r o t h e r ' s f a t h e r had l i v e d common-law with the mother f o r two years before they married s h o r t l y a f t e r the s i s t e r (not hi s c h i l d ) was born. The marriage was short l i v e d as he was abusive of the mother and a l s o , L t o l d her mother that he had made some sort of sexual advance towards her. The men i n the mother's l i f e have been substance abusers and have been - 74 -a b u s i v e o f b o t h t h e mother and her c h i l d r e n . In t h e end the mother a l w a y s came t o t h e d e f e n s e o f h e r c h i l d r e n . On a n o t h e r o c a s s i o n L i n f o r m e d h e r mother t h a t an u n c l e had a l s o made a s e x u a l advance towards h e r . Not much i s known about e i t h e r o f t h e s e s i t u a t i o n s as L has not y e t wanted t o t a l k about t h i s w i t h anyone. In b o t h c a s e s L ' s mother b e l i e v e d L and took s t e p s t o p r o t e c t h e r . C h a r g e s were n e v e r l a i d . These i n c i d e n t s o c c u r r e d about seven y e a r s ago. The mother has a h o r r i d h i s t o r y o f p h y s i c a l and e m o t i o n a l abuse by h e r mother, and s e x u a l abuse by her s t e p - f a t h e r . The s t e p - f a t h e r was c h a r g e d and went t o j a i l . L ' s mother became p r e g n a n t w i t h L when she was a t e e n a g e r . The f a m i l y has r e c e i v e d a m u l t i t u d e o f s e r v i c e s and has r e c e i v e d Income A s s i s t a n c e s i n c e t h a t t i m e . The c h i l d r e n have been i n c a r e f o r b r i e f p e r i o d s i n t h e p a s t . T h e r e i s a h i s t o r y o f c h i l d w e l f a r e c o m p l a i n t s , u s u a l l y i n v o l v i n g u n s a f e and u n s a n i t a r y h o u s e k e e p i n g s t a n d a r d s . D u r i n g the two months p r i o r t o t h e r e s e a r c h i n t e r v i e w s , L was been p l a c e d a t Chimo House ( a r e s i d e n t i a l t r e a t m e n t c e n t r e f o r a d o l e s c e n t s e x p e r i e n c i n g s e v e r e e m o t i o n a l and b e h a v i o r a l p r o b l e m s ) . At t h e t i m e t h a t L came i n t o c a r e , her mother had r e a c h e d the end o f h e r rope i n terms o f L's v o l a t i l e and t h r e a t e n i n g d e f i a n c e . Not o n l y was L e n g a g i n g i n o u t b u r s t s a t home, but she was d o i n g so at s c h o o l as w e l l . L had m i s s e d l a r g e amounts o f s c h o o l . Her s c h o o l h i s t o r y o v e r t h e p a s t c o u p l e o f y e a r s was t h a t e i t h e r she was - 75 -r e f u s i n g t o a t t e n d , o r t h e s c h o o l was r e f u s i n g t o have her back due t o p r o b l e m b e h a v i o u r o r n o n - a t t e n d a n c e . The l a s t g r a d e L a c t u a l l y c o m p l e t e d and p a s s e d was g r a d e s i x . I t s h o u l d a l s o be m e n t i o n e d t h a t L a p p e a r s t o have a s e v e r e l e a r n i n g d i s a b i l i t y a f f e c t i n g h e r a b i l i t y t o r e a d and w r i t e . No doubt t h i s has an impact on L's r e f u s a l t o a t t e n d s c h o o l . Thus a t t h e time L was p l a c e d at Chimo House L's needs were c o n s i d e r e d t o be t o o g r e a t t o e x p e c t t h a t t h e mot h e r ' s p a t i e n c e c o u l d s t r e t c h any f u r t h e r , e s p e c i a l l y g i v e n the moth e r ' s own needs and s c a r s p r e d i c t a b l y stemming f r o m h e r own a b u s i v e h i s t o r y . Some o f the mother's own s t r u g g l e s i n c l u d e d a g o r a p h o b i a , s l e e p d i s o r d e r , r e c u r r i n g h e a l t h d i f f i c u l t i e s , and a h i s t o r y o f c h o o s i n g a l c o h o l i c o r a b u s i v e male p a r t n e r s . In the f o l l o w i n g s e c t i o n L's r e s u l t s on t h e measures t r i e d w i l l be d i s c u s s e d . T h i s a s s e s s m e n t package was a d m i n i s t e r e d d u r i n g f o u r s e s s i o n s o v e r f o u r weeks. T h r e e s e s s i o n s took p l a c e i n t h e w r i t e r ' s o f f i c e , w hich i s p r i v a t e , q u i e t and c o m f o r t a b l e . The f o u r t h s e s s i o n took p l a c e i n t h e p r i v a c y o f a bedroom i n L's A u n t ' s home i n S u r r e y t o where L had r u n ( L has a h i s t o r y o f r u n n i n g ) . L had known t h i s w r i t e r f o r about f i v e months as f a m i l y c o u n s e l l o r t o t h e f a m i l y . The f a c t t h a t a p o s i t i v e r e l a t i o n s h i p a l r e a d y e x i s t e d between us l i k e l y had a p o s i t i v e i m p a c t on L's a b i l i t y t o c o m p l e t e t h e a s s e s s m e n t . As i t was, L became e a s i l y b o r e d and t h e n c o u l d q u i c k l y become s i l l y . In o r d e r - 76 -t o improve v a l i d i t y , and t o a v o i d L becoming f r u s t r a t e d w i t h her l e a r n i n g d i s a b i l i t y , a l l p a p e r and p e n c i l t e s t s were a d m i n i s t e r e d v e r b a l l y by t h i s w r i t e r . The sequence o f i n t e r v i e w s was as f o l l o w s : In s e s s i o n one L was seen on h e r own. The I l e v e l i n t e r v i e w and t h e two s e l f - e s t e e m s c a l e s were a d m i n i s t e r e d . In s e s s i o n two |_ and h e r mother were seen t o g e t h e r . In t h i s s e s s i o n t h e f a m i l y p r o b l e m c h e c k l i s t , the FAM, and the eco-map were a d m i n i s t e r e d . ( L ' s f a t h e r was not i n c l u d e d i n any o f the s e s s i o n s due t o h i s m i s t r u s t o f h e l p i n g p r o f e s s i o n a l s , and due t o h i s o n l y v e r y r e c e n t , and p o s s i b l y s h o r t - l i v e d r e - i n v o l v e m e n t i n t h i s f a m i l y . ) In s e s s i o n t h r e e L and h e r mother a t t e n d e d t o g e t h e r , but were seen i n d i v i d u a l l y . The mother c o m p l e t e d the F I L E , L c o m p l e t e d t h e A - F I L E , and b o t h c o m p l e t e d t h e i r r e s p e c t i v e s e x u a l abuse impact c h e c k l i s t s . The two were then b r o u g h t t o g e t h e r t o s h a r e t h e i r t h o u g h t s , and L was a s k e d t o b r i n g a page o r two on what she t h o u g h t o f s c h o o l t o t h e next s e s s i o n . In s e s s i o n f o u r L was seen i n d i v i d u a l l y a g a i n . T h i s time she c o m p l e t e d the H o p e l e s s n e s s S c a l e , t h e C h i l d r e n ' s D e p r e s s i o n I n v e n t o r y , and t h e l o c u s o f c o n t r o l s c a l e . In each s e s s i o n L and h e r mother were a s k e d whether t h e y were g e t t i n g t i r e d o r b o r e d , o r whether t h e y had t h e e n e r g y t o c o m p l e t e a n o t h e r t e s t b e f o r e i t was a d m i n i s t e r e d . Time was a l s o a l l o t t e d a t t h e end o f e a c h s e s s i o n f o r p r o c e s s i n g any l e f t o v e r t h o u g h t s o r q u e s t i o n s . - ?? -The r e s u l t s from these s e s s i o n s are as f o l l o w s : Self-Esteem: L scored as having s i g n i f i c a n t l y low self-esteem on both the Rosenberg (RSE) and the Hare Self-Esteem S c a l e s (HSS). The HSS was c l e a r l y a more a p p r o p r i a t e and u s e f u l measure to use with t h i s adolescent. L found the wording of the RSE c o n f u s i n g and hard to understand. She r e p e a t e d l y asked f o r c l a r i f i c a t i o n of items on the s c a l e . The p o s s i b l e responses to the items were: s t r o n g l y agree, agree, d i s a g r e e , or s t r o n g l y d i s a g r e e . However, L gave only agree and disagree answers, s t a t i n g at the end that she had f o r g o t t e n she could use the other two p o s s i b l e responses. The HSS provided more meaningful i n f o r m a t i o n r e g a r d i n g L. Although L scored as having s i g n i f i c a n t l y low home sel f - e s t e e m and school self-esteem, she scored as having q u i t e high peer se l f - e s t e e m . This i s o b v i o u s l y c l i n i c a l l y u s e f u l i n f o r m a t i o n i n terms of where to i n t e r v e n e and where to b u i l d on s t r e n g t h s . L found the items easy to understand with the exception of one item on the peer s c a l e which she d e s c r i b e d as being a " s t u p i d q u e s t i o n " . Hopelessness and Depression; L scored as being depressed on both the Hopelessness Scale (HS) and the C h i l d r e n ' s Depression Inventory (CDI). However, n e i t h e r of these scores were a "red f l a g " f o r a s u i c i d a l r i s k . L r e p o r t e d on both the CDI and the sexual abuse Impact C h e c k l i s t that she thought about s u i c i d e , but that she would not do i t . - 78 -The CDI was e a s i e r f o r L to understand and seemed to t a l k more about what was r e a l l y going on i n her l i f e . Again, the items which L f e l t most s t r o n g l y negative about were r e l a t e d to school performance. On the HS, L d i d not score as depressed on items p e r t a i n i n g to a f f e c t i v e l y toned a s s o c i a t i o n s (hope and enthusiasm; happiness; f a i t h ; and good ti m e s ) . She d i d score as depressed on items p e r t a i n i n g to l o s s of mo t i v a t i o n ( g i v i n g up; d e c i d i n g not to want anything; not t r y i n g to get something that i s wanted) and she scored as depressed on items p e r t a i n i n g to f u t u r e e x p e c t a t i o n s . Some of her. responses may have been impacted by the f a c t that the HS seemed to be c o n c e p t u a l l y too d i f f i c u l t f o r L. This i s i n keeping with the I - l e v e l assessment, which i s d i s c u s s e d l a t e r i n t h i s s e c t i o n . Locus of C o n t r o l ; L was assessed by the N-SLCS as having an e x t e r n a l locus of c o n t r o l . She found t h i s assessment device to be too long and too d i f f i c u l t to understand. Her impatience/minor f r u s t r a t i o n / l a c k of c l e a r understanding may have impacted on some of her answers. A l s o , as noted, Nowicki and S t r i c k l a n d (1973) found i n t e r n a l i t y to be s i g n i f i c a n t l y r e l a t e d to higher s o c i a l c l a s s . As w e l l , T y l e r C H o l s i n g e r (1975) and Hawk C Parsons (1976) found Native Indian people to be more e x t e r n a l . Both of these g e n e r a l i z a t i o n s are true i n L's case. - 79 -I n t e r p e r s o n a l M a t u r i t y L e v e l : Although the I - l e v e l i n t e r v i e w seemed to be bori n g and a b i t f r u s t r a t i n g f o r L, i t d i d produce a wealth of i n f o r m a t i o n p e r t a i n i n g to themes and how she understands people and the world around her. See Appendix 0 f o r a p a r t i a l t r a n s c r i p t , a statement of themes, an I - l e v e l r a t i n g ( 1 3 immature c o n f o r m i s t ) , a summary of I 3 cfm c h a r a c t e r i s t i c s , and treatment recommendations. In a n u t s h e l l , L i n t e r v i e w e d as being developmentally delayed and s t i l l viewing the world i n a very concrete " r u l e s and f a i r n e s s " f a s h i o n . Approval of those who are seen to have power i s a c e n t r a l concern to L. Thus i n L's world, the r u l e s and the power change every time she walks out the door to be with her f r i e n d s . Values are not yet i n t e r n a l i z e d . Problems are seen as imposed by the o u t s i d e world, r a t h e r than having anything to do with her own s e l f . She does not yet know much about who she i s , and she has low self-esteem. Since L does not r e a l l y know who she i s , i t i s hard f o r her to f e e l as though she "belongs" anywhere, whether t h i s means knowing her place with a group of f r i e n d s , or knowing her place i n her f a m i l y . L i s not yet capable of t a k i n g the f u t u r e i n t o account i n her plans. Her plans are based on her cur r e n t wants. She handles c r i s i s by escape/running away/substance abuse. Recurring themes i n the i n t e r v i e w were: abandonment/feeling r e j e c t e d / t o s s e d out; f a i r n e s s / p r o p e r treatment; growing up (not wanting to be a l i t t l e g i r l , and yet s t i l l wanting a n u r t u r i n g Mom); j e a l o u s y ; blame/anger; f e e l i n g s o r r y f o r s e l f . - 80 -Treatment recommendations according to I - l e v e l theory w i l l be d i s c u s s e d i n the conclu d i n g chapter. E f f e c t s of sexual abuse as repo r t e d on the Harborview Impact  Check 1i st s: The s o c i a l worker c h e c k l i s t noted s i g n i f i c a n t problems i n the areas of school; mood/affect; a c t i n g out/conduct d i s t u r b a n c e ; and s e l f - c o n c e p t . T h i s i s i n keeping with what has been noted a l r e a d y . The parent completed impact c h e c k l i s t d e s c r i b e d L as having a multitude of symptoms. There were 6B items which the mother could p o t e n t i a l l y haved r a t e d as never, r a r e l y , sometimes, o f t e n , very o f t e n , or don't know. Of the 6S items (known p o s s i b l e symptoms or e f f e c t s of sexual abuse) the mother r a t e d only 7 as "never", and 4 as "don't know". There were a l s o 4 items rated as " r a r e l y " , however these were a l l items where even a rare presence could be s i g n i f i c a n t ( s e r i o u s c r i m i n a l problems; community c o n f l i c t , e.g. vandalism; a c t s s e x u a l l y promiscuous; s e x u a l l y i n a p p r o p r i a t e ) . Of the remaining symptoms ( a l l i n d i c a t o r s of problematic f u n c t i o n i n g ) the mother rated 21 items as being present very o f t e n , 1B items as being present o f t e n , and 14 items as being present sometimes. These r a t i n g s i n d i c a t e extremely d i s t u r b e d behavior. There were two items which the mother found d i f f i c u l t to understand, and two items which the mother found to be "normal f o r teenagers" ( i . e . d r a s t i c mood swings; e a t i n g d i f f e r e n t l y than used t o ) . Another c o n s t r u c t i v e comment the mother made was that there were no p o s i t i v e items i n c l u d e d . - 81 -This i s a very i n t e r e s t i n g comment i n l i g h t of the concept that every traumatic experience not only has a negative impact, but can a l s o b u i l d on s t r e n g t h s and r e s i l i e n c i e s w i t h i n an i n d i v i d u a l . Recent Adult C h i l d r e n of A l c o h o l i c s l i t e r a t u r e by W o i t i t z [1987, 1985) i s beginning to pay a t t e n t i o n to t h i s concept. The adolescent completed impact c h e c k l i s t was d i f f i c u l t f o r L. She needed c l a r i f i c a t i o n to understand many of the items and she found the c h e c k l i s t to be too long and t h e r e f o r e got bored and impatient. For these two reasons some of L's responses may not have a c c u r a t e l y answered some of the questions as they were intended. She d i d not seem to have t r o u b l e with the p o t e n t i a l l y emotion laden content of the items, although a few of them made her g i g g l e . It i s always d i f f i c u l t to know whether some of L's worrisome responses r e f l e c t the impact of sexual abuse, or the impact of other trauma i n her l i f e . In any case, i t was important to take note that L responded "a l o t of the time" to statements such as: I think about k i l l i n g myself;,I run away from home; I "space-out"; I have problems with e a t i n g ; I get headaches and stomachaches. Family F u n c t i o n i n g ; The Family Assessment Measure (FAM III) was completed by both L and her mother. See the FAM diagram l a t e r i n t h i s chapter f o r a p r o f i l e of t h e i r scores. Both L and her mother scored i n the f a m i l y problem range f o r values and norms items. A l s o , L's score f o r a f f e c t i v e e xpression, and the mother's score f o r r o l e performance i n d i c a t e d - 82 -c o n s i d e r a b l e d i s t u r b a n c e . N i e t h e r of them scored i n the f a m i l y s t r e n g t h range f o r any of the seven f a c t o r s . According to the FAM authors, problematic scores i n the values and norms area i n d i c a t e : - components of the f a m i l y ' s value system are dissonant r e s u l t i n g i n c o n f u s i o n and t e n s i o n - c o n f l i c t between the f a m i l y ' s values and those of the c u l t u r e as a whole - e x p l i c i t l y s t a t e d r u l e s are subverted by i m p l i c i t r u l e s - degree of l a t i t u d e i s i n a p p r o p r i a t e . Problematic scores i n the a f f e c t i v e e x p r e s s i o n area i n d i c a t e inadequate a f f e c t i v e communication i n v o l v i n g i n s u f f i c i e n t e x p r e s s i o n , i n h i b i t i o n of Cor o v e r l y intense) emotions a p p r o p r i a t e to a s i t u a t i o n . Problematic scores i n the r o l e performance area i n d i c a t e : - i n s u f f i c i e n t r o l e i n t e g r a t i o n , lack of agreement re g a r d i n g r o l e d e f i n i t i o n s - i n a b i l i t y to adapt to new r o l e s r e q u i r e d i n e v o l u t i o n of the f a m i l y l i f e c y c l e - i d i o s y n c r a t i c r o l e s . Both the mother and L found some of the items on the FAM c o n f u s i n g , hard to understand, or r e p e t i t i v e . When I asked both mother and daughter whether the questions on the FAM would give a good p i c t u r e of how things are i n t h e i r f a m i l y , n e i t h e r of them found the questions to be p a r t i c u l a r l y r e l e v a n t . Family Strength Average Range c o O l o o o 1 ' 1 | ' ' 1 1 1 1 1 1 ' Family Problem o o wvximm i i i 11 i i 1 1 I i i • • • • • • • • • • • ^ • • " • • • • • • • • *T 5 TJ . DO > o r m - 8 4 -L i f e S t r e s s ; Both L and her mother scored i n the top 10% of people e x p e r i e n c i n g high s t r e s s a c c ording to the norms of the Family Inventory of L i f e Events (mother) and the Adolescent Family Inventory of L i f e Events (daughter). The mother was e x p e r i e n c i n g the highest number of s t r e s s o r s i n areas of i n t r a - f a m i l y s t r a i n s , work-family t r a n s i t i o n s and s t r a i n s , and f a m i l y l e g a l v i o l a t i o n s (L had r e c e n t l y been charged and taken to the Youth Detention Centre f o r a s s a u l t i n g a s t a f f member at Chimo House). L was e x p e r i e n c i n g the highest s t r e s s i n the areas of f a m i l y r e s p o n s i b i l i t i e s and s t r a i n s , school s t r a i n s and substance abuse, and f a m i l y l e g a l v i o l a t i o n s . Both L and her mother found the items c l e a r and easy to understand. When asked, both mother and dauthter found the items on the FILE and A-FILE to be more r e l e v a n t to what r e a l l y goes on i n t h e i r f a m i l y than the questions on the FAM. In the case of L i n p a r t i c u l a r , the A-FILE served as a c l i n i c a l l y u s e f u l s t a r t i n g point f o r d i s c u s s i o n and i n t e r v e n t i o n . For example, during the process of v e r b a l l y completing the A-FILE, L responded "yes" to an item that i n d i c a t e d she had begun to have sexual i n t e r c o u r s e w i t h i n the l a s t while. Upon completion of the q u e s t i o n n a i r e , t h i s allowed f o r d i s c u s s i o n about d e c i s i o n making, c h o i c e s , consequences, and c o n t r a c e p t i v e s (which she had not been u s i n g ) . - 85 -Family Concerns; The Family Problems C h e c k l i s t showed that being able to show good f e e l i n g s (happiness, joy, pleasure) i s a s t r e n g t h w i t h i n L's f a m i l y . The c h e c k l i s t a l s o h i g h l i g h t e d that t h i s f a m i l y i s s t r u g g l i n g i n many areas i n c l u d i n g communication, r e s p o n s i b i l i t i e s , anger, d i s c i p l i n e , independence, s i b l i n g r e l a t i o n s h i p s , p a r e n t - c h i l d r e l a t i o n s h i p s , and f i n a n c e s . When asked, both mother and daughter found the items on the problems c h e c k l i s t to be more r e l e v a n t to what r e a l l y goes on i n t h e i r f a m i l y than the questions on e i t h e r the FAM or the FILE or A-FILE. Resources and Connections: The eco-map showed that L's f a m i l y does not have a l o t of strong, p o s i t i v e connections or r e s o u r c e s . Female f r i e n d s h i p s are the most p o s i t i v e o u t s i d e resource to t h i s f a m i l y . The f a m i l y ' s connection to a l l other o u t s i d e i n f l u e n c e s i s e i t h e r tenuous, s t r e s s f u l , or n o n - e x i s t e n t . For example, s p i r i t u a l i t y or church support i s not a resource due to the mother's past negative experiences with her C a t h o l i c upbringing. As well there were no Native c u l t u r e supports i n place f o r t h i s f a m i l y . R e c r e a t i o n i s very l i m i t e d f o r t h i s f a m i l y due to the mother's agoraphobia and due to lack of f i n a n c e s . However, the f a m i l y does enjoy the use of t h e i r computer and t h e i r VCR, both of which can be p o s i t i v e r e s o u r c e s . School has always been a s t r e s s i n t h i s f a m i l y . The mother and both of the school age c h i l d r e n have s e r i o u s l e a r n i n g d i s a b i l i t i e s and have tended to get i n t o t r o u b l e at s c h o o l . As w e l l , f a m i l y r e l a t i o n s are s t r a i n e d , - 86 -with the mother having a b s o l u t e l y no contact with any of her s i b l i n g s , of whom she i s the o l d e s t . The maternal grandmother i s both a s t r e s s and a resource w i t h i n L's f a m i l y . Many disagreements occur and unresolved resentments over past abuse s t i l l e x i s t . However, L's mother i s somewhat dependent on her mother to help her with the o u t s i d e world i n l i g h t of the agoraphobia. Poor housing and inadequate f i n a n c e s (income a s s i s t a n c e ) b r i n g f u r t h e r s t r a i n s . Perhaps r e l a t e d l y , frequent i l l n e s s of a l l f a m i l y members and d i f f i c u l t y i n a c c e s s i n g medical s e r v i c e s (due to agoraphobia) i s yet another source of s t r e s s . - 8 ? -S c h o o l ; As i n d i c a t e d on t h e eco-map, s c h o o l i s a s t r e s s f u l e n e r g y d r a i n f o r L and h e r f a m i l y , due t o l e a r n i n g d i s a b i l i t i e s on t h e p a r t s o f the mother and t h e two s c h o o l - a g e d c h i l d r e n . The themes a r i s i n g out o f L's e s s a y about s c h o o l a r e as f o l l o w s : - f e e l i n g s o f not f i t t i n g i n ( f e e l s o l d e r and more s t r e e t w i s e ) ; - f e e l s e x p o s e d and e m b a r r a s s e d ( r u m o r s , g o s s i p and bad: r e p u t a t i o n c i r c u l a t i n g ) ; - f e e l s t h a t t h e work i s o f t e n t o o h a r d ; - f e e l s m i s u n d e r s t o o d ; - f e e l s r i d i c u l e d ; - sometimes f e e l s s t u p i d . ( S e e A p p e n d i x 0 f o r s c h o o l e s s a y . ) - 88 -CHAPTER FIVE - DISCUSSION OF FINDINGS This chapter w i l l d i s c u s s (1) the f i n d i n g s of t h i s s i n g l e case study, and a l s o , (2) the assessment p r o t o c o l i n g e n e r a l . The S i n g l e Case Study The r e l a t i o n s h i p s between measures i n the case of L very much f o l l o w e d p r e d i c t e d p a t t e r n s . For example, M u l l i n s , S i e g e l , and Hodges (1985) found a strong p o s i t i v e r e l a t i o n s h i p between e x t e r n a l locus of c o n t r o l and l e v e l of dep r e s s i v e symptoms ( r = .59). As w e l l , i t was mentioned i n the previous chapter that e m o t i o n a l l y d i s t u r b e d and p s y c h o l o g i c a l l y maladjusted c h i l d r e n tend to be more e x t e r n a l ( K e n d a l l , F i n c h , L i t t l e , G O l l e n d i c k , 1996; McClanahan, 1995). L's b e l i e f s i n e x t e r n a l c o n t r o l over her l i f e a l s o r e l a t e d i n t h e o r e t i c a l l y p r e d i c t e d ways with her f e e l i n g s of hopelessness as measured by the Hopelessness S c a l e , and with the f a c t that she i s of lower socio-economic and Native Indian background. In terms of L's Native Indian background, she once again f o l l o w e d the p r e d i c t e d p a t t e r n i n terms of self - e s t e e m . Howell (1999) found that Native Indian c h i l d r e n scored as having s i g n i f i c a n t l y lower se l f - e s t e e m than c h i l d r e n of other et hnic groups. As f a r as s e l f - c o n c e p t and self-esteem are concerned, i n a study of s e l f - c o n c e p t of l e a r n i n g d i s a b l e d a d o l e s c e n t s , Rosenberg and Gaier (1999) found that normally a c h i e v i n g - 89 -students scored s i g n i f i c a n t l y higher on self-esteem. This too f i t s f o r L, as she scored p a r t i c u l a r l y p o o r l y i n the school s e c t i o n of the Hare Self-Esteem S c a l e . In terms of se l f - e s t e e m and depression or hopelessness, i n a study conducted by Kazdin, French, Unis, G Esveldt-Dawson (1983), C h i l d r e n ' s Depression Inventory scores c o r r e l a t e d p o s i t i v e l y with hopelessness and n e g a t i v e l y with s e l f esteem. The case study of L d i d not d e v i a t e from the above t h e o r e t i c a l l y expected d i r e c t i o n s . As w e l l , a moderate c o r r e l a t i o n of .4? was found between the C h i l d r e n ' s Depression Inventory and negative l i f e s t r e s s events. This too f i t f o r L. C e r t a i n l y she had experienced many negative l i f e s t r e s s events, i n c l u d i n g sexual abuse, poverty, c h r o n i c p a r e n t a l i l l n e s s , many moves, high turnover of a l c o h o l i c or abusive " s t e p f a t h e r s " , and d i f f i c u l t i e s i n sc h o o l . As noted i n the sexual abuse l i t e r a t u r e review, c h i l d sexual abuse f r e q u e n t l y e x i s t s i n g e n e r a l l y abusive s i t u a t i o n s (e.g. c o - e x i s t i n g p a r e n t a l pathology; p a r e n t a l a l c o h o l i s m ; n e g l e c t ; p h y s i c a l abuse). Again, L's case h i s t o r y r e v e a l s that she i s no exception i n t h i s regard ( e . g. agoraphobia on her mother's part; a l c o h o l i s m on her f a t h e r ' s p a r t , and reformed a l c o h o l i s m on her mother's p a r t ; the neglect that always accompanies a l c o h o l i s m ; previous p h y s i c a l abuse from her mother and cur r e n t p h y s i c a l abuse from her f a t h e r ) . r - 90 -The p r e v i o u s l y noted Harborview Sexual A s s a u l t Center resea r c h a l s o found that high sexual abuse impact scores were p o s i t i v e l y a s s o c i a t e d with poor f a m i l y f u n c t i o n i n g . As w e l l , r e s e a r c h on the Harborview Impact C h e c k l i s t s found that high impact scores were r e l a t e d to poor s e l f - e s t e e m and a c t i n g out behaviour (both c o r r e l a t i o n s were true f o r L ) . As p r e v i o u s l y noted, the r e s i l i e n c y l i t e r a t u r e d e s c r i b e s those who f a r e w e l l d e s p i t e evidence of severe r i s k f a c t o r s i n t h e i r l i v e s as c h a r a c t e r i z e d by a p o s i t i v e outlook, a f e e l i n g of r e s p o n s i b i l i t y / c o n t r o l over what happens, well-developed s o c i a l s k i l l s , good a b i l i t y to problem s o l v e , and the presence of a s i g n i f i c a n t c a r i n g r e l a t i o n s h i p . This p r o f i l e i s i n o p p o s i t i o n to L. Her score on the Hopelessness Scale was i n d i c a t i v e of a negative outlook; her r a t i n g s on the Locus of C o n t r o l Scale and the I-Level i n d i c a t e that she does not f e e l i n c o n t r o l of what happens i n her l i f e ; the I - L e v e l assessment a l s o suggests poorly developed s o c i a l / i n t e r p e r s o n a l s k i l l s and poor problem s o l v i n g a b i l i t y . On the p o s i t i v e s i d e , the mother does c u r r e n t l y appear to be "a s i g n i f i c a n t and c a r i n g person" i n L's l i f e . This p o s i t i v e f a c t o r i s u n f o r t u n a t e l y complicated by L's i n a b i l i t y to accept her mother's c a r i n g without constant doubt and t e s t i n g (as assessed i n the I - L e v e l i n t e r v i e w ) . L's u n c e r t a i n t i e s about her mother's c a r i n g could be r e l a t e d to numerous c o - e x i s t i n g f a c t o r s (e.g. the mother's previous a l c o h o l i s m and r e l a t e d n e g l e c t ; previous p h y s i c a l abuse of L during the time that her mother was s t i l l a maturing - 91 -teenager; the mother's i n a b i l i t y to meet L's needs due to her own high l e v e l of unmet needs) . Not s u r p r i s i n g l y , L f i t s the l i t e r a t u r e ' s p r o f i l e of a n o n - r e s i l i e n t c h i l d (a non-supportive environment i n c l u d i n g f a m i l y d y s f u n c t i o n and d i s r u p t i o n ; and m u l t i p l e placements). Case h i s t o r y and the Family Assessment Measure i n d i c a t e f a m i l y d y s f u n c t i o n . Although L has not had m u l t i p l e placements (she has been i n care a few times f o r b r i e f p e r i o d s ) , the f a m i l y has engaged i n a multitude of moves and thereby d i s r u p t i o n s i n s e r v i c e s and workers. - 92 -Comments on the Process of Assessment  C o g n i t i v e C o n s i d e r a t i o n s A problem with many measures ( p a r t i c u l a r l y f o r a d o l e s c e n t s who are s t i l l d eveloping and maturing at d i f f e r i n g r a t e s ) i s that a s p e c i f i c l e v e l of i n s i g h t i s r e q u i r e d f o r each assessment t o o l . Otherwise the r e s u l t w i l l not be v a l i d . For example, an i n d i v i d u a l c ould answer " l i k e me" to an item such as "I can make up my mind without much t r o u b l e " but i n f a c t be completely unable to do so. In the case of L, she had t r o u b l e p e r c e i v i n g what was being asked i n some of the items on the Rosenberg Self-Esteem S c a l e , the N o w i c k i - S t r i c k l a n d Locus of C o n t r o l S c a l e , the Beck Hopelessness S c a l e , and p o s s i b l y the Family Assessment Measure. Her apparent d i f f i c u l t y with understanding what was being asked by some of the items makes sense i n l i g h t of her r a t i n g on the I n t e r p e r s o n a l M a t u r i t y Level Assessment. This assessment r a t e d L as s t i l l being developmentally at a concrete stage (unable to take the f u t u r e i n t o account, unable to put h e r s e l f i n someone e l s e ' s shoes, unable to understand the reasons behind people's b e h a v i o r s ) . The I-Level assessment i s one measure where no p a r t i c u l a r c o g n i t i v e or developmental l e v e l i s a p r e - r e q u i s i t e since t h i s i n f a c t i s what i s being measured. In other words, i n the I-Level i n t e r v i e w , "not understanding" i s u s e f u l i n f o r m a t i o n . With most other measures, not understanding the que s t i o n throws o f f a v a l i d assessment. - 93 -C u l t u r a l C o n s i d e r a t i o n s C u l t u r a l l y loaded questions a l s o seem to appear on most assessment measures. P a r t i c u l a r e t h n i c , c u l t u r a l , r e l i g i o u s or socio-economic groups or subgroups could have values and p e r c e p t i o n s s i g n i f i c a n t l y d i f f e r e n t from those inherent i n statements on, f o r example, c e r t a i n s e l f - e s t e e m or f a m i l y f u n c t i o n i n g s c a l e s . An adolescent whose value i t i s to be "tough and c o o l " might not f i n d i t " c o o l " to answer p o s i t i v e l y to "my teachers are u s u a l l y happy with the kind of work I do" (a statement on the Hare Self-Esteem S c a l e ) . In other words, the above statement may not v a l i d l y measure self - e s t e e m . As noted p r e v i o u s l y , many we l l known f a m i l y assessment measures are p a r t i c u l a r l y g u i l t y of being c u l t u r a l l y loaded toward white, m i d d l e - c l a s s American values. In i n s t a n c e s where c e r t a i n measures may be found i n v a l i d f o r a s s e s s i n g what they were designed to measure among members of a p a r t i c u l a r group, that f i n d i n g i s i n i t s e l f important i n d e s c r i b i n g the a t t i t u d e s and f u n c t i o n i n g of the group. The above examples i l l u s t r a t e the need f o r c o l l e c t i n g as much i n f o r m a t i o n as i s p r a c t i c a l and p o s s i b l e about the i n d i v i d u a l being assessed. Behavioural o b s e r v a t i o n s from parents or other s i g n i f i c a n t persons can serve as a good source or check. The Harborview Sexual Abuse Impact C h e c k l i s t s were designed i n t h i s way to t r i a n g u l a t e data c o l l e c t i o n from the c h i l d , parent, and s o c i a l worker. - 94 -The I m p o r t a n c e o f S u p p l e m e n t a l Measures and O b s e r v a t i o n s The m a j o r i t y o f m e a s u r e s / t e s t s / a s s e s s m e n t t o o l s r e l y l a r g e l y o r e n t i r e l y on a p e r o n ' s s e l f - r a t i n g o r s e l f - a p p r a i s a l . W h i l e many f a c t o r s such as d e p r e s s i o n o r s e l f - e s t e e m g e n e r a l l y r e m a i n c o n s i s t e n t o v e r o f t e n l o n g p e r i o d s o f t i m e , momentary o r s h o r t - l i v e d c h a n g e s can and do o c c u r . Sudden, d r a s t i c c h a n g e s i n a p e r s o n ' s f a m i l y o r s c h o o l s i t u a t i o n may t e m p o r a r i l y i n f l a t e o r d e f l a t e f a c t o r s such as d e p r e s s i o n o r s e l f - e s t e e m . T h i s can be e s p e c i a l l y t r u e i n a d o l e s c e n c e which can q u i t e n o r m a l l y be a t i m e o f mood s w i n g s . F o r example, a s t u d e n t f r o m an i n t e n s e l y a c h i e v e m e n t - o r i e n t e d f a m i l y who r e c e i v e s a "bad" g r a d e c o u l d s c o r e s i g n i f i c a n t l y more p o o r l y on a s e l f - e s t e e m o r d e p r e s s i o n measure t h e day a f t e r r e c e i v i n g t h e g r a d e t h a n he o r she would have s c o r e d t h e day b e f o r e . A n s w e r i n g th e R e s e a r c h Q u e s t i o n s : Recommendations o f U s e f u l  M e a sures As a q u i c k r e m i n d e r t o t h e r e a d e r , t h e r e s e a r c h q u e s t i o n s were as f o l l o w s : 1. What would c o n s t i t u t e a c o m p r e h e n s i v e a s s e s s m e n t p r o t o c o l f o r use w i t h s e x u a l l y abused a d o l e s c e n t s ? Which i n s t r u m e n t s would p r o v i d e the most c r u c i a l i n f o r m a t i o n ? The o b j e c t i v e i s t o more e f f i c i e n t l y a s s e s s t h e w e l l b e i n g and needs o f s e x u a l l y abused a d o l e s c e n t s i n t r e a t m e n t programs so t h a t we can b e t t e r p l a n f o r them and t h e i r e m o t i o n a l h e a l t h ( p r o v i d e b e t t e r d i f f e r e n t i a l t r e a t m e n t b a s e d on sound a s s e s s m e n t ) . 2. What a r e t h e p r a c t i c a l and c l i n i c a l s t r e n g t h s and - 95 -weaknesses o f the measures used? Where a r e t h e u n n e c e s s a r y o v e r l a p s between measures? H a v i n g c o m p l e t e d o n l y one " t r i a l r u n " w i t h t h e a s s e s s m e n t p r o t o c o l under i n v e s t i g a t i o n i n t h i s t h e s i s , a few p r e l i m i n a r y comments can c a u t i o u s l y be made i n answer t o t h e s e q u e s t i o n s . As has been d i s c u s s e d i n t h e c h a p t e r on method, a measure o f s e l f - e s t e e m a p p e a r s t o be an i m p o r t a n t p a r t o f a s s e s s i n g an i n d i v i d u a l ' s g e n e r a l w e l l b e i n g . In terms o f such a measure, the Hare S e l f - E s t e e m S c a l e a p p e a r s t o be p r a c t i c a l and c l i n i c a l l y u s e f u l . In t h e c a s e o f L, the HSS a l e r t s t h e c l i n i c i a n t h a t L needs s u p p o r t w i t h home and s c h o o l i s s u e s , and t h a t p e r h a p s h e r g r e a t e r s t r e n g t h i n t h e a r e a o f p e e r f u n c t i o n i n g can be b u i l t upon t o h e l p her t o overcome some o f her o t h e r low s e l f - e s t e e m i s s u e s . The R o s e n b e r g S e l f - E s t e e m S c a l e d i d not p r o v i d e as c l i n i c a l l y u s e f u l i n f o r m a t i o n , and i t s r e s u l t s may not have been as v a l i d i n L's c a s e s i n c e she f o u n d t h e RSE h a r d e r t o u n d e r s t a n d . R e l a t e d l y , o f t e n p e o p l e who e x p r e s s a sen s e o f w o r t h l e s s n e s s and s e l f - d i s l i k e a r e a l s o d e p r e s s e d ( B e c k , 1967). As has been a d d r e s s e d more t h o r o u g h l y i n c h a p t e r t h r e e , a d e p r e s s i o n q u e s t i o n n a i r e can be v e r y u s e f u l w i t h i n d i v i d u a l s whose p r e s e n t i n g p r o b l e m s a r e not p r i m a r i l y a f f e c t i v e . In t h e c a s e ,of L, t h e C h i l d r e n ' s D e p r e s s i o n I n v e n t o r y was c l e a r l y more c l i n i c a l l y u s e f u l and c o g n i t i v e l y a p p r o p r i a t e t h a n t h e Beck H o p e l e s s n e s s S c a l e . U n l i k e the HS, - 96 -i t was p o s s i b l e to gather themes from L's responses to the CDI (e.g. that she was f e e l i n g p a r t i c u l a r l y down about s c h o o l ) . Even as an a d u l t reading through both s c a l e s , t h i s w r i t e r found the CDI items to appear d e f i n i t e l y simpler to comprehend. Thus i t does not appear that the CDI would be i n a p p r o p r i a t e f o r more mature adolescents than L. Because the v a r i o u s approaches to a s s e s s i n g depression i n c h i l d and adolescent p o p u l a t i o n s have appeared r e l a t i v e l y r e c e n t l y and, t h e r e f o r e , are not yet w e l l developed, no s i n g l e instrument should be used to i d e n t i f y or diagnose depression, although a c l i n i c a l i n t e r v i e w coupled with an assessment instrument could prove to be very u s e f u l . The Nowicki and S t r i c k l a n d Locus of C o n t r o l Scale d i d not seem to provide new and u s e f u l i n f o r m a t i o n . Locus of  c o n t r o l tends to r e v e a l i t s e l f i n the I - l e v e l i n t e r v i e w , as could be seen i n the I - l e v e l r e s u l t s d i s c u s s e d i n chapter f o u r . The N-SLCS seemed to be c o g n i t i v e l y f r u s t r a t i n g and too lengthy f o r L. As w e l l , i t d i d not r e v e a l any other new themes or i n f o r m a t i o n . It seems a locus of c o n t r o l measure i s not needed a l o n g s i d e an I - l e v e l assessment. There e x i s t few known adolescent measures of moral and  c o g n i t i v e development. i n s p i t e of how time consuming an I - l e v e l i n t e r v i e w i s to conduct, r a t e , and second r a t e , t h i s measure has been i n c l u d e d i n t h i s assessment p r o t o c o l f o r a number of reasons. Many of these have been r e f e r r e d to throughout t h i s paper. As w e l l , I - l e v e l i s one of the few - 97 -measures which assesses not only problems, but strengths as w e l l . A l s o , I - l e v e l theory i s very r e s p e c t f u l of whatever coping mechanisms/skills an adolescent may have developed to get through o f t e n d i f f i c u l t l i f e s i t u a t i o n s . The i n t e r v i e w guide format allows the interviewee more c o n t r o l than any of the other measures i n c l u d e d i n terms of spending more time c o v e r i n g areas of p a r t i c u l a r concern to him or her, or r a i s i n g r e l a t e d i s s u e s of h i s or her own. It has been the c l i n i c a l experience of t h i s w r i t e r that no other assessment t o o l i s as conducive to a l l o w i n g the adolescent to t e l l h i s or her s t o r y and h i g h l i g h t i n g themes. As w e l l , no other measure i n c l u d e d i n t h i s package i s as p r a c t i c a l when i t comes to not only a s s e s s i n g the adolescent, but a l s o p r o v i d i n g t h e o r e t i c a l recommendations f o r treatment based on the assessment. The treatment recommendations i n the case of L are o u t l i n e d l a t e r on i n t h i s chapter. Not only does the I - l e v e l i n t e r v i e w provide treatment recommendations, but i t a l s o overlaps with v i r t u a l l y a l l the other areas being assessed i n t h i s r e s e a r c h p r o j e c t . For example, o f t e n the I - l e v e l i n t e r v i e w w i l l provide themes or i n f o r m a t i o n p e r t a i n i n g to self-esteem, s e l f - c o n c e p t , locus of c o n t r o l , a f f e c t / d e p r e s s i o n / o u t l o o k , the a d o l e s c e n t ' s p e r c e p t i o n of f a m i l y f u n c t i o n i n g , the a d o l e s c e n t ' s p e r c e p t i o n of school f u n c t i o n i n g , peer r e l a t i o n s , c o g n i t i v e a b i l i t y , and h i s t o r y of moves or placements (see Appendix G f o r I - l e v e l i n t e r v i e w g u i d e ) . For t h i s reason the I - l e v e l i n t e r v i e w can act as a c l i n i c a l check f o r the v a l i d i t y of other assessment scores or outcomes w i t h i n t h i s assessment package. - 98 -In terms of a measure of the impact of sexual abuse, i t i s c l e a r that not only does the a c t u a l sexual abuse d i f f e r , but not a l l c h i l d r e n w i l l r e a ct to the experience of being s e x u a l l y abused i n the same way. Consequently i t appears to be important f o r treatment purposes to assess the d i f f e r e n t r e a c t i o n s v i c t i m s have to the experience of sexual v i c t i m i z a t i o n . However, beha v i o u r a l r e a c t i o n s to sexual abuse as measured by the c h e c k l i s t s ere only a part of the p o t e n t i a l impact of c h i l d h o o d sexual e x p e r i e n c e s . Future r e s e a r c h and p r a c t i c e should d i s c o v e r ways to understand and measure other p s y c h o l o g i c a l processes (such as b e l i e f s ) which are i n f l u e n c e d by c h i l d h o o d sexual e x p e r i e n c e s . Nevertheless, the c h e c k l i s t s provide c l i n i c i a n s with a good s t a r t i n g point f o r d i s c u s s i o n and r e l a t i o n s h i p b u i l d i n g . I d e a l l y the parent and c h i l d completed c h e c k l i s t s should alway be administered by a s k i l l e d c l i n i c i a n who has set aside the time to help the c l i e n t s process the p o t e n t i a l l y emotion laden content of these c h e c k l i s t s . As noted, although these c h e c k l i s t s are s t i l l undergoing r e s e a r c h and r e v i s i o n s , the Harborview parent, s o c i a l worker, and c h i l d completed impact c h e c k l i s t s seem to be the most we l l known end researched t o o l s a v a i l a b l e f o r the above mentioned purpose. The i n f o r m a t i o n these c h e c k l i s t s provided was unique i n t h i s assessment package, as i t g e n e r a l l y d i d not overlap with i n f o r m a t i o n obtained from other measures, other than i n terms of c o r r e l a t i o n s . A point to keep i n mind i n regard to the Harborview impact c h e c k l i s t s i s that, they cannot d i s t i n g u i s h between the impact of sexual abuse, or the - 99 -impact of other trauma, or s t i l l other or m u l t i p l e f a c t o r s . H o p e f u l l y the c u r r e n t research and r e v i s i o n s w i l l , among other t h i n g s , r e s u l t i n a b r i e f e r v e r s i o n of the c h e c k l i s t s . In the case of L, she became f r u s t r a t e d by the length and r e p e t i t i v e n e s s of the q u e s t i o n n a i r e . In terms of f a m i l y measures w i t h i n an assessment package, a c r i t i q u e of e x i s t e n t f a m i l y measures i n general has a l r e a d y been addressed. Adding to t h a t , a c c o r d i n g to the r e s e a r c h of Kazak, Himmelberg, McCannell and Grace (1988), the appeal of s e l f - r e p o r t paper and p e n c i l measures of f a m i l y processes i s strong, but very imperfect. It would be i d e a l i f we were c o n f i d e n t that they are r e a l l y able to measure a f a m i l y ' s emotional c l o s e n e s s , or t h e i r c o l l e c t i v e f e e l i n g s about independence. We urge, however, that f a m i l y r e s e a r c h e r s keep c l e a r i n t h e i r minds t h a t , at best, these instruments assess i n d i v i d u a l s ' p e r c e p t i o n s of the f a m i l y system of which they are a p a r t . Furthermore, as our research i n d i c a t e s , the norms by which scores on these measures are evaluated may be incongruous f o r persons i n d i f f e r e n t l i f e stages, f a m i l y circumstances or from d i f f e r e n t backgrounds. S e l f r e p o r t measures can promote a sense of detachment of the r e s e a r c h e r from the people being s t u d i e d , i n that something i s given to the " s u b j e c t " and i n t e r a c t i o n between r e s e a r c h e r s and s u b j e c t s i s minimized. The l o s s of t h i s i n t e r a c t i o n , and the f a i l u r e to acknowledge rese a r c h as an i n t e r a c t i v e process, i s problematic f o r the f i e l d of f a m i l y psychology. Boss (198?) c l a r i f i e s the o f t e n hidden i n t e r a c t i o n s that are common to both good rese a r c h and therapy. With respect to f a m i l y n o r m a l i t y , i t i s important that we ask the people we study about t h e i r notions of n o r m a l i t y , and that we accept our b i a s e s as an i n t e g r a l part of the data that we c o l l e c t , be i t i n a r e s e a r c h s e t t i n g or a therapy s e s s i o n . (pp. 284-28B) - 100 -Keeping a l l t h i s i n mind and given the a v a i l a b l e c h o i c e s , the FAM seems to be u s e f u l f o r re s e a r c h purposes. It i s one of the known standard f a m i l y measures, and i t i s easy to compare i n d i v i d u a l ' s p e r c e p t i o n s of t h e i r f a m i l y on the graph. The FILE and A-FILE could a l s o be u s e f u l , e s p e c i a l l y as s t a r t i n g p o i n t s f o r d i s c u s s i o n or i n t e r v e n t i o n , as was i l l u s t r a t e d using the example of L i n the previous chapter. One can however wonder how c e r t a i n items were chosen f o r i n c l u s i o n on e i t h e r the FILE or the A-FILE, but not both. For example, " p h y s i c a l or sexual abuse or v i o l e n c e i n the home" i s an item on the FILE, yet the A-FILE does not allow a d o l e s c e n t s as c l e a r an op p o r t u n i t y to re p o r t such problems. A l s o , although no one instrument can cover a l l p o s s i b i l i t i e s , a common l o s s such as m i s c a r r i a g e was not mentioned as a s t r a i n on e i t h e r i n v e n t o r y . In terms of c l i n i c a l l y u s e f u l t o o l s f o r a s s e s s i n g f a m i l i e s , the Family Problems C h e c k l i s t provided a very u s e f u l supplement to t h i s assessment package. As a c l i n i c i a n , i t was t h i s c h e c k l i s t , r a t h e r than the FAM or the FILE or A-FILE which would have given t h i s w r i t e r the best i n d i c a t i o n of where i n t e r v e n t i o n most needed to happen with the f a m i l y d e s c r i b e d i n t h i s case study. In terms of an assessment of school i s s u e s , some of t h i s i n f o r m a t i o n was obtained from the I - l e v e l , the Hare Self-Esteem S c a l e , and the C h i l d r e n ' s Depression Inventory. S t i l l , the school essay format used w i t h i n t h i s assessment p r o t o c o l provided some other u s e f u l i n s i g h t s i n t o L's - 101 -p e r c e p t i o n s , which i n turn begins to c l a r i f y where i n t e r v e n t i o n needs to s t a r t . The essay format had the a d d i t i o n a l b e n e f i t of h i g h l i g h t i n g j u s t how poor L's s p e l l i n g and punctuation s k i l l s are, and how d i f f i c u l t i t must be f o r her to have such poor w r i t i n g s k i l l s at her age. A teacher r a t i n g would have been u s e f u l i f L had been i n a school program w i t h i n the l a s t w hile. In summary, having run once through the measures i n c l u d e d i n t h i s t h e s i s , I would now recommend the f o l l o w i n g measures as being most u s e f u l f o r the purpose of a thorough assessment of s e x u a l l y abused adolescents i n treatment programs: - I-Level Assessment - Family Problems C h e c k l i s t - Harborview Sexual Abuse Impact C h e c k l i s t s - Hare Self-Esteem Scale - Kovacs C h i l d r e n ' s Depression Inventory - a school assessment - Eco-Map The assessment p r o t o c o l and model, as presented, i s seen to i n c l u d e major r e l e v a n t f a c t o r s a f f e c t i n g a d o l e s c e n t s ' p s y c h o s o c i a l f u n c t i o n i n g . T h i s assessment model i s i n no way intended to supercede good c l i n i c a l i n t e r v i e w s . I f one wants to know what i s r e a l l y going on f o r a c l i e n t ( a d o l e s c e n t or otherwise) there i s no s u b s t i t u t e f o r t a k i n g the time to r e a l l y l i s t e n . - 102 -In terms of how a l l t h i s r e l a t e s to treatment, perhaps t h i s can best be demonstrated through the case of L. For example, In L's case, treatment recommendations based on I - l e v e l theory would i n c l u d e the e s t a b l i s h i n g of a c l e a r , safe, and c a r i n g environment. This would i n c l u d e developing a s p e c i a l c a r i n g r e l a t i o n s h i p between L and her key worker. The key worker needs to be warned that L has learned to s u r v i v e by t e s t i n g r e l a t i o n s h i p s to check out whether she w i l l be abandoned once again. The worker a l s o needs to be warned that f o r the f i r s t while t h i s would be a n o n - r e c i p r o c a l "give, give, g i v e " r e l a t i o n s h i p on the part of the worker. L i s v i r t u a l l y a "bottomless p i t " i n need of d a i l y p o s i t i v e strokes (hugs, p r a i s e s , encouragement). Any consequences need to be of a short d u r a t i o n and with the c o n t i n u a l message of concern and encouragement. Those working to help L need to keep i n mind that L p r o t e c t s h e r s e l f by l o o k i n g f o r proof that she i s not cared f o r . A c t i o n s w i l l speak louder than words f o r L. Taking her out f o r an ice-cream w i l l mean much more to her than i n s i g h t o r i e n t e d c o u n s e l l i n g , which at t h i s point would be over her head . Abusive or thou g h t l e s s behaviour would be an expression of L's t r y i n g to cope with f e e l i n g i n s e c u r e and threatened. These f e e l i n g s need to be addressed i n an upfront manner. Role p l a y i n g , as well as l a b e l l i n g one's own f e e l i n g s , and h e l p i n g L to i d e n t i f y and l a b e l hers, are good techniques to help L l e a r n about f e e l i n g s and other p o i n t s of view. C r i s e s may be avoided by a n t i c i p a t i n g the a n x i e t y , l a b e l l i n g - 103 -i t , and r e h e a r s i n g how the upcoming s i t u a t i o n c ould be handled. The obvious b e n e f i t of the I - l e v e l assessment and the r e s u l t i n g treatment recommendations i s that s h aring t h i s model with those who are working with L, helps to make the whole process l e s s f r u s t r a t i n g and more understandable to both L and the c a r e g i v e r s ( i n t h i s case the c h i l d care c o u n s e l l o r s at Chimo House). In terms of how the f a m i l y assessment measures and the eco-map r e l a t e to treatment, these need to be d i s c u s s e d together. Based on these assessment t o o l s i t was recommended that the mother seek a good t h e r a p i s t to help her with her multitude of l i f e s t r u g g l e s which are r e l a t e d to her past abuse. Rather than running here and there f o r bandaids and b i t s and p i e c e s of c o u s e l l i n g , i t would be p r e f e r a b l e f o r the mother to seek c o u n s e l l i n g from one long term source i n order to deal with her l a r g e r abuse i s s u e s . T h i s i n turn would a s s i s t the mother i n d e a l i n g b e t t e r with L when she r e t u r n s home, and would help the mother not to allow L to "push emotional t r i g g e r s " . Although there i s l o t s to work on i n t h i s f a m i l y , there are a l s o l o t s of s t r e n g t h s . There i s much love and c a r i n g between the mother and her c h i l d r e n . When they are not f e e l i n g put down or threatened, both L and her mother have open and pleasant p e r s o n a l i t i e s . The mother seems open to non-threatening help and i s w i l l i n g to look at her part i n problem s i t u a t i o n s . - 104 -As long as L's f a t h e r i s i n the p i c t u r e , there are no doubt times when he could be encouraged to become i n v o l v e d i n the c o u n s e l l i n g , although there are a l s o i s s u e s which the mother w i l l want to work on i n d i v i d u a l l y . As w e l l as encouraging the mother to work on the l a r g e r i s s u e s , the key worker at Chimo House took on the r o l e of meeting r e g u l a r l y with L and her parents to help them work on communication s k i l l s and being c l e a r i n t h e i r r e l a t i o n s h i p s with each other. Another va l u a b l e piece of i n f o r m a t i o n to those working with t h i s f a m i l y i s that the eco-map showed f r i e n d s to be a source of s t r e n g t h f o r the f a m i l y . This resource can c e r t a i n l y be encouraged and drawn on i n times of need. The Harborview Sexual Abuse Impact C h e c k l i s t s r e l a t e d to treatment i n that they h i g h l i g h t e d f o r the c l i n i c i a n L's tendency to act i n s e l f - d e s t r u c t i v e ways (e.g. to cope with l i f e s t r e s s by running away or to make s u i c i d a l g e s t u r e s ) . Being aware of t h i s allows f o r an upfront d i s c u s s i o n about c h o i c e s , consequences, and to make a safe and simple plan f o r how to handle f e e l i n g s such as anger, f r u s t r a t i o n , f e a r , or sadness. The impact c h e c k l i s t s are t h e r e f o r e good i n a l e r t i n g the c l i n i c i a n to "red f l a g " i s s u e s which r e q u i r e immediate a t t e n t i o n and safe back-up plans w i t h i n the eco-system. - 105 -I f the Hare Self-Esteem Scale had h i g h l i g h t e d only L's need f o r improved self-esteem, t h i s may have been somewhat redundant, as t h i s a l s o showed i t s e l f i n the I - l e v e l and the school essay. However, the value of the HSS was that i t h i g h l i g h t e d that L's s e l f - e s t e e m i n r e l a t i o n to peers was a c t u a l l y q u i t e good. This i s valuable i n f o r m a t i o n to those working with L, s i n c e t h i s s t r e n g t h can be b u i l t on to a s s i s t L with her more general f e e l i n g s of low s e l f - e s t e e m . There are many ways to b u i l d self-esteem, some of which have been p r e v i o u s l y mentioned i n the I - l e v e l and f a m i l y treatment s e c t i o n s . However, t h i s i s a t o p i c on i t s own and w i l l not be explored f u r t h e r i n t h i s t h e s i s . The C h i l d r e n ' s Depression Inventory i s s i g n i f i c a n t to treatment as i t again h i g h l i g h t e d and v e r i f i e d the important themes of s u i c i a l thoughts and poor school s e l f - e s t e e m . The importance of f i n d i n g out about s u i c i d a l t h i n k i n g i s obvious and has a l r e a d y been d i s c u s s e d . The importance of l e a r n i n g about poor school s e l f - e s t e e m w i l l be d i s c u s s e d i n the f o l l o w i n g s e c t i o n . In L's case, the school essay was an important piece of assessment. I t not only h i g h l i g h t e d how d i f f i c u l t i t i s f o r L to w r i t e w e l l , but i t a l s o h i g h l i g h t e d that L f e e l s s t u p i d , l o s t with the school work, out of p l a c e , more s t r e e t wise than the other students, embarrassed of f a m i l y s e c r e t s , and picked on. Thus L p r o t e c t e d h e r s e l f from having to cope with a l l of these s t r e s s o r s by sabbotaging school placements and - 106 -r e f u s i n g t o a t t e n d s c h o o l . I t i s o b v i o u s t h a t L needs a v e r y s p e c i a l and e n c o u r a g i n g s c h o o l p l a c e m e n t where she can b e g i n t o have l i t t l e s u c c e s s e s and where she w i l l f e e l t h a t she f i t s i n . A c o m p r e h e n s i v e t r e a t m e n t p l a n f o r L a l s o needs t o i n c l u d e t e a c h i n g L s o c i a l s k i l l s i n c l u d i n g r e l a t i o n s h i p s k i l l s and p r o b l e m s o l v i n g s k i l l s so t h a t she does not end up so e a s i l y " f l y i n g o f f t h e h a n d l e " w i t h t e a c h e r s and f e l l o w s t u d e n t s . I t i s p o s s i b l e t h a t L may not be a b l e t o a t t e n d s c h o o l s u c c e s s f u l l y u n t i l some o f h e r s e l f - e s t e e m and s o c i a l s k i l l needs b e g i n t o i m p r o v e . The t r e a t m e n t recommendations d i s c u s s e d on the p r e v i o u s pages were s h a r e d w i t h t h e Chimo House s t a f f and w i t h L's mother ( i n c l u d i n g g i v i n g h e r a l i s t o f names o f good p s y c h i a t r i s t s f o r h e r s e l f s i n c e she has no way o f p a y i n g f o r p r i v a t e c o u n s e l l i n g ) . The r e s u l t s o f t h e a s s e s s m e n t were a l s o s h a r e d w i t h L i n a s i m p l e way, k e e p i n g i n mind her c o n c r e t e t h i n k i n g . She seemed p l e a s e d t h a t h e r b e h a v i o u r a p p e a r e d t o make s e n s e , and t h a t nobody t h o u g h t she was "bad" or c r a z y . Q u e s t i o n s R e m a i n i n g f o r F u t u r e R e s e a r c h 1. Would t h i s a s s e s s m e n t package f i t f o r s e x u a l l y abused o r o t h e r w i s e t r a u m a t i z e d boys o f s i m i l a r age? T h e r e i s an e m e r g i n g body o f l i t e r a t u r e p e r t a i n i n g t o s e x u a l l y abused boys (Lew, 1988; Sonken, 1988), and t h e ways i n which g e n d e r i n f l u e n c e s t h e a s s e s s m e n t p r o c e s s need t o be e x p l o r e d . - 107 -2. Would a p r o j e c t i v e p i c t u r e t e s t be a h e l p f u l a d d i t i o n t o t h i s package i n o r d e r t o s i d e s t e p d e f e n s e s t o a g r e a t e r d e g r e e ? In c o n c l u s i o n , t h e d e v elopment o f any a s s e s s m e n t model i s a p p r o a c h e d w i t h t h e a w a r e n e s s t h a t t h e c o n c e p t u a l d e s c r i p t i o n o f the model i s o n l y the f i r s t s t e p . The model must t h e n c o n t i n u e t o e v o l v e t h r o u g h a t t e m p t s t o use i t i n p r a c t i c e . I t i s t h e a u t h o r ' s c o n v i c t i o n t h a t o n l y t h r o u g h a t t e m p t i n g t o p r a c t i c e w i t h i n a d e v e l o p m e n t a l and e c o l o g i c a l framework w i l l h e l p i n g p r o f e s s i o n a l s b e g i n t o g e n e r a t e the a d d i t i o n a l d a t a n e c e s s a r y t o meet the complex demands o f e f f e c t i v e and r e s p o n s i b l e s o c i a l work p r a c t i c e w i t h a d o l e s c e n t s and t h e i r e n v i r o n m e n t s . To r e s t a t e the above f r o m a s l i g h t l y d i f f e r e n t p e r s p e c t i v e , " t h e model s u g g e s t s t h a t i n t e r v e n t i o n C w i t h s e x u a l l y a b u s e d a d o l e s c e n t s ) w i l l o f t e n r e q u i r e c o - o r d i n a t e d r e m e d i a t i o n i n v a r i o u s l i f e s e c t o r s , not j u s t i n ones n a r r o w l y r e l a t e d t o s e x u a l a b u s e . T h i s p l a c e s a renewed emphasis on c o - o r d i n a t e d c a s e management and t h e f o s t e r i n g o f a t r u e r e s p o n s e network" ( W a c h t e l , 1988). "And, f i n a l l y , the e c o l o g i c a l f o c u s on ( d e v e l o p m e n t a l ) u n i v e r s a l l i f e p r o c e s s e s r e m i n d s s o c i a l w o r k e r s t h a t s u p p o r t i n g p e o p l e ' s s t r e n g t h s and r e d u c i n g e n v i r o n m e n t a l b a r r i e r s t o growth and a d a p t a t i o n a r e t h e i r f o r e m o s t c o n c e r n s " ( G e r m a i n , 1981). - 108 -In terms o f some f u r t h e r c o n c l u s i o n s f o r s o c i a l w o r k e r s i n p a r t i c u l a r , as m e n t i o n e d i n the i n t r o d u c t i o n , i n o r d e r f o r s o c i a l w o r k e r s t o e f f e c t i v e l y c o u n s e l o r p l a n f o r s e x u a l l y a bused o r o t h e r t r o u b l e d a d o l e s c e n t s and t h e i r f a m i l i e s , we need t o b e t t e r u n d e r s t a n d s e x u a l abuse o r o t h e r trauma as one o f s e v e r a l p o s s i b l e p r e - a n d / o r c o - e x i s t i n g s o u r c e s o f i n d i v i d u a l s t r e s s . We need t o be a b l e t o b e t t e r a s s e s s p o s s i b l e s o u r c e s o f s t r e s s and r e s i l i e n c y . At t i m e s i t may even be a p p r o p r i a t e f o r s o c i a l w o r k e r s t o l o o k at t h e m s e l v e s as a p o s i t i v e o r n e g a t i v e s t r e s s o r i n t h e i r c l i e n t s ' l i v e s . F o r example, W a c h t e l (1988) n o t e s t h a t t h e l i t e r a t u r e i n d i c a t e s t h a t d i s c l o s u r e i s a s i g n i f i c a n t and s e p a r a t e f a c t o r i n a f f e c t i n g an i n d i v i d u a l ' s a b i l i t y t o cope w i t h s e x u a l a b u s e . O f t e n t h i s i m p o r t a n t d i s c l o s u r e e x p e r i e n c e o c c u r s i n t h e p r e s e n c e o f a s o c i a l w o r k e r . T h i s t h e s i s took a n ormal d e v e l o p m e n t a l framework i n t o a c c o u n t . As s o c i a l w o r k e r s , t h i s framework a l l o w s us t o be o p t i m i s t i c t h a t o v e r t i m e change can o c c u r i n p e r c e p t i o n o r s u b j e c t i v e e x p e r i e n c e , as b o t h c o g n i t i v e and e m o t i o n a l growth o c c u r . A normal d e v e l o p m e n t a l framework a l s o t a c i t l y g i v e s s o c i a l w o r k e r s a r e s p o n s i b i l i t y t o p r e p a r e c l i e n t s f o r t h e r e c u r r i n g impact o f a p a r t i c u l a r s t r e s s , such as s e x u a l abuse, as an i n d i v i d u a l i s f a c e d w i t h c h a n g i n g l i f e t a s k s w h i c h might t r i g g e r s t r e s s once a g a i n . - 109 -REFERENCES Adams-Tucker, C. (1982). Proximate effects of sexual ( abuse in childhood: a report on 28 children. American  Journal of Psychiatry, 139, (10), 1252 - 1256. Alter-Reid, K., (1986). Sexual abuse of children: a review of the empirical findings. Clinical Psychology Review, 6^  249 - 266. 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New York: Harper. - 115 -Trute, B. (1986). Evaluating c l i n i c a l service in family practice settings: basic issues and beginning steps, Canadian Social Work Review. Vondra, J. (1986). Socioeconomic stress and family functioning in adolescence. In J. Garbarino, Troubled Youth, Troubled Families. 191 - 195. New York: Aldine. Wachtel, A. (1988). The Impact of Child Sexual Abuse in  Developmental Perspective: a model and literature review. A report for Nisha Children's Society, 2478 West 21 Ave., Vancouver, B.C. Funded by Health & Welfare, Canada, project # 4569-1-238. Wallston, K., Wallston, B., & DeVellu, R. (1978). Development of the multidimensional health locus of control scales, Health Education Monography, 6, 160 - 170. Warren, M., & the Community Treatment Project Staff. (1966). Interpersonal Maturity Level Classification: Juvenile  Diagnosis and Treatment of Low, Middle and High Maturity  Delinquents. Sacramento: California Youth Authority. Woititz, J. (1985). Struggle for Intimacy. Pompano Beach, Florida: Health Communications. Wolf, M. (1978). Social validity: the case for subjective measurement, or how applied behavior analysis is finding i t s heart. Journal of Applied Behaviour Analysis, 11, 203 - 214. - 1 1 6 -APPENDIX A: THE SPONSORING AGENCY N i s h a C h i l d r e n ' s S o c i e t y - 1 1 7 -Nisha C h i l d r e n ' s S o c i e t y Nisha C h i l d r e n ' s S o c i e t y i s a n o n - p r o f i t s o c i e t y dedicated to the p r o v i s i o n of high q u a l i t y p r o f e s s i o n a l treatment and c o u n s e l l i n g s e r v i c e s f o r adolescents and f a m i l i e s . Nisha S o c i e t y formed i n 1984 at the time of p r i v a t i z a t i o n of c h i l d care s e r v i c e s i n B r i t i s h Columbia. Chimo House, Park House and Eagle High Nisha operates three treatment programs f o r a d o l e s c e n t s : two r e s i d e n t i a l c h i l d care programs (Park House and Chimo House), and a day t r e a t m e n t / s p e c i a l education program (Eagle High). These programs provide s e r v i c e to approximately 6G teens per year. The p o p u l a t i o n i s approximately h a l f male and h a l f female, with an average age of 15.5 years. Looking at the p o p u l a t i o n from 1984 to 1986 i t was found that 75.9% were known or suspected to have been s e x u a l l y abused (31.7% known, 44.2% suspected). Of these cases, 59.5% were g i r l s , 39.6% were boys. 40.5% of the p o p u l a t i o n were suspected of sexual o f f e n d i n g , and 2.5% were known to have s e x u a l l y offended. V i o l e n t behaviour was documented f o r 59.5% of the p o p u l a t i o n . Of the s e x u a l l y abused a d o l e s c e n t s , 91.1% were seen as depressed, 77.2% were known to have been p h y s i c a l l y abused, and 58.2% were substance abusers. The above f i g u r e s were compiled from r e p o r t s from MSSH s o c i a l workers and from Nisha c h i l d care c o u n s e l l o r s . Adolescents r e f e r r e d to the treatment programs are e x p e r i e n c i n g severe emotional and b e h a v i o u r a l problems i n t h e i r f a m i l y , community, and school f u n c t i o n i n g . The o b j e c t i v e of the - 1 1 8 -treatment programs i s to help adolescents f u n c t i o n more a p p r o p r i a t e l y i n the community, to gain emotional s t r e n g t h , and develop values, b e h a v i o u r a l c o n t r o l s and s o c i a l s k i l l s which w i l l enable them to move on to more normalized r e s o u r c e s . T h e o r e t i c a l l y , the Nisha treatment approach i s based on seeing the d i s t u r b e d c h i l d p r i m a r i l y as having the same normal growth and developmental needs as a l l other c h i l d r e n . However, Nisha S o c i e t y b e l i e v e s o f t e n the c o n d i t i o n s that c r e a t e d the emotional d i s t u r b a n c e have prevented the c h i l d from a c h i e v i n g the stage of development that i s c h r o n o l o g i c a l l y a n t i c i p a t e d , or that these c o n d i t i o n s have d i s t o r t e d the c h i l d ' s p e r c e p t i o n of r e a l i t y . It i s the b e l i e f of Nisha S o c i e t y that c h i l d r e n have the r i g h t to maximize t h e i r p o t e n t i a l . The e m o t i o n a l l y d i s t u r b e d c h i l d i s not caught i n an inescapable t r a p , but r a t h e r she or he can break through the l i m i t a t i o n s of the d i s t u r b a n c e and proceed with normal development. This i s worked towards through the p r o v i s i o n of assessment, a safe and n u r t u r i n g environment, s k i l l e d c h i l d care c o u n s e l l i n g based on i n d i v i d u a l i z e d treatment plans, and o u t s i d e c o u n s e l l i n g as a p p r o p r i a t e . Nisha C h i l d r e n ' s S o c i e t y operates three other programs as w e l l as those mentioned a l r e a d y . These are the Family C o u n s e l l i n g Program, the Support Program f o r Teen Parents, and the Independent L i v i n g Program. The Family C o u n s e l l i n g Program provides c o u n s e l l i n g f o r teens and parents i n c o n f l i c t . The o b j e c t i v e i s to prevent teens coming i n t o care unless c h i l d p r o t e c t i o n concerns a r i s e . - 1 1 9 -The I n d e p e n d e n t L i v i n g Program p r o v i d e s l i f e s k i l l s d e v e l o p m e n t f o r 16 t o 18 y e a r o l d s who a r e i n t h e c a r e o f MSSH. The program a s s i s t s a d o l e s c e n t s i n l e a r n i n g t h e p r a c t i c a l t a s k s o f i n d e p e n d e n t l i v i n g ( a c c o m m o d a t i o n s e a r c h , homemaking, s e l f - c a r e , b u d g e t i n g , j o b s e a r c h , e t c . ) . C o u n s e l l i n g i s p r o v i d e d t o s u p p o r t f u n c t i o n i n g i n r e s p o n s i b l e and s e l f - a c t u a l i z i n g ways. The S u p p o r t Program f o r Teen P a r e n t s t e a c h e s l i f e s k i l l s ( s e e above) and p a r e n t i n g s k i l l s and p r o v i d e s c o u n s e l l i n g f o r p r e g n a n t t e e n s and t e e n p a r e n t s . - 120 -APPENDIX B The Rosenberg Self-Esteem Scale Reference: Rosenberg, M. (1979) Conceiving the S e l f . New York: B a s i c Books - 121 -APPENDIX C The Here S e l f - E s t e e m S c a l e R e f e r e n c e : Hare, B. C1985) The HARE g e n e r a l and a r e a - s p e c i f i c ( s c h o o l , p e e r , and home) s e l f - e s t e e m s c a l e . U n p u b l i s h e d m a n u s c r i p t , Dept. o f S o c i o l o g y SUNY S t o n y Brook, S t o n y Brook, New York. - 122 -APPENDIX D The H o p e l e s s n e s s S c a l e R e f e r e n c e : Beck, A., Weissman, A., L e s t e r , D. & T r e x l e r , L. (1974) The Measurement o f P e s s i m i s m : The H o p e l e s s n e s s S c a l e . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y . V o l . 42, 861-86S. - 123 -APPENDIX E The C h i l d r e n ' s D e p r e s s i o n I n v e n t o r y R e f e r e n c e : K o v a c s , M. ( 1983) The C h i l d r e n ' s D e p r e s s i o n I n v e n t o r y . U n p u b l i s h e d M a n u s c r i p t , U n i v e r s i t y o f P i t t s b u r g h . - 124 -APPENDIX F The C h i l d r e n ' s N o w i c k i - S t r i c k l a n d L o c u s o f C o n t r o l S c a l e R e f e r e n c e : N o w i c k i , S. G S t r i c k l a n d , B. (1973) A L o c u s o f C o n t r o l S c a l e f o r C h i l d r e n . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y . 40., 145-154. - 125 -APPENDIX G I - L e v e l I n t e r v i e w G u i d e R e f e r e n c e : I n g r i d K a s t e n s f o r N i s h a C h i l d r e n ' s S o c i e t y . (1989) Based on t h e work o f S t u a r t A l c o c k and M a r g u e r i t e Warren. - 126 -I - L e v e l I n t e r v i e w G u i d e F o r t h e As s e s s m e n t o f Teens i n N i s h a T r e a t m e n t Programs P l e a s e n o t e t h a t t h i s i s a g u i d e . A l l t h e q u e s t i o n s need not be a s k e d e v e r y i n t e r v i e w . I t i s i m p o r t a n t t o d e l e t e and add as a p p r o p r i a t e , and t o f o l l o w t h e a d o l e s c e n t ' s l e a d , j u s t p e r s u i n g f o r more c o m p l e x i t y o r i n s i g h t about any g i v e n t o p i c . When t h i n g s get t o o e m o t i o n a l t o p r e s s on, i t may be a p p r o p r i a t e t o go t o a s a f e r t o p i c f o r a w h i l e . I n t r o d u c t i o n - I would l i k e y o u r i d e a s and o p i n i o n s - The way you see t h i n g s - I t ' s OK i f you c h o o s e not t o answer some q u e s t i o n s - I t ' s OK i f you w i s h not t o use names I n t e r e s t s - What a r e y o u r i n t e r e s t s o r h o b b i e s - How d i d you get i n t e r e s t e d i n t h a t - How i s i t you d r o p p e d y o u r i n v o l v e m e n t i n . . . - What s o r t s o f t h i n g s do you do i n y o u r f r e e t i m e The P r e s e n t - Where a r e you l i v i n g now - Can you t e l l me a b i t about t h i s p l a c e - How i s i t someone ends up l i v i n g t h e r e - What i s t h i s p l a c e f o r - How i s i t you came t o l i v e t h e r e - Why t h e r e as opposed t o . . . - What would you change i f you were i n c h a r g e - Why do you suppose t h e y have the r u l e s t h a t t h e y have - What a r e t h e t h i n g s t h a t you l i k e P e o p l e - What a r e t h e s t a f f l i k e - Do you have f a v o r i t e s - What i s i t you l i k e a bout them - What i s t h e i r p e r s o n a l i t y l i k e - How do you suppose t h e y came t o be l i k e t h i s - I f you were h i r i n g t h e s t a f f , what s o r t s o f q u a l i t i e s would you l o o k f o r - What s o r t s o f s t a f f p e o p l e do you a v o i d ? Why? - 127 -H i s t o r y and Moves - Have you moved v e r y much s i n c e you were b o r n - C o u l d you b r i e f l y t e l l me about where you've l i v e d and who you've l i v e d w i t h s i n c e you were b o r n - What's y o u r r e c o l l e c t i o n o f why the moves happened - What was you f a v o r i t e p l a c e - What d i d you l i k e about i t - What happened t h a t you had t o move - What was y o u r l e a s t f a v o r i t e p l a c e - What d i d n ' t you l i k e about i t - Have you e v e r r u n away - What b r o u g h t t h a t on - What t h i n g s a r e r e a l l y i m p o r t a n t t o you w h e r e v e r you l i v e - Where do you i d e a l l y hope t o l i v e i n t h e f u t u r e - What t h i n g s can you do t o b r i n g t h i s about F r i e n d s and O t h e r s - What s o r t s o f t e e n a g e r s do you l i k e t o hang out w i t h - What s o r t s o f t e e n a g e r s do you a v o i d ? Why? - Do you have a l a r g e o r s m a l l group o f f r i e n d s - How do you g e t a l o n g w i t h t h e k i d s where you l i v e - Do you have f a v o r i t e s - What do you l i k e about them - How do you suppose t h e y got t o be t h a t way - Do you have a b e s t f r i e n d - What i s i t you l i k e about t h i s p e r s o n - Have you e v e r had an i d o l ? Who? Why? B o y f r i e n d / G i r l f r i e n d - Do you have a b o y f r i e n d / g i r l f r i e n d - What i s i t t h a t a t t r a c t e d you t o t h i s p e r s o n - Who i n y o u r l i f e [ i f anyone) has spoken w i t h you about sex and c o n t r a c e p t i v e s - Where would you go f o r c o n t r a c e p t i v e s School/Work - Can you t e l l me a b i t about y o u r s c h o o l / w o r k - What a r e t h e t e a c h e r s / e m p l o y e r l i k e - How do you suppose t h e y got t o be t h a t way - What does i t t a k e t o be a good t e a c h e r / b o s s - Who was y o u r f a v o r i t e t e a c h e r e v e r - What d i d you l i k e about h e r / h i m - Who was y o u r l e a s t f a v o r i t e t e a c h e r e v e r - What d i d n ' t you l i k e about h e r / h i m - How do you do at s c h o o l - Why do you suppose t h a t i s - What i s y o u r f a v o r i t e / l e a s t f a v o r i t e s u b j e c t - Have you gone t o a l o t o f s c h o o l s - Why do you suppose t h a t i s - How i s y o u r a t t e n d a n c e - Why do you suppose t h a t i s - 128 -L e g a l T r o u b l e ( a s a p p l i c a b l e ) - Have you e v e r had r u n i n s w i t h t h e p o l i c e - Have you e v e r been c h a r g e d - What were t h e c h a r g e s - What happened i n c o u r t - How d i d a l l t h i s b e g i n i n y o u r l i f e - Were o t h e r p e o p l e i n v o l v e d - How do you f e e l about i t now - How do y o u r p a r e n t ( s ) f e e l about i t - What do you p l a n t o do i n t h i s r e g a r d i n t h e f u t u r e F a m i l y - Who i s i n y o u r f a m i l y - D e s c r i b e t h e p e r s o n you c o n s i d e r t o be y o u r f a t h e r / m o t h e r - What i s h i s / h e r p e r s o n a l i t y l i k e - What i s t h e n i c e s t t h i n g about him/her - What do you wi s h you c o u l d change about him/her - Any i d e a s about how he/she got t o be l i k e t h a t - How do y o u r p a r e n t s g e t a l o n g - What k i n d s o f t h i n g s do t h e y d i s a g r e e about - What does y o u r Mom/Dad do when she/he i s mad - What does y o u r f a m i l y l i k e t o do t o g e t h e r - I s t h e r e anyone e l s e r e a l l y i m p o r t a n t t o you - What do you l i k e about h i m / h e r . . . - Who i s y o u r f a v o r i t e r e l a t i v e - What do you l i k e about h i m / h e r . . . - Do you have a f a v o r i t e b r o t h e r o r s i s t e r . . . - So a l l i n a l l , who has r e a l l y been t h e r e f o r you i n l i f e - Who would you go t o i n an emergency - What i s t h e b i r t h o r d e r o f t h e k i d s i n y o u r f a m i l y - Which c h i l d do you t h i n k y o u r p a r e n t ( s ) f a v o r - Any i d e a s about why - What s o r t o f c o n t a c t do you have w i t h y o u r p a r e n t ( s ) - How d i d t h i s a r r a n g e m e n t come about - A r e you happy w i t h t h i s S e l f - You've t a l k e d a l o t about o t h e r p e o p l e , how would you d e s c r i b e y o u r s e l f - What a r e y o u r s t r o n g p o i n t s - What a r e t h e t h i n g s about y o u r s e l f you don't l i k e - How would y o u r f a t h e r / m o t h e r d e s c r i b e you - What would y o u r f a t h e r / m o t h e r say t h e y r e a l l y l i k e about you - What b o t h e r s y o u r f a t h e r / m o t h e r about you - How would y o u r f r i e n d s d e s c r i b e you - Who do you t a k e a f t e r i n y o u r f a m i l y - In what ways - Have you o r y o u r p a r e n t ( s ) e v e r had any c o u n s e l l i n g b e f o r e - How d i d i t go - 129 -F u t u r e - What a r e y o u r p l a n s f o r the next s i x months - What c o u l d you see y o u r s e l f d o i n g 10 y e a r s f r o m now - What k i n d o f work do you hope t o get i n t o - How d i d you get i n t e r e s t e d i n t h i s - How can you make t h i s p o s s i b l e - Do you t h i n k y o u ' l l get m a r r i e d - What s o r t o f a p e r s o n would you c h o o s e as a p a r t n e r - What do you t h i n k i s most i m p o r t a n t i n making a m a r r i a g e work - Would you have k i d s - What would you do t h e same a s / d i f f e r e n t l y f r o m you p a r e n t ( s ) - What would you do i f y o u r k i d got i n t o t r o u b l e D r u g s / A l c o h o l - What about d r u g s o r a l c o h o l i n y o u r l i f e - How much? How o f t e n - How o l d were you when you f i r s t got i n v o l v e d - Do you remember what e l s e was h a p p e n i n g i n y o u r l i f e a t the t ime A b u s e / V i o l e n c e ( a s a p p l i c a b l e ) - Do p e o p l e g e t h i t i n y o u r f a m i l y - Who h i t s who - Does anyone get h u r t - Why do you suppose t h e y do t h i s - Do you know what abuse i s - What about s e x u a l abuse, has t h a t e v e r happened t o anyone i n y o u r f a m i l y / y o u - Who was t o l d about i t - What happened. . . Memories S T h o u g h t s - What do you remember about y o u r e a r l y y e a r s - What i s y o u r e a r l i e s t memory - What i s t h e b e s t / w o r s t t h i n g t h a t e v e r happened t o you - What e v e n t f s ) ( h a p p y o r sad) do you remember as h a v i n g t h e b i g g e s t i m p a c t on y o u r l i f e - Over the y e a r s , what have you l e a r n e d about o t h e r p e o p l e - Over the y e a r s , what have you l e a r n e d about how t o s u r v i v e i n l i f e - I f you c o u l d have 3 magic w i s h e s , what would you w i s h f o r C o n c l u d i n g I n t e r a c t i o n - Thank you. Any q u e s t i o n s ? - I s t h e r e a n y t h i n g e l s e I s h o u l d have a s k e d about t o get a b e t t e r p i c t u r e o f how you see t h i n g s I n t e r v i e w e r ' s I m p r e s s i o n s Take n o t e o f p o s t u r a l c u e s , t i c s , r e s t l e s s n e s s . D i d i t f e e l as t h o u g h t h e i n t e r v i e w e r were p u l l i n g t e e t h ? Was t h e i n t e r v i e w d i f f i c u l t o r r e l a x e d f o r t h e a d o l e s c e n t ? Immediate i m p r e s s i o n o f I - l e v e l ? Why?... - 130 -APPENDIX H H a r b o r v i e w S e x u a l Abuse Impact C h e c k l i s t s R e f e r e n c e : C o n t e , J . , B e r l i n e r , L . & Schuerman J . (1986) Impact o f S e x u a l Abuse on C h i l d r e n , F i n a l R e p o r t A v a i l a b l e f r o m t h e a u t h o r s a t The U n i v e r s i t y o f C h i c a g o , S c h o o l o f S o c i a l S e r v i c e A d m i n i s t r a t i o n . - 131 -APPENDIX I The F a m i l y A s s e s s m e n t Measure R e f e r e n c e : S k i n n e r , H. G S t e i n h a u e r , P. (1983) The F a m i l y A s s e s s m e n t Measure, C a n a d i a n J o u r n a l o f Community  M e n t a l H e a l t h . 2 ( 2 ) , 91-108. - 132 -APPENDIX J F a m i l y I n v e n t o r y o f L i f e E v e n t s and Changes R e f e r e n c e : McCubbin, H., P a t t e r s o n , J . G W i l s o n , L. (1980) F a m i l y I n v e n t o r y o f L i f e E v e n t s and Changes ( F I L E ) S t . P a u l : F a m i l y S o c i a l S c i e n c e . - 133 -APPENDIX K A d o l e s c e n t - F a m i l y I n v e n t o r y o f L i f e E v e n t s and Changes R e f e r e n c e : McCubbin, H., P a t t e r s o n , J . , Bauman, E. G H a r r i s , L. (1981) A d o l e s c e n t - F a m i l y I n v e n t o r y o f L i f e E v e n t s and Changes ( A - F I L E ) S t . P a u l : F a m i l y S o c i a l S c i e n c e . - 134 -APPENDIX L The F a m i l y P r o b l e m s C h e c k l i s t A v a i l a b l e f r o m : The M o r r i s o n C e n t e r f o r Youth and F a m i l y S e r v i c e 3355 S.E. P o w e l l B l v d . , P o r t l a n d , Oregon, 97202. - 13B -APPENDIX M Eco-Map R e f e r e n c e : Hartman, A. G L a i r d , J . (1983) The F a m i l y i n S p a c e : E c o l o g o c a l A s s e s s m e n t . In F a m i l y C e n t e r e d S o c i a l Work P r a c t i c e . New York: The F r e e P r e s s . APPENDIX N L's I - L e v e l A s s e s s m e n t : P a r t i a l T r a n s c r i p t I 3 cfm C h a r a c t e r i s t i c s T r e a t m e n t Recommendations - 137 -NISHA CHILDREN'S SOCIETY 247* Wut 2Ut Avtnuz, VanzouvVi, B.C. V6L 1K1 [604] 733-3603 I L e v e l In te rv iew ( p a r t i a l t r a n s c r i p t ] L_ age 14 Date of I n te rv iew; Mar. 6, 1989. Preamble: L was q u i t e Impat ient i n the i n t e r v i e w . I b e l i e v e that she found some of the q u e s t i o n s to be f r u s t r a t i n g s i n c e the i n t e r v i e w r e v e a l e d t h a t she does not have the i n s i g h t to r e a l l y have understood the c o m p l e x i t y o f some of the q u e s t i o n s a s k e d . Due to L ' s impa t ience I d e c i d e d to make i t e a s i e r f o r L by s k i p p i n g over some q u e s t i o n s and r u s h i n g through o t h e r s . In te rv iew Conten t : Whet are your i n t e r e s t s these days? What s o r t s o f t h i n g s do you l i k e to do? I l i k e to d r i n k , I l i k e to p a r t y , I l i k e to have f u n , end I hate s c h o o l . . . w e l l I l i k e I t a l i t t l e b i t . . . T h e r e ' s people there that I can m e e t . . . I t ' s not l i k e I'm stuck to the same f r i e n d s I had. I can meet new o n e s . . . Is Eag le High d i f f e r e n t from o t h e r s c h o o l s that y o u ' v e been t o , or not r e a l l y ? I t ' s d i f f e r e n t . It d o e s n ' t have as many k i d s , and you know e x a c t l y what two rooms you go t o . . . d i f f e r e n t group of k i d s , some ere wacko, some are r e a l l y b i z a r r e . . . Which ones are your f a v o r i t e s ? I d o n ' t know, I 've on ly been there t w i c e . Do you l i k e any of the a d u l t s y e t , o r i s i t too soon? Too 8 0 o n . . . I l i k e Mar ianne. She was n i c e . What was the n i c e part about her? I d o n ' t know she seemed r e a l l y n i c e . I know schoo l has been a r e a l s t r u g g l e f o r y o u . What are the p a r t s t h a t have been the s t r u g g l e i n the past? G e t t i n g up i n the morning, g e t t i n g d r e s s e d , g e t t i n g ready to go to s c h o o l . I f i t ' s sunny o u t s i d e I want to go and have f u n . I f i t ' s r a i n i n g o u t s i d e I want to s t a y i n s i d e i n my b e d . . . L i k e i f schoo l s t a r t e d around noon 1 c o u l d p r o b a b l y make i t . . . How about schoo l work? What do you th ink of tha t? . . . A f t e r about 2 hours of i t I get so bored of i t ( s t a r t s to yawn) . . .my b r a i n ' s on o v e r l o a d . . . L i k e when I had to do a l l - 138 -those t e 8 t s . . . I walked i n t o the o f f i c e with those t e s t s and s a i d I c a n ' t do no more because I o o u l d add 7+4 but i t ' s j u s t l i k e l o o k i n g at i t and g o i n g what 's t h a t . . . T h a t ' s j u s t an example. What 's your f a v o r i t e s c h o o l y o u ' v e ever gone to? Eag le H i g h . . . I a lways hated s c h o o l . They always made me u n c o m f o r t a b l e . They never do n o t h i n g . T h e r e ' s n o t h i n g to look forward t o . I hate b i g s c h o o l s wi th 40 k ids to a o l e s s . Y o u ' r e lucky to ask one q u e s t i o n b e f o r e the end of the p e r i o d . . . ( A t E a g l e High) they e x p l a i n i t to you . They d o n ' t Jus t t e l l you the answer and you d o n ' t got to wait 10 m i l l i o n h o u r s . . . a n d t h e r e ' s f o o d t h a t ' s h o t . . . Have you ever had a f a v o r i t e t e a c h e r ? My grade S t e a c h e r . . . What was s p e c i a l about her? She was r e a l l y r e a l l y n i c e . She spent time wi th everybody . She took us out f o r l u n c h one at a t ime i f we were r e a l l y good d u r i n g the w e e k . . . I t h i n k i t was my grade 5 t e a c h e r . I d o n ' t know. I have a p i c t u r e of h e r . What do you th ink i t t akes to be a n i c e teacher? I f t h e r e ' s something not done and you have a r e a s o n a b l e e x c u s e , not to make them s t a y a f t e r s c h o o l , but to make sure they do i t that n i g h t . I f you were h i r i n g t e a c h e r s what q u a l i t i e s would you look f o r ? As long as t h e y ' r e n i c e and as long as t h e y ' r e not o l d b i d d i e s . . . o l d , o l d t e a c h e r s that are r e a l l y r e a l l y s t r i c k . . . Do you have any i d e a s what makes some people l i k e that ( s t r i o t ) ? T h a t ' s the way they were r a i s e d . From the way that y o u ' r e be ing r a i s e d , what are you going to l e a r n ? I'm r a i s i n g m y s e l f . I f e e l l i k e my Mom i s t o s s i n g me around l i k e i f I was i n a t o s s e d s a l a d . I d o n ' t f e e l l i k e she wants me. L i k e when I go t h e r e she t o t a l l y ignores me, when I phone there she t o t a l l y i g n o r e s me. I t ' s l i k e A l l e n and Maggey and my Dad and my Mom are the p e r f e c t f a m i l y . I have a chance to move to A l b e r t a w i th my A u n t . I th ink I'm going to take i t . . . S h e ' s moving t o A l b e r t s o r Saskatchewen or Man i toba , somewhere, or C a l i f o r n i e . . . I 'm go ing to run away end l i v e wi th h e r . Or I c o u l d a lways go wi th my f r i e n d s . . . How do you th ink y o u r Mom f e e l s about you? I d o n ' t th ink she f e e l s about me. I th ink she t h i n k s L ' s my daughter and I l o v e her but I wish she wasn't part o f my l i f e any more, I wish t h e r e was J u s t A l l e n and Maggey.. .Now that I'm i n Chimo I'm Jus t t h e r e u n t i l I can f i n d another p l a c e to l i v e ( s inoe L assumes Mom won't want her beck home) . . .My Mom's J e a l o u s of my Aunt C a r o l because I do love her a l o t and I 'd do almost any th ing to l i v e wi th h e r . . . T h a t ' s Just because my Aunt l i v e s i n the ' 8 0 ' s . My Mom l i v e s when her Mom used to beat - 139 -h e r . . . I n her p o s t . . . s h e (Mom) goes "we l l et l e a s t you d o n ' t got i t as bed o f f as 1 d i d " . . . I d o n ' t th ink A l l e n or Maggey should be wi th her e i t h e r . I th ink she has a mental prob lem. I th ink she s h o u l d go to a p s y c h i c (meant p s y c h i a t r i s t ) . How do you t h i n k the f a c t that your Mom was beaten has e f f e c t e d your Mom? I d o n ' t know. My Aunt was beaten end i t h a s n ' t e f f e c t e d her . You can see sometimes that s h e ' s h u r t , but she d o e s n ' t take i t out on k i d s . She d o e s n ' t take i t out on anybody, but she has disowned her mother , end I am disowning my mother because I d o n ' t l i k e the way she t r e a t s me end I d o n ' t th ink the way she t r e a t s me i s f a i r . How would you l i k e to be t r e a t e d ? I 'd l i k e to be t r e a t e d l i k e a human b e i n g , not l i k e a 4 year o l d l i t t l e b r a t . . . S h e d o e s n ' t went me to grow u p . . . L i k e F r i d a y n ight I came to Chimo House t o t a l l y p i s s e d . I was h igher than a k i t e end that was f i n e so they j u s t t o l d me to go to bed, end I d i d n ' t want to go to bed so they sent me f o r a walk end I went f o r a wa lk , came baok, c r a s h e d . Next day I had a hangover end I went over to my Mom's house which was r e a l l y s t u p i d but I d i d , and she r e a l l y got on me. She s a i d I c a n ' t see her ' t i l whenever and I s a i d f i n e I d o n ' t want to see you no m o r e . . . S h e ' s r e a l l y f u c k e d u p . . . S h e s a i d "I d o n ' t went you t u r n i n g out l i k e your f a t h e r , " end I'm going to tu rn out l i k e my f a t h e r i f she k i c k s me out end she d o e s n ' t t e l k to m e . . . E v e n i f she d i d t e l k about i t , i t ' s my problem. I ' l l do what I want to d o . . . I want t o d i v o r o e my p a r e n t s , but you c a n ' t do thet so I'm j u s t go ing to l e a v e my peren ts end get somebody e l s e to adopt me . . .My Mom d o e s n ' t t r e a t me p r o p e r . Whet would p r o p e r t reatment be? My Aunt knows the t I do whet I do. Orugs and s h i t l i k e t h e t . . . S h e seys " i f y o u ' r e go ing to do them d o n ' t come back ' t i l y o u ' r e sober ' c a s u s I d o n ' t want the k i d s to s e e " . . . M y Mom's not l i k e t h e t . She b e e t s me wi th i t (meaning l e c t u r e s ) . . . My Mom c a r r i e s i t on f o r months and m o n t h s . . . T h e r e ' s no way i n H e l l I'm going to q u i t Just f o r my M o t h e r . . . I w o u l d n ' t q u i t f o r nobody. I'm not going to change my p e r s o n a l i t y J u s t because somebody wants me t o . At t h i s p o i n t i n y o u r l i f e , how come you 've chosen to do the drug s t u f f ? Because I went t o . . . I ' m sure everybody does i t . For e long time I never knew t h e t my Mom d i d d r u g s . I thought she wes r e a l l y good about t h a t , u n t i l I walked i n t o the bedroom one day end there she wee t o k i n g up and then she wes so stoned thet she goes "I d o n ' t l o v e y o u , get out of my s i g h t " . . . M y Oed 's taught me to d r i n k end my Mom's taught me to toke u p . . . e n d I'm not going to go do t rea tment or any th ing f o r i t because t h a t ' s whet I went to d o . . . I know why I'm doing i t but I'm not going to go eround t e l l i n g e v e r y b o d y . . . ' c a u s e I d o n ' t f e e l l i k e i t . Whet about your Ded? Whet do you th ink about him these days? My Dad 's an a s s h o l e somet imee . . .most of the t ime . H e ' s t u r n i n g out to be l i k e my mother . He l i k e s my b r o t h e r , he l i k e s my - 140 -s i s t e r , he does c a r t h i n g s wi th my b r o t h e r , he takes my s i s t e r s h o p p i n g , but he never does that wi th m e . . . t h a t ' s r e a l l y f u c k i n g r i d i c u l o u s . He used to t r e a t me a l o t b e t t e r u n t i l he and my Mom got back t o g e t h e r . . . My Mom i s p o i s o n i n g my f a t h e r l i k e my Mom has p o i s o n e d me. Is there a n y t h i n g tha t you l i k e about your Dad? H e ' s n i c e when he wants to be . Is there a n y t h i n g you l i k e about your Mom? N o . . . sometimes she oan be n i c e but t h a t ' s not o f t e n . . . o n l y when I do t h i n g s f o r h e r . . . I a lways have to do something to ga in her r e s p e c t . My s i s t e r and b r o t h e r on ly have to be there to ga in her r e s p e c t . Do you know what y o u r Mom t h i n k s of you? I d o n ' t th ink she t h i n k s of me. I d o n ' t th ink she l i k e s me that m u c h . . . ' c a u s e I'm t u r n i n g out to be l i k e my f a t h e r . Can you th ink of a n y t h i n g she does l i k e about you? N o . . . s h e ' s j e a l o u s o f m e . . . o f my l i f e , of my l o o k s , o f what I do . How can you t e l l ? The way she t r e a t s me. . .When I he lp her c l e a n up she s a y s . . . " t h a t ' s r e a l l y g o o d " , and then f o r Maggey i t ' s a 2 hour d i s c u s s i o n how good and how p r e t t y her l i t t l e g i r l i s , and A l l e n , how s t r o n g her boy i s . Me, I'm Just l i k e a d i r t y o l d shoe to be k i c k e d a r o u n d . What do you t h i n k o f Maggey and A l l e n ? I th ink t h e y ' r e b r a t s . . . They ' r e very s p o i l e d , and I'm not J e a l o u s . . . I'm not J e a l o u s o f nobody or n o t h i n g . Do you th ink i t ' s a bad t h i n g to be j e a l o u s ? I th ink i t ' s w r o n g . . . y o u shou ld be happy with what you have. Are you happy w i th some o f the t h i n g s you have? I'm happy wi th a lmost e v e r y t h i n g except my p a r e n t s . Whet are the t h i n g s In your l i f e that y o u ' r e happy about? E v e r y t h i n g , except I c o u l d l o s e some weight , ( c o u l d n ' t e l a b o r a t e ) Maybe I can ask you e b i t more about your i n t e r e s t s . . . ? I l i k e to s o c i a l i z e . . . I l i k e to go out with people shopping and go p l a c e s where I h a v e n ' t been , I l i k e to t r a v e l . I ' ve on ly t r a v e l l e d o n c e . . . I went to C a l g a r y . . . m y Mom needed m o n e y . . . Have you ever had a hobby Me and my f r i e n d used to b r a i d w i th yarn f o r h o u r s . . . Is there a n y t h i n g e l s e that y o u ' r e good at? I'm good at s i n g i n g . I'm good at a c t i n g . I'm good et c o o k i n g , b a k i n g , end I'm good at r e i s i n g a n i m a l s . . . ( y a w n ) and I'm good at be ing t i r e d . - 141 -Can you d e s c r i b e y o u r s e l f . . . Whet 's L l i k e ? I d o n ' t know. Whet ere the t h i n g s the t you l i k e ebout L 7 N o t h i n g . I d o n ' t know. Is there e n y t h i n g y o u ' d l i k e to chenge ebout y o u r s e l f ? E v e r y t h i n g . L i k e whet? I 'd r a t h e r l i v e somewhere e l s e f a r ewey, e f a r ewey p i e n e t . I wish I wes en a l i e n to be d i s c o v e r e d on Mars. I f your Mom were d e s c r i b i n g you to me or e f r i e n d , whet would she say? T e l l you thet I'm e b r e t , thet I never do as I'm t o l d , I'm b a s i c a l l y e b i t c h . Whet ere the t h i n g s she r e a l l y l i k e s ebout you? I d o n ' t know. How ebout your Ded? He 'd p robeb ly sey s h e ' s such e oute l i t t l e g i r l . . . I hete thet ' cause I'm not e l i t t l e g i r l . Whet i s i t you l i k e ebout your Aunt C a r o l ? I d o n ' t know. She t r e a t s me d i f f e r e n t . Don' t ask me how she t r e e t s me. How do you l i k e or not l i k e Chimo House? I t ' s OK I g u e s s . I f you were i n c h a r g e . . . ? I 'd make i t a h e l l o f e l o t d i f f e r e n t Whet t h i n g s would you change? I 'd l e t there be smoking i n the house, t h e r e ' d be e T V . . . B l a k e broke i t . The phone would be a l lowed out longer h o u r s . There wouldn ' t be a cu r few . You 'd heve to phone i n ( i n s t e a d o f a c u r f e w ) . . . I ' d eey " f i n e but remember you got schoo l i n the morning and i f you d o n ' t go that docks o f f 2 S cen ts o f f your a l l o w a n c e " . . . o r e d o l l a r , but I wou ldn ' t make i t too m u c h . . . e n d i f they d i d n ' t go to s c h o o l or they d i d n ' t go to work, w e l l I guess t h e y ' r e not go ing to have t h e i r knowledge now are they? Whet are the t h i n g s you l i k e ebout Chimo House? I d o n ' t know, and I hete thet they never heve J u i o e . . . How do you l i k e the s t a f f ? Some of them ere OK. Do you have f e v o r i t e people? I r e a l l y , r e a l l y l i k e J u d y . - 142 -What makes Judy such a good o h i l d cere worker? She d o e s n ' t take s h i t . . . l i k e she says " f i n e d o n ' t he lp me, see i f I c a r e " . . . l i k e r e v e r s e p s y c h o l o g y . . . I t ' s j u s t J u d y ' s p e r s o n a l i t y , she e c t s r e e l tough . I f you were r u n n i n g the s c h o o l f o r c h i l d cere w o r k e r s . . . ? I 'd make them a l l to be l i k e J u d y , end Cathy sometimes. No e l l to be l i k e Judy end y o u . Mow come? Ceuse you both are r e a l l y , r e a l l y n i c e . . . How much l o n g e r i s t h i s ( i n t e r v i e w ) go ing to l e s t ? ( g e t t i n g r e s t l e s s ) Do you heve e b o y f r i e n d r i g h t now? Sor t o f . H e ' s In Y D C . . . Not wi th t h i s b o y f r i e n d , but do you th ink y o u ' d ever get mar r ied i n the f u t u r e ? No. Too much o f e h a s s l e to get d i v o r c e d . ( g e t t i n g more r e s t l e s s end f i d g e t i n g more with the mike) Do you th ink y o u ' d ever l i k e to heve k i d s ? Y e a h . . . two. How would you r a i s e them? P r o p e r l y . . . I 'd elwey be there f o r them to t e l k to m e . . . I ' d probab ly run a d a y c a r e . . . you c a n ' t be too s t r i c t but there has to be r u l e s . . . I d o n ' t know. I'm not e mother y e t . Whet s o r t s of people do you tend to be f r i e n d s wi th? P e r t y p e o p l e . How can you t e l l when you f i r s t meet p e o p l e . . . ? The wey they d r e s s . . . d e f i n i t e l y . . . I'm g e t t i n g very b o r e d . . . Las t q u e s t i o n . I f you c o u l d heve three magic w i s h e s , what would you wish f o r ? To be p r e t t y , and to heve l o t s of money, end f o r K e l l y to be out of YOC. ( p r e t e n d s to eat the mike) - 143 -Comment« - I got the i m p r e s s i o n tha t q u i t e a few of L ' s s ta tements were fen tesy ( i e . c l a i m i n g i n the i n t e r v i e w to hove c o i n c i d e n t e l l y bumped i n t o Aunt C e r o l on the s t r e e t i n Sur rey at which time the p l e n to l i v e wi th her was d e c i d e d ; a l s o , I c e n ' t see L ' s Mom t e l l i n g L . even wh i le s tone the t she d o e s n ' t love L Perhaps these are Jus t a s ta tements of how L f e e l s end she wants o t h e r s to Know about these f e e l i n g s / f e a r s ) . - L l i k e s " n i c e " p e o p l e , but oou ld never e l a b o r a t e on what t h i s meant. - Al though L can be q u i t e c o n t r a r y , she can a l s o be a p l e a s s r ( e g . her need to t e l l me as the i n t e r v i e w e r thet good c h i l d cere workers are J u s t l i k e m e . . . r e a l l y n i c e ) . - Because L does not r e a l l y seem to have i n t e r n a l i z e d some of her s ta ted v a l u e s , she sometimes c o n t r a d i c t s h e r s e l f i n the i n t e r v i e w ( e g . Chlmo House s h o u l d n ' t heve r u l e s , but l a t e r L s t e t e s thet i f she had k i d s " t h e r e has to be r u l e s " ) . Themes -Abandonment ; f e e l i n g r e j e c t e d , t o s s e d o u t , unwonted; F e e l i n g there i s n ' t a p l a c e f o r h e r s e l f i n the f e m i l y . - F a i r n e s s , p roper t reatment ( d o e s n ' t seem to see a c o n n e c t i o n between her own b e h a v i o r and " f a i r t reatment") - Growing up; not want ing to be e l i t t l e g i r l , and yet s t i l l wanting e n u r t u r i n g Mom. - Jea lousy - Blame - F e e l i n g s o r r y f o r s e l f . I - l e v e l Rat ing - Al though there i s the o c e s s i o n a l glimmer of b e g i n n i n g l e v e l 4 i n s i g h t in t h i s i n t e r v i e w , b a s i c a l l y L gave a f a i r l y concre te I - l e v e l 3 i n t e r v i e w ( 1 3 c f m ) . I 3 cfm C h a r a c t e r i s t i c s - Therefore e c o o r d i n g to I - l e v e l t h e o r y , at t h i s stage of her development, L i s s t i l l concerned wi th who has the power and whet ere the r u l e s . Thus i n L ' s w o r l d , the r u l e s and the power chenge every time she welks out C h i m o ' s door to be wi th her f r i e n d s . - L w i l l do almost a n y t h i n g f o r peer a p p r o v a l . - Values are not yet i n t e r n a l i z e d . - Problems ere seen as imposed by the o u t s i d e w o r l d , r a t h e r then having e n y t h i n g to do w i th her own s e l f . - 144 -- L has low s e l f - e s t e e m , end o t h e r w i s e does not yet Know much about who she i s . Beceuse L does not r e a l l y Know who she i s , i t i s herd f o r her to f e e l as though she " b e l o n g s " enywhere, whether t h i s means Knowing her p i e c e with e group o f f r i e n d s , or Knowing her p i e c e i n her f a m i l y . - L i s not yet cepeb le o f t a k i n g the f u t u r e i n t o eocount i n her p l a n s . Her p lans are based on her c u r r e n t wants. - Handles c r i s i s by e s c e p e / r u n n i n g away /substance abuse. I 3 cfm Treatment Recommendations - E s t a b l i s h a c l e a r , s e f e , and c a r i n g env i ronment . - Any consequences should be of a s h o r t d u r e t i o n end wi th the c o n t i n u e l message of concern and encouragement . Keep i n mind thet L i s l o o k i n g f o r p r o o f the t she i s n ' t cored f o r . - W o r k on e s t a b l i s h i n g e s p e c i a l c a r i n g r e l a t i o n s h i p between L end her key worker. L w i l l t e s t t h i s to check out whether she w i l l be ebendoned once e g e i n . For the f i r s t whi le t h i s w i l l be e n o n - r e c i p r o c a l " g i v e , g i v e , g i v e " r e l a t i o n s h i p on the pert o f the key worker . L i s v i r t u a l l y e "bot tomless p i t t " i n need of d a i l y p o s i t i v e s t r o k e s ( h u g s , p r a i s e s , encouragement) . - A c t i o n s w i l l speak louder then words . Tek ing her out f o r an i c e - c r e a m w i l l mean much more to her then i n s i g h t o r i e n t e d c o u n s e l l i n g which would be over her head. - Abus ive or t h o u g h t l e s s b e h a v i o r w i l l be an e x p r e s s i o n of L ' s f e e l i n g i n s e c u r e and t h r e e t e n e d . These f e e l i n g s w i l l need to be a d d r e s s e d . - Role p l e y i n g as we l l as l a b e l l i n g o n e ' s own f e e l i n g s and h e l p i n g L to i d e n t i f y and l e b e l hers should be e f f e c t i v e t e c h n i q u e s . C r i s e s mey be avo ided by a n t i c i p a t i n g the a n x i e t y , l a b e l l i n g i t , and r e h e a r s i n g how the upcoming s i t u a t i o n con be h a n d l e d . - E v e n t u a l l y n e g o t i a t i o n w i l l become a more and more r e a l i s t i c method of d e a l i n g with L I n g r i d Kastens APPENDIX 0 The S c h o o l E s s a y 146 -Topic'- hlou .//.. C a m t . Lt -fhcj I Q < ^ M&m, d&yC£, <Q$2ify£2 asicrusria/ - 147 -\juLiua£.JL Lit M&L s?z<!>=£ s£%r<?^ i j i - 148 -APPENDIX P Co n s e n t Form - 150 -APPENDIX Q A p p r o v a l o f The U.B.C. O f f i c e o f R e s e a r c h S e r v i c e s 

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