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UBC Theses and Dissertations

Study of changes in functioning of multi-problem families Crane, Stephanie Enid 1967

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STUDY OF CHANGES IN FUNCTIONING OF MULTI-PROBLEM FAMILIES by S t e p h a n i e E n i d Crane J a n e t C a r o l e Haddock Doreen E l i z a b e t h H a r r i s o n Rhoda J e a n J a r v i s Shahnaz Zoya K i d w a l Norma J o a n W h i t e T h e s i s S u b m i t t e d I n P a r t i a l F u l f i l l m e n t o f the Requirements f o r the Degree o f MASTER OF SOCIAL WORK i n the S c h o o l o f S o c i a l Work A c c e p t e d as c o n f o r m i n g to the s t a n d a r d r e q u i r e d f o r the degree o f M a s t e r o f S o c i a l Work S c h o o l o f S o c i a l Work 1967 The U n i v e r s i t y o f B r i t i s h C o l umbia i i ABSTRACT I n r e c e n t y e a r s a c o n s i d e r a b l e amount o f r e s e a r c h has been done on the s u b j e c t o f the m u l t i - p r o b l e m f a m i l y . The r e a l i z a t i o n t h a t some f a m i l i e s were u t i l i z i n g most o f the communities s e r v i c e s , time and money and s t i l l showing l i t t l e change l e a d s o c i a l a g e n c i e s to s t u d y . a n d e x p e r i m e n t w i t h new ways o f s e r v i n g t h e s e f a m i l i e s . I n 1959 the Community Ch e s t and C o u n c i l s o f Vancouver recommended t h a t a s p e c i a l p r o j e c t be d e v e l o p e d i n one a r e a o f the c i t y t o d e m o n s t r a t e c o - o r d i n a t i o n and i n t e g r a t i o n o f s e r v i c e s t o the m u l t i - p r o b l e m f a m i l y . From t h i s p r o p o s a l the A r e a Development P r o j e c t o f Vancouver was e s t a b l i s h e d . T h i s p r o j e c t has c o - o r d i n a t e d h e a l t h , w e l f a r e and r e c r e a t i o n a l s e r v i c e s to f a m i l i e s w i t h complex problems. One p a r t o f the p r o j e c t i s c o n c e r n e d w i t h d i r e c t t r e a t m e n t o f m u l t i - p r o b l e m f a m i l i e s and t h i s p a r t o f the p r o g r a m . i s c a l l e d I n t e g r a t e d F a m i l y . S e r v i c e s . F i v e c a s e w o r k e r s p r o v i d e s e r v i c e to 100 f a m i l i e s s e l e c t e d on the b a s i s o f c h r o n i c and m u l t i p l e agency u s e . Each worker p r o v i d e s b a s i c w e l f a r e s e r v i c e s t o the f a m i l y as a whole a n d . c a r r i e s o u t f u n c t i o n s d e l e g a t e d by s e v e r a l a g e n c i e s . The second p a r t o f the s e r v i c e i s c a r r i e d o u t by two s o c i a l w o r k e r s and v i e w s the n e i g h -bourhood as the f o c u s o f s e r v i c e . I n a d d i t i o n t o the d e m o n s t r a t i o n s e r v i c e s p r o v i d e d by the p r o j e c t , t h e r e i s a s t r o n g r e s e a r c h component. The e x p e r i -m e n t a l d e s i g n c a l l s f o r 100 f a m i l i e s i n the t r e a t m e n t group, and 200 f a m i l i e s i n two c o n t r o l g r o u p s , i n o r d e r to t e s t the a s s u m p t i o n t h a t the demonstra-t i o n s e r v i c e s o f the p r o j e c t a r e more e f f e c t i v e i n i m p r o v i n g the f u n c t i o n i n g o f f a m i l i e s w i t h complex problems t h a n the " u s u a l . s e r v i c e s " o f h e a l t h and w e l f a r e a g e n c i e s . The p r e s e n t s t u d y i s i n t e n d e d to s t u d y changes i n s o c i a l f u n c t i o n -i n g between the t r e a t m e n t and c o n t r o l group o f the A r e a Development P r o j e c t and t o measure the e f f e c t s o f s e l e c t e d f a m i l y c h a r a c t e r i s t i c s on the changes i n . s o c i a l f u n c t i o n i n g . A l t h o u g h d e f i n i t e c o n c l u s i o n s c a n n o t be reached, as i i i t he w r i t e r s touched on o n l y a l i m i t e d a r e a o f the t o t a l p r o j e c t we f e e l t h a t the o b s e r v a t i o n s and p r o p o s a l s d e s e r v e c l o s e r c o n s i d e r a t i o n . The i n t r o d u c t o r y c h a p t e r g i v e s a b r i e f , summary, of the problems the community e n c o u n t e r s i n d e a l i n g w i t h the m u l t i - p r o b l e m f a m i l y and the r a t i o -n a l e behind- e x p e r i m e n t a l p r o j e c t s d e s i g n e d t o s t u d y t h e s e f a m i l i e s . I n C h a p t e r I I a summary o f s e v e r a l s t u d i e s and p r o j e c t s on the m u l t i - p r o b l e m f a m i l y i n the U n i t e d S t a t e s o f f e r s a means o f c o m p a r i s o n to the l o c a l s c e n e . I t a l s o i l l u s t r a t e s the v a r i o u s approaches t h a t c a n be t a k e n toward the f a m i l i e s w i t h complex problems and d e f i n e s the term " m u l t i -p r o b lem" as u t i l i z e d i n t h i s s t u d y . The purpose o f the s t u d y , i t s scope, and the methods u t i l i z e d . a r e o u t l i n e d i n g r e a t e r d e t a i l i n C h a p t e r I I I . I n C h a p t e r IV, the r e s e a r c h da.ta a r e c l a s s i f i e d and p r e s e n t e d i n t a b l e form where a p p r o p r i a t e . A b r i e f ana-l y s i s o f the d a t a i s a l s o p r e s e n t e d . The c h a p t e r , a l s o c o n t a i n s o b s e r v a t i o n s on the r e s e a r c h p r o j e c t and i t s f i n d i n g s as a whole. The t h e s i s c o n c l u d e s b y . p r e s e n t i n g some i m p l i c a t i o n s and o u t l i n i n g f u r t h e r a r e a s o f s t u d y based on the f i n d i n g s o f the t h e s i s . T h i s a r e a o f s t u d y was s u g g e s t e d by the s t a f f o f the A r e a Develop-ment; P r o j e c t and i t - w a s hoped t h a t the f i n d i n g s o f the t h e s i s would p r o v i d e added i m p l i c a t i o n s and o b s e r v a t i o n s f o r t h e i r p r o j e c t . i v TABLE OF CONTENTS Cha p t e r I : I n t r o d u c t i o n The s o c i a l work pr o b l e m c r e a t i n g a need f o r r e s e a r c h . Summary, s t a t e m e n t o f the problem. P e r s o n s and groups c o n n e c t e d w i t h the p r o b l e m . The r e s e a r c h p r o b l e m and a l t e r n a t i v e ways o f d e a l i n g w i t h i t . O r g a n i z a t i o n o f the r e s e a r c h , r e p o r t . ., P. 1 Chapt e r I I : L i t e r a t u r e Review Purposes o f the s t u d i e s r e v i e w e d . V a r i o u s d e f i n i t i o n s o f m u l t i - p r o b l e m f a m i l i e s . M a j o r c o n c e p t s employed i n a n a l y s i s o f f a m i l y f u n c t i o n i n g . Measures of. f a m i l y f u n c t i o n i n g d e v e l o p e d . How d a t a i s o b t a i n e d i n the v a r i o u s s t u d i e s . •A summary o f r e -s e a r c h f i n d i n g s t h a t a r e p e r t i n e n t t o t h i s s t u d y P. 8 C h a p t e r I I I : The Study D e s i g n The t h e o r e t i c a l framework. H y p o t h e s i s and a s s u m p t i o n s o f the s t u d y w i t h s u p p o r t i n g r a t i o n a l e . O p e r a t i o n a l l y d e f i n e d dependent and i n d e p e n d e n t v a r i a b l e s . D e s c r i p t i o n o f f i e l d ex-p e r i m e n t d e s i g n . P l a n o f d a t a a n a l y s i s . S a m p l i n g p r o c e d u r e s used. S o u r c e s and methods o f g a t h e r i n g d a t a . S t a n d a r d i z e d t e x t used .. . P. 20 Cha p t e r I V : Study F i n d i n g s D e s c r i p t i v e d a t a on s t u d y sample. F i n d i n g s on h y p o t h e s e s P.. 33 Chapt e r V: Summary, C o n c l u s i o n s and Recommendations I m p l i c a t i o n s and p r o p o s a l s based on the st u d y f i n d -i n g s . S uggested a r e a s o f f u r t h e r r e s e a r c h P. 40 B i b l i o g r a p h y ; P. 45 Appen d i x : S c h e d u l e f o r Data C o l l e c t i o n P. 47 V L I S T OF TABLES T a b l e I The R e l a t i o n s h i p o f Treatment t o Changes i n F a m i l y F u n c t i o n i n g . P. 34 T a b l e I I The R e l a t i o n s h i p Between^Degree and Type o f Move-ment i n F a m i l y , F u n c t i o n i n g . P. 36 T a b l e I I I The R e l a t i o n s h i p o f S e l e c t e d F a m i l y H i s t o r y F a c t o r s t o Change i n F u n c t i o n i n g D u r i n g a P e r i o d o f 12 to 18 Months (Treatment and C o n t r o l Groups Combined) P. 38 ACKNOWLEDGEMENTS We would l i k e t o e x p r e s s our s i n c e r e a p p r e c i a t i o n t o a l l t h o s e who h e l p e d us c o m p l e t e t h i s s t u d y . S i n c e r e thanks go t o the s t a f f o f the A r e a Development P r o j e c t , p a r t i c u l a r l y M r s . E f f i e Keay f o r t h e i r c o - o p e r a t i o n and v a l u a b l e a s s i s t a n c e . We would a l s o l i k e t o e x p r e s s our thanks t o D o c t o r John Crane, our t h e s i s a d v i s o r , f o r h i s g u i d a n c e i n h e l p i n g us complete the p r o j e c t . CHAPTER I INTRODUCTION THE SOCIAL WORK PROBLEM CREATING A NEED FOR RESEARCH Summary Sta t e m e n t o f the Pro b l e m The " M u l t i - p r o b l e m " f a m i l y has been a t o p i c o f c o n c e r n f o r many y e a r s , and t h e r e i s much to be l e a r n e d about the c h a r a c t e r i s t i c s i n v o l v e d i n the c o n c e p t . These f a m i l i e s have a l s o been d e s c r i b e d as " h a r d - c o r e " , " c h r o n i c a l l y d i s t u r b e d " o r " r e s i s t a n t " f a m i l i e s . They u s u a l l y have m u l t i p l e p r o b l e m s , and i n t h e i r s e a r c h f o r h e l p come i n c o n t a c t w i t h numerous a g e n c i e s . The s o c i a l s e r v i c e s have been p r o v i d e d by, a g e n c i e s to d e a l w i t h problems on a c a t e g o r i c a l b a s i s , and t h e r e f o r e , because s e r v i c e s a r e o r i e n t e d t o a p r o b l e m p o i n t o f v i e w r a t h e r t h a n . t o s e e i n g the p r o b l e m i n r e l a t i o n t o the t o t a l f u n c t i o n i n g o f the f a m i l y , problems have been d e a l t w i t h on a c r i s i s -o r i e n t e d b a s i s u s i n g s t o p - g a p measures. I f the f a m i l y c a n be t r e a t e d as a whole and the problems seen i n r e l a t i o n t o the t o t a l s t r u c t u r e and f u n c t i o n i n g o f the f a m i l y t h e n p o s s i b l y problems c a n be i d e n t i f i e d b e f o r e they r e s u l t i n the d i s i n t e g r a t i o n o f the f a m i l y ; and h e l p w i l l be more e f f e c t i v e when e x t e n d e d . The e s t a b l i s h m e n t o f a p r o j e c t to s t u d y the e f f e c t i v e n e s s o f the v a r i o u s t r e a t m e n t approaches a l l o w s f o r f l e x i b i l i t y i n e x p e r i m e n t i n g w i t h d i f f e r e n t methods o f t r e a t m e n t i n r e a c h i n g f a m i l i e s because the p r o j e c t does n o t have t o work w i t h i n s p e c i f i c agency p o l i c y o r s t r u c t u r e . The main c o n d i t i o n w h i c h l e d t o the e s t a b l i s h m e n t o f the A r e a Development P r o j e c t o f Vancouver was the p r e s e n c e i n the community o f a s u b s t a n t i a l number o f f a m i l i e s w i t h a h i s t o r y o f c h r o n i c and m u l t i p l e c o n t a c t w i t h s o c i a l s e r v i c e a g e n c i e s . I n o r d e r t o cope w i t h the p r o b l e m i t was d e c i d e d to f o c u s on the f a m i l y as a whole, w i t h one w o r k e r i n c o r p o r a t i n g the f u n c t i o n s o f a number o f s o c i a l a g e n c i e s , so t h a t the f a m i l y d i d n o t have to c o n t a c t a number o f a g e n c i e s f o r s e r v i c e s r e q u i r e d . G r e a t e r r e t u r n s i n the form o f improved f a m i l y f u n c t i o n i n g c a n be e x p e c t e d from an i n t e g r a t e d , s e r v i c e s a p p r o a c h , w h i c h may f a c i l i t a t e the e a r l y i d e n t i f i c a t i o n of p r o b l e m s . P e r s o n s or Groups Concerned W i t h the P r o b l e m P o l i c y makers and a d m i n i s t r a t o r s o f the v a r i o u s s o c i a l s e r v i c e a g e n c i e s a r e aware o f the e n o r m i t y o f the p r o b l e m . The p r e s e n t p r o v -i s i o n o f u s u a l agency s e r v i c e s a p p e ars to be c o s t l y and l a r g e l y i n e f f e c t i v e i n r e l a t i o n to the " m u l t i - p r o b l e m " f a m i l y . As the p r o j e c t i s d e s i g n e d t o h e l p f a m i l i e s i n t r o u b l e who a r e a c o n c e r n t o the community, i t i s presumed t h a t the community as a whole w i l l be i n t e r e s t e d i n the s t u d y . I n . a d d i t i o n , because the e x i s t e n c e o f ' m u l t i - p r o b l e m ' f a m i l i e s i s a s o c i a l p r o b l e m r e l a t e d t o a l l c o m m u n i t i e s , t h i s s t udy, w i l l be o f i n t e r e s t t o s o c i e t y , a t l a r g e as p r o v i d i n g an a d d i t i o n t o the l i t e r a t u r e d e s c r i b i n g the ' m u l t i - p r o b l e m ' f a m i l i e s b o t h from a t r e a t m e n t and e t i o l o g i c a l p o i n t o f v i e w w i t h the u l t i m a t e aim b e i n g t h a t o f p r e v e n t i o n , t h r o u g h e a r l y i d e n t i f i c a t i o n . As the work o f the p r o j e c t i s c l o s e l y c o o r d i n a t e d w i t h s o c i a l i n s t i t u t i o n s w i t h i n the community such as p u b l i c h e a l t h and e d u c a t i o n , the r e s u l t s o f the s t u d y w i l l be o f i n t e r e s t to o t h e r p r o f e s s i o n s i n the community i n t h e i r work w i t h m u l t i - p r o b l e m f a m i l i e s . From the p o i n t o f v i e w o f p r o f e s s i o n a l s o c i a l w o r k e r s i n t h e f i e l d , i t w i l l be o f i n t e r e s t i n a n a l y s i n g the p r e s e n t p r o v i s i o n and e f f e c t i v e n e s s o f s e r v i c e and as p r o v i d i n g a b a s i s f o r the m o d i f i c a t i o n o r change i n e x i s t i n g s e r v i c e s . I n g e n e r a l the p r o j e c t i s o f i n t e r e s t to s o c i a l work i n t h a t i t adds t o the l i t e r a t u r e , b r i d g i n g the gap between the p s y c h o l o g i c a l as a g a i n s t the s o c i o l o g i c a l a p p r o a c h . The c o n c e p t o f s o c i a l r o l e s i n terms o f which, f u n c t i o n i n g o f f a m i l i e s i s a n a l y s e d g i v e s meaning t o the s o c i a l work g o a l o f ' t r e a t i n g the f a m i l y as a whole'. As the aim o f r e s e a r c h i s n o t o n l y the assessment o f the e f f e c t i v e n e s s o f p r o v i d i n g i n t e g r a t e d s e r v i c e b u t a l s o t o g a i n an u n d e r s t a n d i n g o f the a p p l i c a b i l i t y and f e a s i b i l i t y o f i m p l e m e n t i n g i n t e g r a t e d s e r v i c e s , i t i s hoped t h a t the p r e s e n t study, w i l l be o f i n t e r e s t t o the A.D.P. i n p r o v i d i n g some i n d i c a t i o n o f the e f f e c t i v e n e s s o f s e r v i c e and a l s o i n the a n a l y s i n g o f background m a t e r i a l r e l a t e d to the f a m i l i e s p r o v i d e some i m p l i c a t i o n s f o r the r e o r g a n i z a t i o n o f s e r v i c e s . The R e s e a r c h P r o b l e m I t m i g h t be s u g g e s t e d t h a t as an a l t e r n a t i v e t o p r o v i d i n g t r e a t m e n t t h r o u g h a f a m i l y c e n t e r e d w o r k e r , t h a t what i s needed i s m e r e l y an improvement o f the e x i s t i n g r e s o u r c e s . Such improvements c o u l d be a c h i e v e d t h r o u g h r e d u c i n g c a s e l o a d s and by i n c r e a s i n g f i n a n c i a l a s s i s t a n c e and o t h e r forms o f r e s o u r c e p r o v i s i o n . However, the f o c u s m i g h t s t i l l be on the i n d i v i d u a l . The agency i s s t i l l s e e k i n g the terms by d e f i n i n g the s o r t o f p r o b l e m w i t h w h i c h they a r e p r e p a r e d t o d e a l . A n o t h e r a l t e r n a t i v e t o the f a m i l y c e n t e r e d worker approach has been t o i n i t i a t e s e r v i c e i n terms o f the community as a whole. T h i s means t h a t the needs o f the community a r e a s s e s s e d and a t t e m p t s made to meet t h e s e needs, t h r o u g h p r o v i d i n g s e r v i c e s . I n Vancouver Woodland P a r k has been an example o f t h i s . By f o c u s i n g on the community i t has been f e l t t h a t c o n d i t i o n s w h i c h have l e a d t o the d i s i n t e g r a t i o n and d i s o r g a n i z a t i o n o f the f a m i l i e s c a n be a l l e v i a t e d thus a t t a c k i n g the i n d i v i d u a l problems i n d i r e c t l y . I t i s a l s o f e l t t h a t i n o r d e r to d e a l w i t h f u n d a m e n t a l s o c i a l problems i t i s n e c e s s a r y t o o r g a n i s e i n terms o f an o v e r a l l d e c i s i o n making framework, s o ; > t h a t an a t t e m p t i s made to e s t a b l i s h a b a l a n c e between needs and r e s o u r c e s . The a p p r o a c h o f f e r e d by ADP t o r e s e a r c h ways o f i m p r o v i n g the f u n c t i o n i n g o f the m u l t i - p r o b l e m f a m i l y and to p r e v e n t i n g c o n d i t i o n s l e a d i n g t o the d i s o r g a n i z a t i o n o f f a m i l i e s does no t negate the v a l i d i t y o f a t t a c k i n g the p r o b l e m t h r o u g h i m p r o v i n g e x i s t i n g r e s o u r c e s o r t h r o u g h s e e i n g the p r o b l e m i n terms o f the community as a whole. The ADP however, i s o l a t e s the t r e a t m e n t v a r i a b l e by comparing the type o f s e r v i c e s o f f e r e d a t the p r e s e n t time w i t h , an i n t e g r a t e d f a m i l y s e r v i c e a p p r o a c h . A l t h o u g h i m p r o v i n g e x i s t i n g r e s o u r c e s m i g h t a p p a r e n t l y l e a d t o improved f u n c t i o n i n g o f t h e s e f a m i l i e s , i t would n o t be c l e a r as t o w h i c h f a c t o r s were a c t u a l l y r e l a t e d t o subsequent improvement i n f u n c t i o n i n g . However, i f the t r e a t m e n t v a r i a b l e i s i s o l a t e d i n the form o f c h a n g i n g the way s e r v i c e i s d e l i v e r e d , w i t h one worker r e s p o n s i b l e f o r a l l t r e a t -ment, the e f f e c t t h i s has on f a m i l y f u n c t i o n i n g t h r o u g h a c o m p a r i s o n o f movement i n b o t h t h e t r e a t m e n t and c o n t r o l groups c a n be a s s e s s e d . By f o c u s i n g on the p a r t i c u l a r problems o f i n d i v i d u a l f a m i l i e s , and comparing r e s u l t s , f a c t o r s i n the community w h i c h have l e a d t o and w h i c h m a i n t a i n a p o v e r t y group ca n perhaps be d e t e r m i n e d . T h i s would have i m p l i c a t i o n s f o r p r o v i s i o n . a n d d e l i v e r y o f r e s o u r c e s so t h a t not o n l y the type o f r e s o u r c e s needed b u t a l s o the a v a i l a b i l i t y o f r e s o u r c e s c o u l d be t a k e n i n t o . a c c o u n t i n p l a n n i n g . I n o r d e r to measure the e f f e c t s o f the t r e a t m e n t v a r i a b l e , 300 f a m i l i e s were s e l e c t e d from the c a s e l o a d s o f major a g e n c i e s i n V a n c o u v e r . The c r i t e r i a o f s e l e c t i o n o f the m u l t i - p r o b l e m f a m i l i e s was on the b a s i s o f m u l t i p l i c i t y and c h r o n i c i t y o f agency c o n t a c t s and on the b a s i s o f worker judgement, w h i c h was based on f a i l u r e i n the c h i l d r e a r i n g f u n c t i o n . However minor changes were l a t e r made i n the s e l e c t i o n o f f a m i l i e s when i t was found t h a t some o f the f a m i l i e s i n i t i a l l y s e l e c t e d were, a c c o r d i n g to assessment by ADP w o r k e r s , n o t f u n c t i o n i n g a t a l e v e l t o w a r r a n t t h e i r b e i n g c l a s s i f i e d a s . ' m u l t i -p r o b l e m ' . Of the 300 f a m i l i e s a s s e s s e d as b e i n g m u l t i - p r o b l e m , 100 each were randomly a s s i g n e d t o the two c o n t r o l and one t r e a t m e n t groups Movements were t o be measured, a f t e r t w e l v e and e i g h t e e n month However, a l t h o u g h some time was a l l o w e d f o r o r i e n t a t i o n o f the A.D.P. wo r k e r s t o t h e i r r o l e s as i n t e g r a t e d f a m i l y s e r v i c e w o r k e r s , the time a l l o t t e d was n o t found t o be s u f f i c i e n t , , and d i f f i c u l t i e s a r o s e i n the p r o v i s i o n o f s e r v i c e , t r e a t m e n t i n i t i a l l y t a k i n g on some o f the fragmen t a t i o n o f s e r v i c e the p r o j e c t was d e s i g n e d to e l i m i n a t e . I t has been s u g g e s t e d , as a r e s u l t , t h a t a p r e t e s t p e r i o d be i n i t i a t e d d e s i g n e d t o d e m o n s t r a t e the s e r v i c e b e f o r e e n t e r i n g i n t o a p e r i o d o f t e s t i n g the r e s e a r c h d e s i g n ' s t r e a t m e n t v a r i a b l e . Due to the e x t e n s i o n o f the o r i e n t a t i o n p e r i o d i n t o the time i n i t i a l l y d e t e r m i n e d f o r t e s t i n g the v a r i a b l e , measurements a f t e r t w e l v e and e i g h t e e n months a c t u a l l y c o v e r a p e r i o d o f e i g h t to f i f t e e n months and s i x t e e n t o twenty-one months r e s p e c t i v e l y . I n a d d i t i o n , as i n f o r m a t i o n , a p p l i c a b l e t o the i n i t i a l a ssessment o f the f a m i l y c a n be l e a r n e d a t any p o i n t i n the c o u r s e o f t r e a t m e n t , the co m p a r i s o n s a f t e r t w e l v e months a r e o n l y t e n t a t i v e u n t i l the c o n c l u s i o n o f the P r o j e c t . F o r the pu r p o s e s o f the p r e s e n t s t u d y , s e l e c t i o n o f c a s e s was l i m i t e d t o tho s e f o r whom f a m i l y p r o f i l e s c o r e s were a v a i l a b l e . Due t o t h e l i m i t a t i o n s o f the sample s i z e the c o n c l u s i o n s r e a c h e d a r e o n l y t e n t a t i v e and i n d i c a t e t r e n d s perhaps more t h a n d e f i n i t e c o n e l u s i o n s . I n a d d i t i o n t o t e s t i n g the e f f i c a c y o f the t r e a t m e n t v a r i a b l e , the s t u d y i s a l s o d e s i g n e d t o a s s e s s and compare new methods o f t r e a t -ment. Due t o the f l e x i b i l i t y o f the P r o j e c t and the s m a l l c a s e l o a d s , t h e r e i s an o p p o r t u n i t y f o r d e v e l o p i n g i n d i v i d u a l : methods o f t r e a t m e n t r e l a t e d t o the p a r t i c u l a r needs o f the c l i e n t s . W i t h r e l a t i o n t o t h i s , some a t t e m p t w i l l be made to a n a l y z e t r e a t m e n t methods i n i n d i v i d u a l c a s e s , i n groups o f c a s e s , and i n the t o t a l , t h r o u g h a p r e c e d e d r e c o r d i n g system so t h a t o b j e c t i v e e v a l u a t i o n s c a n be made o f the d a t a r e l a t i n g t o b o t h p r o b l e m • a r e a s o f f a m i l y f u n c t i o n i n g and t r e a t m e n t t e c h n i q u e s o f t h e w o r k e r s i n r e s p o n s e to t h e s e p r o b l e m s . I n a d d i t i o n , Neighborhood S e r v i c e s have been i n i t i a t e d w i t h a number o f f a m i l i e s t o d e v e l o p b o t h p r o f e s s i o n a l r e s o u r c e s i n the community and t o m o b i l i z e t h o s e l i v i n g i n the community to i n i t i a t e t h e i r own programs and to d e v e l o p r e s o u r c e s w h i c h they v i e w as n e c e s s a r y . The s t u d y i s a l s o d e s i g n e d t o . a t t e m p t t o i d e n t i f y a number o f c h a r a c t e r i s t i c s o f t h e s e m u l t i - p r o b l e m f a m i l i e s i n a d d i t i o n t o t h e i r r e s p o n s e s t o the t r e a t m e n t component. A c o m p a r a t i v e s t u d y on the b a s i s o f e l e v e n c h a r a c t e r i s t i c s has been c o n d u c t e d w i t h one hundred f a m i l i e s , f i f t y o f whom were a s s e s s e d t o be more a d e q u a t e l y f u n c t i o n i n g and f i f t y o f the most p o o r l y f u n c t i o n i n g . B o t h groups a r e from a s i m i l a r s o c i o - e c o n o m i c background and b o t h met the o r i g i n a l s e l e c t i o n c r i t e r i a f o r i n c l u s i o n i n the P r o j e c t . I t i s hoped t h a t an "Index Of F a m i l i e s A t R i s k " c a n be d e v e l o p e d so t h a t knowing some o f the f a c t o r s l e a d i n g t o d i s i n t e g r a t i o n o f f a m i l i e s c a n l e a d t o e a r l y i d e n t i f i c a t i o n and p r e v e n t i o n o f the m u l t i - p r o b l e m f a m i l y . I n a t t e m p t i n g to d i s c o v e r something o f the r e l a t i o n s h i p between t h e s e f a c t o r s and f u n c t i o n i n g o f f a m i l i e s , t h i s s t u d y has r e l a t e d the e l e v e n c h a r a c t e r i s t i c s t o move-ment f o r b o t h the c o n t r o l and t r e a t m e n t g r o u p s . O r g a n i z a t i o n Of The R e s e a r c h R e p o r t C h a p t e r Two w i l l r e v i e w the l i t e r a t u r e r e l a t e d t o a t h e / m u l t i -p r o b l e m f a m i l y and to o t h e r s t u d i e s i n v e s t i g a t i n g s o l u t i o n s t o t h i s c h r o n i c p r o b l e m . Chapter Three w i l l d e s c r i b e the r e s e a r c h . d e s i g n , i n c l u d i n g the c o n c e p t u a l framework, h y p o t h e s e s , l e v e l o f d e s i g n , . s a m p l i n g p r o c e d u r e s and methods o f c o l l e c t i n g the d a t a . C h a p t e r F o u r w i l l o u t -l i n e the s t u d y f i n d i n g s and Cha p t e r F i v e w i l l g i v e a summary o f the s t u d y and i m p l i c a t i o n s o f the f i n d i n g s , a l o n g w i t h p r o p o s a l s f o r f u t u r e r e s e a r c h 8. CHAPTER I I REVIEW OF SELECTED LITERATURE OF "THE MULTI-PROBLEM FAMILY" V a r i o u s approaches t o the dilemma o f t h e m u l t i - p r o b l e m f a m i l y have been employed o v e r many y e a r s . Numerous r e s e a r c h p r o j e c t s have been u n d e r t a k e n w i t h the s e r i o u s l y d i s o r g a n i z e d f a m i l y t o d e t e r m i n e a c o n c e p t u a l framework f o r use i n the u n d e r s t a n d i n g , e a r l y i d e n t i f i c a t i o n and f o r m a t i o n of a program f o r w o r k i n g w i t h t h e s e f a m i l i e s . R e p r e s e n t a t i v e samples o f t h e l i t e r a t u r e p u b l i s h e d as a r e s u l t o f t h e s e p r o j e c t s were s e l e c t e d and r e a d . The f o l l o w i n g i s a summary o f the i n f o r m a t i o n g a i n e d w i t h r e f e r e n c e t o t h e p r e s e n t s t u d y . P u r p o s e of the S t u d i e s The l i t e r a t u r e s e l e c t e d f o r s t u d y c o v e r e d r e s e a r c h u n d e r t a k e n i n t h e v a r i o u s a s p e c t s o f s o c i a l work s e r v i c e s extended t o t h e - m u l t i - p r o b l e m f a m i l y . These a r e a s a r e : (a) an a n a l y s i s o f c a s e l o a d s c a r r i e d by s o c i a l w o r k e r s . (b) development o f knowledge w h i c h may l e a d t o an e a r l y i d e n t i f i c a t i o n o f the m u l t i - p r o b l e m f a m i l y . ( c ) development o f methods of casework and p r o c e s s e s of community o r g a n i z a t i o n d e s i g n e d t o h e l p t h o s e f a m i l i e s i n t r o u b l e who a r e o f c o n c e r n t o the community. (d) a r e l i a b l e t e c h n i q u e f o r m e a s u r i n g changes i n the s o c i a l f u n c t i o n i n g o f m u l t i - p r o b l e m f a m i l i e s . (e) the a p p l i c a t i o n of the method of r e s e a r c h t o e v a l u a t e t h e r e s u l t s o b t a i n e d from f a m i l y c e n t e r e d t r e a t m e n t . ( f ) a r e c o r d of d i r e c t s e r v i c e i n a f a m i l y c e n t e r e d p r o j e c t a v a i l a b l e f o r c r i t i c a l s c r u t i n y as w e l l as f o r use i n s t a f f development programs. (g) an assessment of t h e development and n a t u r e o f p r e s e n t knowledge and a c l a r i f i c a t i o n o f the l i n e s of f u t u r e s t u d y and p r a c t i c e . I n t h e s t u d y o f the C a s e l o a d A n a l y s i s (1) c a s e l o a d s o f " a v e r a g e " or " o r d i n a r y " f a m i l i e s as opposed t o a " m u l t i - p r o b l e m f a m i l y c a s e l o a d " , from e l e v e n major a g e n c i e s i n Vancouver were chosen, based on m u l t i p l i c i t y and c h r o n i c i t y of agency c o n t a c t s . A complete h i s t o r y was o b t a i n e d of the' f a m i l i e s 1 f i r s t c o n t a c t s w i t h 1 t h e a g e n c i e s f o r the t o t a l group o f f a m i l i e s . The s o - c a l l e d m u l t i - p r o b l e m f a m i l i e s form o n l y a s m a l l p o r t i o n o f t h e group. T h i s s t u d y shows t h a t the " a v e r a g e " f a m i l y i s more c h r o n i c a l l y dependent t h a n assumed. (1 p.4) From t h i s s t u d y t h e e x p e r -i m e n t a l and c o n t r o l group were chosen f o r the A r e a Development P r o j e c t o f V a n c ouver. An a n a l y s i s of background f a c t o r s and t h e i r a s s o c i a t i o n w i t h p r e s e n t f u n c t i o n i n g p a t t e r n s d e t e r m i n e d what f a c t o r s i n t h e f a m i l y h i s t o r y a r e r e l e v a n t t o a b e t t e r u n d e r s t a n d i n g o f t h e i r p r e s e n t s t a t e o f d i s o r g a n -i z a t i o n , and thus may l e a d t o t h e development o f knowledge n e c e s s a r y f o r e a r l y i d e n t i f i c a t i o n o f the m u l t i - p r o b l e m f a m i l y . Such a n . a n a l y s i s was conducted w i t h f a m i l i e s l i v i n g i n a h o u s i n g p r o j e c t i n New Haven, C o n n e c t i c u t U.S.A., (10, pp.94-171) and was a c o m p a r i s o n of d i s o r g a n i z e d f a m i l i e s w i t h s t a b l e f a m i l i e s . I t p o i n t e d up t h e c o m p l e x i t y o f such s i t u a t i o n s , w h i c h a r e n o t r o o t e d s o l e l y i n p o v e r t y ; i t a l s o d i s c l o s e s the magnitude of i n a d e q u a t e i n t r a - f a m i l i a l r e l a t i o n s h i p s as opposed to s o c i a l r o l e p e r f o r -mances . The F a m i l y C e n t e r e d P r o j e c t o f S t . P a u l was the p r o j e c t h a v i n g the d u a l f o c u s o f d e v e l o p i n g methods of casework and p r o c e s s e s o f community o r g a n i z a t i o n , w i t h a c o n c e n t r a t i o n o f e f f o r t on h a r d - t o - r e a c h , s e r i o u s l y 10. d e p r i v e d f a m i l i e s who were b e s e t by numerousj p r o b l e m s . ( 7 ) There was s e r i o u s l y d e v i a n t b e h a v i o u r i n each f a m i l y , p l u s a h e a l t h or economic p r o b l e m . I n most i n s t a n c e s t h e c h i l d r e n were i n . " c l e a r and p r e s e n t d a nger," t h a t i s , t h e i r p h y s i c a l o r e m o t i o n a l w e l f a r e was b e i n g t h r e a t -ened t o the e x t e n t t h a t t h e community had a r e s p o n s i b i l i t y t o i n t e r v e n e . T h i s e f f o r t t o h e l p t h e f a m i l y i n t r o u b l e has found e x p r e s s i o n m a i n l y t h r o u g h casework and community o r g a n i z a t i o n s e r v i c e s . The t a s k of r e -s e a r c h i s t o g i v e e f f e c t i v e s u p p o r t t o b o t h , and t o c o n t r i b u t e t o our knowledge of s o c i a l s t r u c t u r e and p r o c e s s as i t i s r e l a t e d t o t h e work o f t h e P r o j e c t as a w hole. The i m p l i c a t i o n s o f the F a m i l y U n i t R e p o r t Study of 1948 posed the problems w h i c h l e d t o the c r e a t i o n of t h e Vancouver A r e a Development P r o j e c t . T h i s s t u d y was an a c c o u n t i n g i n S t . P a u l of problems and s e r v i c e s on a. community wide b a s i s i n the a r e a s o f economic need, s o c i a l m a l a d j u s t m e n t , i l l h e a l t h and r e c r e a t i o n . As p a r t o f t h e F a m i l y C e n t e r e d P r o j e c t of S t . P a u l , a s t u d y was s e t up t o d e v i s e a r e l i a b l e t e c h n i q u e f o r m e a s u r i n g changes i n t h e s o c i a l f u n c t i o n i n g of m u l t i - p r o b l e m f a m i l i e s . ( 8 ) T h i s i n v o l v e d d e v e l -o p i n g a method of e v a l u a t i n g f a m i l y b e h a v i o u r as e x p r e s s e d i n t h e c o n c e p t o f s o c i a l f u n c t i o n i n g ; and f i n d i n g ways of a p p r a i s i n g changes i n f u n c t i o n i n g known as movement. The t e c h n i q u e s d e v e l o p e d were t h e L e v e l s of F u n c t i o n i n g Scheme, t h e S c h e d u l e of F a m i l y F u n c t i o n i n g , and P r o f i l e s o f F a m i l y F u n c t i o n i n g and o f Movement. " P a t t e r n s o f Change i n P r o b l e m F a m i l i e s " (9) i s a n o t h e r s t u d y from the S t . P a u l P r o j e c t . I t s p u r p o s e was t o s t u d y f o r the main p a r t t h e a p p l i c a t i o n o f the method o f r e s e a r c h r a t h e r t h a n the development of method. The c e n t r a l q u e s t i o n w i t h r e g a r d t o t h i s b e i n g what a r e t h e o b s e r v e d changes i n m u l t i - p r o b l e m f a m i l i e s r e c e i v i n g t r e a t m e n t and s p e c i f i c a l l y how 11. m o d i f i c a t i o n s i n s o c i a l f u n c t i o n i n g a f f e c t t h e t o t a l f a m i l y and how t h e y a f f e c t t h e w e l f a r e of the community. The main p u r p o s e f o r s t u d y i n g t h e a p p l i c a t i o n of method th e n was t o e v a l u a t e the r e s u l t s o b t a i n e d from f a m i l y c e n t e r e d t r e a t m e n t . The "Casework Notebook" (13) was d e v e l o p e d by t h e S t . P a u l P r o j e c t w o r k e r s t o r e c o r d t h e i r common e x p e r i e n c e i n t h e p r a c t i c e f i e l d t h r o u g h t h e use o f case i l l u s t r a t i o n s . T h i s r e c o r d p r o v i d e d an o p p o r t u n i t y f o r c r i t i c a l s c r u t i n y of t h e i r work by the seven a g e n c i e s i n v o l v e d as w e l l as b e i n g a u s e f u l t o o l i n s t a f f development programs. I t g i v e s a b r i e f e x a m i n a t i o n o f the r a t i o n a l e of " r e a c h i n g - o u t " or " a g g r e s s i v e " ^casework, as w e l l as a n s w e r i n g t h e q u e s t i o n s of how t o s t a r t work w i t h f a m i l i e s ; how t o p r o c e e d w i t h f a m i l i e s , and what the p r o j e c t has t a u g h t . A c o m p lete b i b l i o g r a p h y of work done i n the a r e a of t h e m u l t i -p r o b l e m f a m i l y i s c o n t a i n e d i n the book, "The M u l t i - p r o b l e m F a m i l y , An A n n o t a t e d B i b l i o g r a p h y " by S c h l e s i n g e r & S p e n c e r . ( 1 4 ) I t a l s o i n c l u d e s the r e p o r t aimed a t a s s e s s i n g the development and n a t u r e of our p r e s e n t knowledge and.at c l a r i f y i n g t h e l i n e s o f f u t u r e s t u d y and p r a c t i c e . The r e p o r t i s c oncerned w i t h t h e i n t e r n a l b e h a v i o u r of t h e s e f a m i l i e s and t h e i r r e l a t i o n s h i p w i t h t h e s o c i a l e n v i r o n m e n t i n w h i c h we l i v e . T h i s p r o p o s e d s t u d y i s p a r t o f t h e t o t a l r e s e a r c h program of the A r e a Development P r o j e c t i n Vancouver. The l i t e r a t u r e p r e s e n t l y a v a i l a b l e (16) shows i t as a d e m o n s t r a t i o n p r o j e c t aimed a t p r o v i d i n g an i n t e g r a t e d program of i n t e n s i v e casework, group work, h e a l t h and community o r g a n i z a t i o n s e r v i c e s under one a d m i n i s t r a t i o n f o r a s e l e c t e d group o f m u l t i - p r o b l e m f a m i l i e s i n one g e o g r a p h i c a r e a o f the c i t y . Four a r e a s o f r e s e a r c h were b r o a d l y o u t l i n e d : (a) s t u d y o f changes i n f a m i l y f u n c t i o n i n g . (b) s t u d y o f t r e a t m e n t methods employed. (c ) s t u d y of o r g a n i z a t i o n a l change. (d) s t u d y of depth of the c h a r a c t e r i s t i c s o f p r o b l e m f a m i l i e s . D e f i n i t i o n of M u l t i - P r o b l e m F a m i l i e s I n e x a m i n i n g the l i t e r a t u r e chosen f o r s t u d y i n d e v e l o p i n g t h i s t h e s i s p r o j e c t t h e d e f i n i t i o n o f t h e m u l t i - p r o b l e m f a m i l y i s n o t a c l e a r c u t s t a t e m e n t , b u t v a r i e d w i t h the s p e c i f i c p u r p o s e s w h i c h m i g h t be s e r v e d by t h e concept and d e f i n i t i o n s e l e c t e d . The p u r p o s e s may be summarized under the f o l l o w i n g h e a d i n g s : (a) u n d e r s t a n d i n g of f a m i l y f u n c t i o n i n g (b) i d e n t i f i c a t i o n ( c ) d i a g n o s i s (d) t r e a t m e n t (e) e v a l u a t i o n o f change. (1 P-21) Most of t h e d e f i n i t i o n s used were based upon t h e c a r e extended t o the c h i l d r e n by t h e i r p a r e n t s and the b e h a v i o u r o f the c h i l d r e n i n the community. F o l l o w i n g a r e a few examples: 1. T h e - f a m i l i e s s e l e c t e d had t o meet t h e s e c o n d i t i o n s : (a) they must have a l l had a t l e a s t one c h i l d under e i g h t e e n i n " c l e a r and p r e s e n t d a n g e r " whether t h r o u g h d e l i n q u e n c y o r v e r i f i e d n e g l e c t . (b) i n a d d i t i o n t o a b e h a v i o u r p r o b l e m w h i c h has a n e g a t i v e impact on c h i l d r e n , the f a m i l i e s must have a p r o b l e m i n e i t h e r t h e h e a l t h or economic a r e a . 2. The m u l t i - p r o b l e m f a m i l i e s denote t h o s e f a m i l i e s w h i c h a r e of p u b l i c c o n c e r n because o f t h e i r s o c i a l and economic c o s t t o the community and a r e c h a r a c t e r i z e d by (a) a p a t h o l o g i c a l f a m i l y (b) dependent or e x p l o s i v e b e h a v i o u r t o t h e community ( c ) p e r s i s t e n t f a i l u r e t o respond t o h e l p (d) a s t a t e o f c h r o n i c dependency on s o c i a l s e r v i c e s . 3. The a l t e r n a t e term " s e r i o u s l y d i s o r g a n i z e d f a m i l y " , w h i c h p e r t a i n s t o a s i t u a t i o n where a f a m i l y ' s s o c i a l p e r f o r m a n c e i s a d v e r s e l y a f f e c t e d by more t h a n one m a j o r p r o b l e m , whether i n t h e a r e a of income p r o d u c t i o n , 13. h e a l t h , f a m i l y r e l a t i o n s h i p s , c h i l d c a r e or some o t h e r a r e a o f s o c i a l f u n c t i o n i n g . (8 p.10) These few examples of the d e f i n i t i o n s used t o d e s c r i b e the m u l t i -p r o b l e m f a m i l y g i v e some i d e a o f t h e d i f f i c u l t i e s e n c o u n t e r e d . The A r e a Development P r o j e c t of Vancouver chose the d e f i n i t i o n --"a f a m i l y w i t h c h i l d r e n i n " c l e a r and p r e s e n t danger," t h a t i s , where t h e immediate p h y s i c a l and/or e m o t i o n a l w e l f a r e o f t h e c h i l d r e n i s b e i n g t h r e a t e n e d t o the e x t e n t t h a t t h e community has a r e s p o n s i b i l i t y t o i n i t i a t e s e r v i c e ; - a f a m i l y w i t h c l e a r e v i d e n c e o f f a i l u r e i n the c h i l d - r e a r i n g f u n c t i o n , where c h i l d r e n under s i x t e e n a r e a d v e r s e l y i n f l u e n c e d by n e g l e c t or d e l i n q u e n c y . B e f o r e o f f e r i n g a c r i t i c i s m o f t h e s e d e f i n i t i o n s , an h i s t o r i c a l v i e w i s g i v e n i n summary.(1 pp. 24-31) I n G r e a t B r i t a i n t he m u l t i - p r o b l e m f a m i l y was c h a r a c t e r i z e d by the i n a b i l i t y o f some f a m i l i e s t o l i v e up t o t h e s t a n d a r d s o f f a m i l y l i f e i n a w e l f a r e s t a t e . A t the t u r n o f t h e c e n t u r y C h a r l e s Booth spoke o f the "submerged t e n t h " , and u n d o u b t e d l y some m u l t i -p r o b l e m f a m i l i e s would be found i n t h i s group. D u r i n g the 1 9 t h C e n t u r y c r i m i n o l o g i s t s and s o c i a l r e f o r m e r s were s t r u c k by w i d e s p r e a d c r i m e i n c e r t a i n s o c i a l c l a s s e s and l a b e l e d t h e m ^ " c l a s s e s d a n g e r e u s e s " . However, t h e r e i s no r e l i a b l e i n f o r m a t i o n on how t h e s e groups were s i m i l a r i n c h a r a c t e r i s t i c s t o to d a y ' s " m u l t i - p r o b l e m " f a m i l i e s . The c o n c e p t o f m u l t i - p r o b l e m f a m i l y d e v e l o p e d out o f the f a m i l i e s i n a b i l i t y t o f u n c t i o n i n h i s e n v i r o n m e n t . . I n the e a r l y days i n G r e a t B r i t a i n t h e s e p e o p l e were seen as a group r a t h e r t h a n s p e c i f i c f a m i l i e s . E a r l y s t u d i e s r e p o r t e d t h a t sub-normal i n t e l l i g e n c e and '•mental d e f e c t s i w e r e : t h e main f a c t o r s i n c o n t r i b u t i n g t o the m u l t i - p r o b l e m f a m i l y . Even e a r l i e r t h a n t h i s , c i v i l i z a t i o n s saw. s u p e r n a t u r a l f o r c e s a t work. F o l l o w i n g the 14. P r o t e s t a n t R e f o r m a t i o n , a f o r m u l a t i o n o f the t h e o r y of poverty and r e l a t e d phenomena i n terms o f " p r e d e s t i n a t i o n " g a i n e d ground. L a t e l y , emphasis has s h i f t e d from the f a c t o r of i n t e l l i g e n c e t o p e r s o n a l i t y , and t h e main f a c t o r i n c o n t r i b u t i n g t o the m u l t i - p r o b l e m f a m i l y i s seen as "immature e m o t i o n a l development". L i t t l e work has been done t o a s s e s s t h e i n f l u e n c e o f h e r e d i t y and b i o l o g y . The U n i t e d S t a t e s i n r e c e n t y e a r s has g i v e n us i m p o r t a n t developments i n f o r m i n g a c o n c e p t of the m u l t i - p r o b l e m f a m i l y . From.the p o i n t o f v i e w o f f a m i l y d i a g n o s i s s t u d i e s were done t h a t f o c u s e d on number and c h r o n i c i t y of problems i n c e r t a i n a r e a s : c h r o n i c economic dependency, i l l - h e a l t h and m a l a d j u s t m e n t . The e x i s t e n c e o f two o f t h e t h r e e problems was enough t o c h a r a c t e r i z e a f a m i l y as m u l t i - p r o b l e m . I n the S t . P a u l s t u d y number and c h r o n i c i t y of problems has g i v e n way t o " l e v e l o f f u n c t i o n -i n g " o f t h e f a m i l y . The f a m i l y i s r a t e d i n terms o f i t s adequacy on a s e v e n - p o i n t s c a l e . I n t h e San Mateo s t u d i e s emphasisviwas on f a m i l y p a t h o l o g y and f a m i l i e s were c l a s s i f i e d , i n terms of the l e v e l of t h e i r p a t h o l o g y and t r e a t m e n t was d e t e r m i n e d a c c o r d i n g t o t h i s l e v e l . The m u l t i - p r o b l e m f a m i l y i s e a s i e r t o d e s c r i b e t h a n t o d e f i n e , and i n f a c t , t h e m a j o r i t y of d e f i n i t i o n s a r e d e s c r i p t i o n s . I t i s a f a u l t y term i n t h a t i t i s n o t a v e r y u s e f u l term d i a g n o s t i c a l l y . The word " p r o b l e m " i s i t s e l f vague and i s u s u a l l y used t o d e s c r i b e t h e symptoms t r o u b l i n g a f a m i l y r a t h e r t h a n a p r e c i s e d i a g n o s i s . And what o f t h e t e r m . " c l e a r and p r e s e n t d a n g e r " so f r e q u e n t l y used i n t h e s t u d i e s u n d e r t a k e n ? I t has been e x p l a i n e d as s i t u a t i o n s i n w h i c h t h e immediate p h y s i c a l and/or e m o t i o n a l w e l f a r e o f t h e c h i l d r e n i s b e i n g t h r e a t e n e d t o the e x t e n t t h a t the community has a r e s p o n s i b i l i t y t o i n i t i a t e s e r v i c e . However, j u s t what c o n s t i t u t e s p h y s i c a l and e m o t i o n a l w e l f a r e i s n o t made c l e a r . I n s p i t e of t h e s e d i f f i c u l t i e s and d i f f e r e n c e s i n a p p r o a c h , and of t h e l i m i t a t i o n s o f d e f i n i t i o n , t h e r e i s g e n e r a l agreement o v e r t h e m ain s o c i a l c h a r a c t e r i s t i c s o f the m u l t i - p r o b l e m f a m i l y . D i r t , s q u a l o r , d i s e a s e , p o v e r t y and dependency, d e l i n q u e n c y and c r i m e , a l c o h o l i s m , -p r o s t i t u t i o n , c h i l d n e g l e c t , t r u a n c y , and d e s e r t i o n have a l l been mentioned i n numerous s t u d i e s . M a j o r c o n c e p t s employed i n A n a l y s i s o f F a m i l y F u n c t i o n i n g Many a t t e m p t s have been made t o f o r m u l a t e a. c l e a r c o n c e p t u a l framework t h a t can be used t o s t u d y and t r e a t the m u l t i - p r o b l e m f a m i l y . I n d e v e l o p i n g an adequate concept t h e r e a r e s e v e r a l p o i n t s o f v i e w t h a t one can t a k e . For example, i n the U n i t e d S t a t e s t h e r e has r e c e n t l y been some work done i n d e v e l o p i n g a concept from the p o i n t of v i e w o f f a m i l y d i a g n o s i s . These s t u d i e s f o c u s on number and c h r o n i c i t y o f problems i n c e r t a i n a r e a s such as c h r o n i c economic dependency, i l l - h e a l t h and m a l a d j u s t -ment. The e x i s t e n c e of two of the t h r e e problems i s enough t o c h a r a c t e r -i z e a f a m i l y as m u l t i - p r o b l e m . ( 1 4 p.6) I n the San Mateo s t u d i e s emphasis i s on f a m i l y p a t h o l o g y and f a m i l i e s were c l a s s i f i e d i n terms of t h e l e v e l o f t h e i r p a t h o l o g y and t r e a t m e n t was d e t e r m i n e d a c c o r d i n g t o t h i s l e v e l . Casework has g i v e n much t o the concept of the m u l t i - p r o b l e m f a m i l y as s o c i a l w o r k e r s have been c o n t i n u a l l y f a c e d w i t h the consequences o f i n a d e q u a t e s o c i a l f u n c t i o n i n g . Most s t u d i e s on the m u l t i - p r o b l e m f a m i l y have used the term s o c i a l f u n c t i o n i n g i n t h e i r a n a l y s i s o f b e h a v i o r , and i s t h e c o n c e p t u t i l i z e d by Geismar and A y r e s i n the S t . P a u l s t u d y . S o c i a l f u n c t i o n i n g i s l o o k e d a t i n terms of r o l e s . The f a m i l y i s seen as an open system o f i n t e r d e p e n d e n t r o l e s and r e l a t i o n s h i p s i n w h i c h s t r e s s i n t h e r o l e p e r f o r m a n c e of one member has consequences f o r r e l a t e d r o l e s b o t h i n s i d e and o u t s i d e the f a m i l y group. I n the S t . P a u l P r o j e c t f a m i l y d i s o r g a n i z a t i o n was d e f i n e d i n terms 16. of t y p e an i n t e n s i t y o f m u l t i - p r o b l e m s o c i a l f u n c t i o n i n g . The degree o f m a l f u n c t i o n i n g was judged i n n i n e b a s i c a r e a s by the e x t e n t t o w h i c h f a m i l y members pe r f o r m e d t h e s o c i a l l y e x p e c t e d r o l e s i n l i n e w i t h b e h a v i o r seen as c o n d u c i v e or h a r m f u l t o t h e w e l f a r e o f the f a m i l y and community. The n i n e major c a t e g o r i e s o f s o c i a l f u n c t i o n i n g a r e : 1. F a m i l y r e l a t i o n s h i p s and f a m i l y u n i t y 2. I n d i v i d u a l b e h a v i o r and a d j u s t m e n t 3. Care and t r a i n i n g o f c h i l d r e n 4. S o c i a l a c t i v i t i e s 5. Economic p r a c t i c e s 6. Household p r a c t i c e s 7. H e a l t h c o n d i t i o n s and p r a c t i c e s 8. R e l a t i o n s h i p t o f a m i l y c e n t e r e d worker 9. Use o f community r e s o u r c e s T h i s c o n c e p t l o o k s a t f u n c t i o n i n g as a t w o - f o l d m a t t e r r e f e r r i n g on t h e one hand t o t h e way c e r t a i n f a m i l y t a s k s a r e b e i n g p e r f o r m e d and on t h e o t h e r t o t h e o v e r a l l a d j u s t m e n t o f each f a m i l y member as judged by h i s pe r f o r m a n c e i n the sum t o t a l o f the s o c i a l r o l e s he i s p l a y i n g . A b a s i c a s s u m p t i o n i s t h a t i n d e a l i n g w i t h s e r i o u s l y d i s o r g a n i z e d f a m i l i e s s o c i a l w o r k e r s were a b l e t o equate the concept of s o c i a l l y a s s i g n e d f u n c t i o n s o r r o l e e x p e c t a t i o n s , w i t h the i d e a t h a t t h e community has s e t up c e r t a i n s t a n d a r d s below w h i c h f a m i l y p e r f o r m a n c e can be termed as i n a d e q u a t e . These may be r e f e r r e d t o as minimum s t a n d a r d s o f s o c i a l f u n c t i o n i n g , and t h e y mean i n a g e n e r a l way b e h a v i o r w h i c h i s n o t a c o n c e r n t o t h e community. These i n c l u d e t he p r e s e r v a t i o n of a degree o f f a m i l y u n i t y w h i c h w i l l p r o v i d e a b a s i s f o r the s o c i a l i z a t i o n o f the c h i l d r e n , t he m e e t i n g o f p h y s i c a l and e m o t i o n a l needs of the young, the o b s e r v a n c e of law and the p r e v e n t i o n o f the f a m i l y o t h e r w i s e becoming an. undue burden upon or a t h r e a t t o the community. I n a d e q u a t e p e r f o r m a n c e can b e s t be d e f i n e d i n r e l a t i o n t o p a t t e r n s o f b e h a v i o r w h i c h f a l l s h o r t o f the minimum s t a n d a r d s d e f i n e d f o r the group. Measures o f F a m i l y F u n c t i o n i n g Developed To measure s o c i a l f u n c t i o n i n g , a c o n t i n u i m has been d e v i s e d , w i t h extremes o f i n a d e q u a t e f u n c t i o n i n g and adequate f u n c t i o n i n g and a c e n t r a l p o i n t o f m a r g i n a l f u n c t i o n i n g . G e n e r a l l y s p e a k i n g , m a r g i n a l f u n c t i o n i n g i m p l i e s b e h a v i o r w h i c h i s i n k e e p i n g w i t h minimum r e q u i r e m e n t s f o r the p r o t e c t i o n o f t h e f a m i l y and t h e community. In a d e q u a t e f u n c t i o n -i n g r e f e r s t o b e h a v i o r w h i c h c l e a r l y e n t i t l e s t h e community t o i n t e r v e n e because laws a r e b e i n g v i o l a t e d , t h e w e l f a r e of the community t h r e a t e n e d , and the w e l l b e i n g o f t h e f a m i l y s e r i o u s l y j e o p a r d i z e d . F o r each of t h e n i n e b a s i c c a t e g o r i e s and the t w e n t y s i x s u b c a t e g o r i e s used i n the s c h e d u l e of F a m i l y F u n c t i o n i n g , the t h r e e l e v e l s o f i n a d e q u a t e , m a r g i n a l and adequate f u n c t i o n i n g were c a r e f u l l y d e f i n e d . T h i s made up the l e v e l s o f F u n c t i o n -i n g Scheme. A seven p o i n t s c a l e was drawn up u t i l i z i n g t h e s e t h r e e m ain anchor p o s i t i o n s p l u s f o u r o t h e r s c a l e p o s i t i o n s n o t d e s c r i p t i v e l y d e f i n e d b u t meant t o i n d i c a t e l e v e l s o f f u n c t i o n i n g c l o s e t o one o f the anchor p o s i t i o n s . The s c a l e used was as f o l l o w s : I nadeq. Near Below M a r g i n a l Above . Near Adequate Inadeq. M a r g i n M a r g i n a l Adeq. X - - X - - X 1 2 3 4 5 6 7 T h i s c o n c e p t of s o c i a l f u n c t i o n i n g and the above m e a s u r i n g s c a l e i s the one t h a t i s most o f t e n c i t e d i n the l i t e r a t u r e . How. Data i s O b t a i n e d One f r e q u e n t l y used way o f o b t a i n i n g data, i s t h a t t h e c a s e w o r k e r s 18. on t h e b a s i s of t h e i r r e c o r d i n g , d e s c r i b e f a m i l y b ehavior, under each of t h e n i n e main c a t e g o r i e s and t w e n t y - s i x s u b - c a t e g o r i e s o f f a m i l y f u n c t i o n -i n g . T h i s i s done b o t h f o r t h e b e g i n n i n g s i t u a t i o n and l a t e r a t t h e t i m e o f e v a l u a t i o n . U s i n g t h e seven p o i n t s c a l e the w o r k e r s can n u m e r i c a l l y r a t e t h e i r f a m i l i e s l e v e l o f f u n c t i o n i n g i n each o f t h e c a t e g o r i e s and s u b c a t e g o r i e s f o r the b e f o r e s i t u a t i o n and the a f t e r s i t u a t i o n . The d i f f e r e n c e between the b e f o r e a n d . a f t e r s i t u a t i o n gave a movement s c o r e . The r e s u l t i n g n u m e r i c a l judgements c o u l d be p l o t t e d v e r t i c a l l y by c a t e g o r y and s u b c a t e g o r y t o y i e l d a p r o f i l e o f f a m i l y f u n c t i o n i n g . How R e l i a b i l i t y and V a l i d i t y Problems were D e a l t W i t h To t e s t the r e l i a b i l i t y o f judgements or r a t i n g s o f f a m i l y f u n c t i o n i n g , the S t . P a u l s t u d y u t i l i z e d t h e i d e a of t h r e e d i f f e r e n t p e r s o n s t o i n d e p e n d e n t l y r a t e t h e s e f a m i l i e s as t o the l e v e l o f f u n c t i o n i n g . That i s , t h e r e l i a b i l i t y t e s t was e s s e n t i a l l y an assessment of t h e amount of agreement o f d i f f e r e n t j udges c o n c e r n i n g the l e v e l s a t w h i c h f a m i l i e s were f u n c t i o n i n g . Work done by Geismar and A y r e s i n " M e a s u r i n g F a m i l y F u n c t i o n -i n g " i n d i c a t e s t h a t when the s c h e d u l e s were r a t e d by d i f f eren,t. :people s i m i l a r r e s u l t s were o b t a i n e d i n r a t i n g t h e s o c i a l f u n c t i o n i n g and movement and t h a t t h i s method of s c h e d u l e w r i t i n g was r e l i a b l e . (10 p.108) R e s e a r c h F i n d i n g s t h a t a r e P e r t i n e n t t o t h i s Study S e v e r a l of t h e s t u d i e s have a r r i v e d a t s t u d y f i n d i n g s t h a t w i l l be u s e f u l t o t h i s t h e s i s . The f o l l o w i n g i s a l i s t o f s e v e r a l o f t h e s e f i n d i n g s ; F a m i l y s o l i d a r i t y , m a r i t a l r e l a t i o n s h i p , i n c i d e n c e o f b e h a v i o r d i s o r d e r s , money management, p h y s i c a l c a r e of c h i l d r e n , h e a l t h p r a c t i c e s and h o u s e k e e p i n g p r a c t i c e s were found t o be the most u s e f u l i n d i c e s of the f a m i l i e s o v e r a l l s o c i a l f u n c t i o n i n g . I n a d e q u a t e e m o t i o n a l c a r e o f c h i l d r e n and poor p a r e n t - c h i l d r e l a t i o n s h i p s were too common i n t h e f a m i l i e s t o s e r v e as u s e f u l i n d i c a t o r s o f o v e r a l l f a m i l y f u n c t i o n i n g . (7 p.20) A d i r e c t r e l a t i o n s h i p between l a c k of f a m i l y s o l i d a r i t y ( o r c o h e s i v e n e s s ) and h i g h i n c i d e n c e o f v a r i o u s t y p e s o f d e v i a n t b e h a v i o r on t h e p a r t o f f a m i l y members i n g e n e r a l , and c h i l d r e n i n p a r t i c u l a r , s e r v e d t o s t r e n g t h e n e x i s t i n g h y p o t h e s i s about t h e i m p o r t a n c e of f a m i l y c o h e s i o n i n t h e development of c h i l d r e n . (7 p.20) A r e a s showing t h e g r e a t e s t power o f d i s c r i m i n a t i o n between th e d i s o r g a n i z e d and t h e s t a b l e f a m i l y a r e i n t h e c a t e g o r y o f I n d i v i d u a l B e h a v i o r and A d j u s t m e n t , and i n the c a t e g o r y o f F a m i l y R e l a t i o n s h i p s and U n i t y . That i s a c h a r a c t e r i s t i c p a t t e r n o f s o c i a l m a l f u n c t i o n i n g , c h i e f l y i n the a r e a o f i n t r a f a m i l i a l r e l a t i o n s h i p s , can be found i n the m u l t i - p r o b l e m f a m i l y . (11 p. 114) Background i n f o r m a t i o n on m u l t i - p r o b l e m f a m i l i e s i n d i c a t e s t h a t w i v e s p l a c e d a l o w e r v a l u e on h a v i n g c h i l d r e n ; b i r t h s were no t as w e l l s p a c e d , i n d i c a t i n g an absense o f r e a l i s t i c e x p e c t a t i o n and p l a n n i n g f o r t h e f u t u r e i n the d i s o r g a n i z e d f a m i l i e s . F a m i l i e s were found t o e n c o u n t e r t h e i r most s e r i o u s problems i n t h e a r e a s of c h i l d c a r e , i n d i v i d u a l b e h a v i o r and f a m i l y r e l a t i o n s h i p s . (11 pp.168-170) There tends t o be a h i e r a r c h y o f c a t e g o r i e s of f a m i l y f u n c t i o n i n g from the most p r o b l e m a t i c a r e a ( I n d i v i d u a l B e h a v i o r and A d j u s t m e n t ) t o t h e l e a s t p r o b l e m a t i c ( R e l a t i o n s h i p t o C a s e w o r k e r ) . Low s c o r e f a m i l i e s a r e more l i k e l y , t o show.adequate f u n c t i o n i n g i n the a r e a s a t the bottom o f the h i e r -a r c h y of f a m i l y f u n c t i o n i n g , i . e . R e l a t i o n s h i p t o Caseworker, Economic P r a c -t i c e s , S o c i a l A c t i v i t i e s , and Household P r a c t i c e s . C o n v e r s e l y , t h e h i g h e r the t o t a l s c o r e o f f u n c t i o n i n g t h e more l i k e l y t h a t the f a m i l y f u n c t i o n s w i l l be i n the a r e a s o f F a m i l y R e l a t i o n s h i p s , C h i l d Care and I n d i v i d u a l A d j u s t m e n t . I n o t h e r words, i t can be s a i d t h a t adequate f u n c t i o n i n g w i t h r e g a r d t o the way f a m i l y members a d j u s t and r e l a t e t o one a n o t h e r and b r i n g up t h e i r c h i l d -r e n tends to c a r r y w i t h i t s u c c e s s f u l p e r f o r m a n c e o f o t h e r f a m i l y f u n c t i o n s . 20. CHAPTER I I I The T h e o r e t i c a l Framework A major c o n c e p t employed i n t h i s p r o j e c t was t h a t the f a m i l y i s a t o t a l u n i t and the worker s h o u l d a d d r e s s h i m s e l f to the f a m i l y . a s a whole r a t h e r t h a n segments o f i t . I n k e e p i n g w i t h t h i s , the f a m i l y i s view e d as a s o c i a l system, and the i n d i v i d u a l members o f t h i s system " p e r f o r m s o c i a l r o l e s w h i c h may be seen as the i n s t r u m e n t f o r i m p l e m e n t i n g the f u n c t i o n s a s s i g n e d t o the N o r t h A m e r i c a n . f a m i l y " , ( 7 , p. 143). The f u n c t i o n s o f the f a m i l y a r e seen i n the r o l e s p e r f o r m e d by the f a m i l y members. "The c o n c e p t o f s o c i a l r o l e i s d e f i n e d as an i n d i v i d u a l ' s a c t u a l f u n c t i o n i n g ( t h i s i n c l u d e s b e h a v i o r , a t t i t u d e s , and f e e l i n g s ) w i t h i n the c o n t e x t o f c e r t a i n s o c i a l s i t u a t i o n s . (7 p. 1 4 3 ) . The c o n c e p t o f r o l e a l s o c o n n e c t s the i n d i v i d u a l to the b r o a d e r s o c i a l s t r u c t u r e and d e f i n e s h i s r e l a t i o n to the s o c i a l systems o f w h i c h he i s a p a r t . T h i s study, has d i s t i n g u i s h e d between f u n c t i o n s r e q u i r i n g r o l e p e r f o r m a n c e w i t h i n the f a m i l y group and r o l e p e r f o r m a n c e o u t s i d e the f a m i l y g roup. I n o r d e r to round o u t the c o n c e p t u a l framework, the t o t a l f a m i l y f o c u s has t a k e n . i n t o a c c o u n t (a) " I n d i v i d u a l b e h a v i o r and a d j u s t m e n t , w h i c h r e p r e s e n t s an e v a l u a t i o n o f f a m i l y members s o c i a l f u n c t i o n i n g as jud g e d by t h e i r t o t a l r o l e p e r f o r m a n c e . (7 p. 145)" (b) " F a m i l y r e l a t i o n s h i p s and f a m i l y u n i t y , w h i c h might be view e d as an e v a l u a t i o n o f r e l a t i o n s h i p s among f a m i l y members i n terms o f t h e i r c o l l e c t i v e a b i l i t y , to m a i n t a i n a c o h e s i v e s o c i a l system. (7 p. 149)" (c ) " E v a l u a t i o n o f c a s e w o r k e r s r e l a t i o n s h i p i n terms o f the s p e c i f i c t r e a t m e n t f o c u s w h i c h p u t s the worker i n . a p r i m a r y h e l p i n g p o s i t i o n . " The p r o j e c t e q uated the c o n c e p t o f s o c i a l l y a s s i g n e d f u n c t i o n s w i t h the i d e a t h a t the community has s e t up c e r t a i n s t a n d a r d s below w h i c h 21. p e r f o r m a n c e c a n be termed i n a d e q u a t e . A f a m i l y ' s s o c i a l f u n c t i o n i n g was measured by the Geismar - Ayres; s c a l e . HYPOTHESIS I I f m u l t i - p r o b l e m f a m i l i e s r e c e i v e I n t e g r a t e d F a m i l y S e r v i c e s t h e r e w i l l be more improvement and/or l e s s r e g r e s s i o n i n f a m i l y f u n c t i o n -i n g t h a n i f m u l t i - p r o b l e m f a m i l i e s r e c e i v e o r d i n a r y s e r v i c e s . * R a t i o n a l e The p r i m a r y r e s e a r c h purpose o f the A r e a Development P r o j e c t was to s t u d y the e f f e c t of. a t r e a t m e n t program w h i c h i n t e g r a t e s and c o o r d i n a t e s h e a l t h and w e l f a r e s e r v i c e s to f a m i l i e s w i t h complex p r o b l e m s . As was p r e v i o u s l y p o i n t e d o u t , many m u l t i - p r o b l e m f a m i l i e s have had numerous c o n t a c t s w i t h s o c i a l s e r v i c e s a g e n c i e s i n Vancouver, w i t h no a p p r e c i a b l e improvement b e i n g e v i d e n t . Thus the a s s u m p t i o n was made t h a t s e r v i c e s p r o v i d e d under a d i f f e r e n t system would p r o v e t o be o f g r e a t e r b e n e f i t t o t h i s c h r o n i c a l l y dependent group o f f a m i l i e s . The components o f the t r e a t m e n t program d e v e l o p e d c e n t e r e d • around the c o n c e p t o f p r o v i d i n g b a s i c s o c i a l s e r v i c e s to a l l members o f a f a m i l y t h r o u g h c o n t a c t w i t h one s o c i a l w o r k e r . T h i s I n t e g r a t e d F a m i l y , S e r v i c e approach i n c l u d e s : (a) P l a c i n g w o r k e r s from s e v e r a l a g e n c i e s under one a d m i n i s t r a t i o n and i n one l o c a t i o n . (b) C h a n n e l l i n g f u n c t i o n s o f s e v e r a l . a g e n c i e s t h r o u g h one w o r k e r . * I t s h o u l d be n o t e d t h a t the h y p o t h e s e s t o be t e s t e d a r e o n e - t a i l o r d i r e c t i o n a l h y p o t h e s e s w i t h a s i g n i f i c a n c e l e v e l o f .10. 22. (c ) C o o r d i n a t i o n o f s k i l l s t h a t cannot be s u p p l i e d by t h i s w o r k e r . (d) P r o v i d i n g c o n t i n u i t y of s e r v i c e . (e) U s i n g the n e i g h b o r h o o d and i t s f a c i l i t i e s i n s e r v i n g f a m i l i e s . D e f i n i t i o n o f Terms F o r p u r p o s e s o f t h i s t h e s i s , t h e d e f i n i t i o n o f m u l t i - p r o b l e m f a m i l y employed by t h e A r e a Development P r o j e c t s t a f f was f o l l o w e d . (17, i v , p. 1 1 ) . F a m i l y : c o n s i s t s o f a t l e a s t one p a r e n t or p a r e n t f i g u r e w i t h one or more c h i l d r e n under the age of 14 i n th e home. M u l t i - p r o b l e m : (a) c u r r e n t problem: members o f the f a m i l y must be on th e c a s e l o a d s o f one or more o f t h e seven major a g e n c i e s . * (b) m u l t i p l i c i t y o f p r o b l e m s : members of the f a m i l y must have been on the c a s e l o a d s o f a t l e a s t two a d d i t i o n a l a g e n c i e s o f the seven and/or o f the a d d i t i o n a l f o u r a g e n c i e s i n the p a s t s e v e n y e a r s . * * ( c ) c h r o n i c i t y o f problems: members of the f a m i l y must have been on the c a s e l o a d of one of the s p e c i f i e d a g e n c i e s a t l e a s t 3 y e a r s p r i o r t o the b e g i n n i n g of the s t u d y p e r i o d and/or the p a r e n t s o f e i t h e r man.or woman l e a d i n g the f a m i l y must have been known to t h r e e o f the s p e c i f i e d a g e n c i e s i n the p a s t . * C a t h o l i c C h i l d r e n s 1 A i d S o c i e t y . C i t y S o c i a l S e r v i c e Dept.; F a m i l y and C h i l d r e n s 1 C o u r t ; F a m i l y S e r v i c e Agency; M e t r o p o l i t a n Board o f H e a l t h . ** C r e a s e C l i n i c : M e n t a l H e a l t h C e n t r e : P r o v i n c i a l M e n t a l H e a l t h ; Vancouver G e n e r a l H o s p i t a l , S o c i a l S e r v i c e Department. 23. The c a s e s e l e c t i o n p r o c e d u r e s a r e t o be d e t a i l e d i n . t h e f o l l o w i n g s u b s e c t i o n . The main i n d e p e n d e n t v a r i a b l e examined was the type o f t r e a t -ment g i v e n t o the m u l t i - p r o b l e m f a m i l i e s under s t u d y . The two p o s s i b l e modes o f t r e a t m e n t a r e d e f i n e d a s : (a) I n t e g r a t e d F a m i l y S e r v i c e s : Each wo r k e r p r o v i d e s the b a s i c w e l f a r e s e r v i c e s t o the f a m i l y as a whole-and c a r r i e s o u t the f u n c t i o n s d e l e g a t e d by s e v e r a l a g e n c i e s . (b) O r d i n a r y S e r v i c e s : • Each worker p r o v i d e s s e p a r a t e l y the s p e c i f i c f u n c t i o n s t r a d i t i o n a l l y o u t l i n e d under the e s t a b l i s h e d s o c i a l w e l f a r e agency s t r u c t u r e . The main dependent v a r i a b l e examined was the degree o f change i n f a m i l y f u n c t i o n i n g d u r i n g the p e r i o d o f s t u d y . The G e i s m a r - A y r e s s c a l e o f f a m i l y f u n c t i o n i n g , w h i c h was p r e v i o u s l y d e s c r i b e d , was employed to e v a l u a t e the movement o b t a i n e d . A n a l y s i s o f the change i n the l e v e l o f f a m i l y f u n c t i o n i n g was s t u d i e d and compared a f t e r t w e l v e or e i g h t e e n months f o r our s t u d y p o p u l a t i o n . F o r r e s e a r c h . p u r p o s e s i n t h i s t h e s i s , o v e r a l l movement was d e f i n e d f o r e v a l u a t i o n i n t o f o u r c a t e g o r i e s : (a) No Movement: the l e v e l o f f a m i l y f u n c t i o n i n g remains unchanged d u r i n g the s t u d y , p e r i o d . (b) N e g a t i v e Movement: B e h a v i o r o f the f a m i l y members r e g r e s s e s one o r more u n i t s down the s c a l e o f f a m i l y f u n c t i o n i n g . f r o m the l e v e l i n the b e g i n n i n g s i t u a t i o n . ( c ) L i m i t e d Movement: B e h a v i o r o f the f a m i l y members advances one, two, o r t h r e e u n i t s up the s c a l e from the o r i g i n a l l e v e l o f f a m i l y f u n c t i o n i n g . (d) S i g n i f i c a n t Movement: B e h a v i o r o f the f a m i l y members advances f o u r o r more u n i t s up the s c a l e from the 24. o r i g i n a l l e v e l o f f a m i l y f u n c t i o n i n g . HYPOTHESES I I Bo t h those m u l t i - p r o b l e m f a m i l i e s r e c e i v i n g I n t e g r a t e d F a m i l y S e r v i c e s and t h o s e r e c e i v i n g o r d i n a r y s e r v i c e s w i l l show more improve-ment and/or l e s s r e g r e s s i o n . i n i n s t r u m e n t a l as opposed t o e x p r e s s i v e a r e a s o f f a m i l y f u n c t i o n i n g . R a t i o n a l e One o f the o b s e r v a t i o n s o f the w o r k e r s i n the S t . P a u l P r o j e c t was t h a t f r e q u e n t l y i n the b e g i n n i n g s i t u a t i o n they had to. p r o v e t h e i r " u t i l i t y v a l u e " (13, p. 50) i n c o n c r e t e s e r v i c e s t o t h e s e m u l t i -p r o b l e m f a m i l i e s b e f o r e any m e a n i n g f u l a t t e m p t c o u l d be made to d e a l w i t h f e e l i n g s and r e l a t i o n s h i p s . T h i s t r e n d o f p r o g r e s s from the outward o r i n s t r u m e n t a l a r e a s o f f u n c t i o n i n g t o the f e e l i n g o r e x p r e s s i v e b e h a v i o r a l t a s k s seems t o be p a r t i c u l a r l y e v i d e n t w i t h t h e s e d i s o r g a n i z e d f a m i l i e s b ecause o f t h e i r d e f e n s i v e a t t i t u d e o f apathy.and d i s t r u s t . T h i s i s i n l i n e w i t h the o b s e r v a t i o n s by L.L. Geismar and M. L a S o r t e ( 1 1 , p. 114) t h a t the a r e a s o f b e h a v i o r showing the g r e a t e s t a b i l i t y t o d i s c r i m i n a t e between.the d i s o r g a n i z e d and s t a b l e f a m i l i e s a r e e m o t i o n a l , where mal-f u n c t i o n i n g i s more l i k e l y t o be a p e r v a s i v e l i f e s t y l e . Hence, i t was assumed t h a t e f f o r t s t o r e a c h t h e s e m u l t i - p r o b l e m f a m i l i e s would have the g r e a t e s t e f f e c t i v e n e s s i n the b e g i n n i n g phase o f t r e a t m e n t on the b e h a v i o r o f f a m i l y members i n t h e i r i n s t r u m e n t a l o r m a n i f e s t a r e a s o f r e s p o n s i b i l i t y b e f o r e i m p r o v e m e n t . c o u l d be e x p e c t e d i n the i n t e r r e l a t e d a r e a o f f a m i l y c o h e s i v e n e s s o r s o l i d a r i t y . D e f i n i t i o n o f Terms I n e x a m i n i n g t h i s h y p o t h e s i s , the d e s c r i p t i o n d e v e l o p e d by L.L. Geismar and M. L a S o r t e o f f e r s a v a l i d d e f i n i t i o n o f the d i s t i n c t i o n 25. between e x p r e s s i v e and i n s t r u m e n t a l f u n c t i o n s . They s t a t e ; " T h i s d i s t i n c t i o n has t o do w i t h whether a c t i o n s a r e aimed p r i m a r i l y a t r e g u l a t i n g the i n t e r n a l a f f a i r s o f the f a m i l y and m a i n t a i n i n g a p a t t e r n of r e l a t i o n -s h i p s w h i c h s a t i s f i e s the e m o t i o n a l needs of i t s members ( e x p r e s s i v e ) , or whether a c t i o n s a r e geared c h i e f l y t o t h e problem.- of r e l a t i o n s between the f a m i l y and s i t u a t i o n s o u t s i d e the f a m i l y system ( i n s t r u m e n t a l ) . The l a t t e r f u n c t i o n s , moreover, a r e geared t o m e e t i n g f a m i l y needs r e l a t i v e t o i t s b i o p h y s i c a l e x i s t e n c e such as the h e a l t h and economic w e l f a r e o f i t s members." (12 pp.42-43) U s i n g t h e G e i s m a r - A y r e s s c a l e of f a m i l y f u n c t i o n i n g , t h e c a t e g o r i e s w h i c h a r e i n d i c a t i v e o f e x p r e s s i v e f u n c t i o n i n g a r e t h o s e o f : (a) F a m i l y R e l a t i o n s h i p s (b) I n d i v i d u a l B e h a v i o r ( c ) Care a n d - T r a i n i n g of C h i l d r e n Those a r e a s w h i c h r e f l e c t t h e f a m i l y ' s mode o f i n s t r u m e n t a l f u n c t i o n i n g , i n c l u d e the f i v e c a t e g o r i e s o f : (a) S o c i a l R e l a t i o n s h i p s (b) Economic P r a c t i c e s ( c ) Household P r a c t i c e s (d) H e a l t h Problems and P r a c t i c e s (e) Community R e s o u r c e s * The time range f o r t h i s a n a l y s i s o f i n s t r u m e n t a l v e r s u s e x p r e s s i v e a r e a s o f f u n c t i o n i n g was the t o t a l o f t w e l v e and e i g h t e e n months f o r b o t h t r e a t m e n t and c o n t r o l g r oups. * The c a t e g o r y of t h e f a m i l y ' s r e l a t i o n s h i p t o t h e worker w i l l be e x c l u d e d as i t i s the m ain v a r i a b l e used i n a s s e s s i n g movement. 26. HYPOTHESIS I I I Those f a c t o r s found t o be d i s c r i m i n a t i n g between l e v e l s o f f u n c t i o n i n g a t one p o i n t i n t i m e , w i l l be s i g n i f i c a n t l y a s s o c i a t e d , w i t h movement i n f a m i l y f u n c t i o n i n g when I n t e g r a t e d F a m i l y S e r v i c e s a r e p r o v i d e d but n o t when o r d i n a r y s e r v i c e s a r e the method of t r e a t m e n t . R a t i o n a l e As was p r e v i o u s l y d e s c r i b e d , many s t u d i e s have a t t e m p t e d t o f a c t o r out c e r t a i n d e f i n a b l e c h a r a c t e r i s t i c s o f the m u l t i - p r o b l e m f a m i l y . The l o n g - r a n g e g o a l o f t h e s e r e s e a r c h e f f o r t s has been t o d e v e l o p a more comprehensive and s t a t i s t i c a l l y s u p p o r t e d s o c i a l d i a g n o s i s as an a i d t o a s s e s s i n g the e x t e n t o f d i s o r g a n i z a t i o n w i t h i n t h e s e f a m i l i e s . T h i s was done (by the A.D.P.) w i t h the a s s u m p t i o n t h a t an "Index o f F a m i l i e s At. R i s k " (17 v i p.22) c o u l d be d e v e l o p e d w h i c h would be a b l e t o i d e n t i f y f a m i l i e s w i t h a h i g h " r i s k p o t e n t i a l " e a r l y i n t h e i r c o n t a c t w i t h s o c i a l a g e n c i e s and hence would a i d i n d e t e r m i n i n g t h e mode o f t r e a t m e n t . I t was assumed t h a t c e r t a i n p o s i t i v e f a c t o r s c o u l d be i d e n t i f i e d i n the f a m i l y ' s p r e s e n t and p a s t l i f e e x p e r i e n c e s w h i c h were i n d i c a t i v e o f i t s c a p a c i t y t o b e n e f i t from t r e a t m e n t e f f o r t s . F u r t h e r m o r e , i t was f e l t t h a t t h e s e f a m i l y s t r e n g t h s c o u l d be b e s t u t i l i z e d by an I n t e g r a t e d F a m i l y S e r v i c e w o r k e r who a c t i v e l y r e a c h e d out t o t h e s e p o o r l y m o t i v a t e d f a m i l i e s , t h a n by a worker, o p e r a t i n g under the t r a d i t i o n a l agency s t r u c t u r e ; t h u s , g r e a t e r movement would be a t t a i n e d i n the t r e a t m e n t group. D e f i n i t i o n o f Terms The A r e a Development P r o j e c t i n t h e i r P r o g r e s s R e p o r t f o r . 1966, have o u t l i n e d e l e v e n v a r i a b l e w h i c h t h e y f e l t appeared t o be t h e most s i g -n i f i c a n t i n r e l a t i o n t o d i s t i n g u i s h i n g between l e v e l s of " p o o r l y f u n c t i o n -i n g " and "more a d e q u a t e l y f u n c t i o n i n g " f a m i l i e s . ( 1 7 , v i , p . 2 7 ) The com-p a r a t i v e f a c t o r s u t i l i z e d f o r ..our s t u d y were: 27 . (a) E d u c a t i o n o f the p a r e n t s : grade e i g h t or l e s s . (b) A d d i t i o n a l t r a i n i n g o f the f a t h e r : yes or no. ( c ) F a t h e r ' s o c c u p a t i o n : s k i l l e d o r u n s k i l l e d . (d) . M a i n d i f f e r e n c e i n ages o f m a r i t a l p a i r : L e s s t h a n b\ y e a r s or g r e a t e r t h a n 5% y e a r s . (e) Mother under twenty a t age of f i r s t m a r r i a g e : yes or no. ( f ) T o t a l number o f c h i l d r e n 19 and,under i n the home: 3 or . l e s s , f o u r ; f i v e or more. (g) C h i l d r e n o f more t h a n one u n i o n i n t h e home: yes or no. (h) Source o f income i n the l a s t 12 months; s o c i a l a s s i s t a n c e o n l y , or o t h e r . ( i ) R e s i d e n t i a l m o b i l i t y or moves w i t h i n the l a s t t w e l v e months: no moves; one move; o r two or more. ( j ) F i r s t c h i l d b o r n p r i o r t o m a r r i a g e : yes or no. (k) Mother under 20 a t t h e b i r t h o f the f i r s t c h i l d : yes or no. The t i m e range f o r t h i s a n a l y s i s was a t o t a l o f t w e l v e and e i g h t e e n months f o r b o t h t h e t r e a t m e n t and c o n t r o l g roups. Methods o f G a t h e r i n g Data. The d a t a used i n t h i s t h e s i s were c o l l e c t e d from the m a t e r i a l a v a i l a b l e a t t h e A r e a Development P r o j e c t . The A.D.P. d a t a was o b t a i n e d i n the f o l l o w i n g manner: (a) A s i n g l e i n t e r v i e w was h e l d w i t h c o n t r o l f a m i l i e s i n w h i c h i n f o r m a t i o n was g a t h e r e d f o r the p r o f i l e . F a m i l y L i f e H i s t o r i e s and. P a r e n t A t t i t u d e R a t i n g I n s t r u m e n t s were a d m i n i s t e r e d . (b) A t t w e l v e or e i g h t e e n months a r e v i e w r a t i n g was done on some of the c o n t r o l f a m i l i e s . Because o f time and s t a f f a v a i l a b i l i t y n o t a l l o f the c o n t r o l f a m i l i e s had a r e v i e w r a t i n g . 28. ( c ) W i t h the t r e a t m e n t f a m i l i e s , t h e P.A.R.I. was a d m i n i s t e r e d by a case a i d . The f a m i l y l i f e h i s t o r y and p r o f i l e i n f o r m a t i o n was g a t h e r e d by the f a m i l y c e n t e r e d w o r k e r . A r e v i e w was done of t h e s e f a m i l i e s a t t w e l v e o r e i g h t e e n months. We have drawn s e l e c t i v e l y from t h e a v a i l a b l e m a t e r i a l . I n b o t h t h e c o n t r o l , and t r e a t m e n t samples we have chosen f a m i l i e s on whom t h e r e was a t w e l v e o r e i g h t e e n month r e v i e w r a t i n g , p l u s i n f o r m a t i o n on the e l e v e n f a m i l y c h a r a c t e r i s t i c s we have s e l e c t e d t o s t u d y . S t a n d a r d i z e d T e s t s Used The o n l y s t a n d a r d i z e d t e s t used i n t h i s t h e s i s i s t h e Geismar-A y r e s r a t i n g s c a l e w h i c h has been d e s c r i b e d i n a p r e v i o u s s e c t i o n . Once t h i s s c a l e was d e v e l o p e d t h e r e was a need to t e s t the r e l i a b i l i t y o f the t e c h n i q u e , t h a t i s , t o a s s e s s t h e degree of agreement among ju d g e s c o n c e r n -i n g t h e l e v e l s a t w h i c h f a m i l i e s f u n c t i o n e d . I t was f e l t t h a t a t l e a s t t h r e e i n d e p e n d e n t judges were n e c e s s a r y t o e s t a b l i s h minimum c r i t e r i a o f r e l i a b i l i t y . W i t h r e g a r d t o the c r i t e r i o n o f r e l i a b i l i t y t h e q u e s t i o n a r o s e as t o what c o n s t i t u t e s an a c c e p t a b l e degree of agreement. I t was n o t r e a s o n -a b l e t o e x p e c t complete agreement on one p o s i t i o n of the seven p o i n t s o c i a l f u n c t i o n i n g c o n t i n u i m . I t was f e l t t h a t agreement by t h r e e i n d e p e n d e n t judges on i d e n t i c a l o r a d j a c e n t p o s i t i o n s would be a s u f f i c i e n t l y r i g o r o u s c r i t e r i o n . Agreement on the main c a t e g o r y of f a m i l y f u n c t i o n i n g was h i g h e r t h a n on s u b c a t e g o r i e s because the former r e p r e s e n t s a c o m p o s i t e judgment o f t h e l a t t e r , w hich r e s u l t e d i n a l e v e l i n g o f f o f d i s a g r e e m e n t s . A s t a n d a r d d e v i a t i o n of 1.30 f o r the average o f t h r e e i n d e p e n d e n t r a t i n g s i n d i c a t e d a l i m i t e d s c a t t e r o f judgments over t h e seven p o i n t c o n t i n u i m o f s o c i a l f u n c t i o n i n g . The p r e l i m i n a r y a n a l y s i s of t h e r e l a t i o n o f s c a t t e r and r e l i a b i l i t y i n d i c a t e d t h a t t h e agreement a c h i e v e d was n o t a f u n c t i o n o f the l i m i t e d s c a t t e r o f r a t i n g s . The r e l i a b i l i t y was judged t o be adequate. (10, p.107) The i n t e r r e l a t i o n s h i p o f c a t e g o r i e s i n the p a t t e r n o f f u n c t i o n i n g has been examined by s c a l e a n a l y s i s . R e s u l t s s u g g e s t e d t h a t t h e c o n c e p t o f s o c i a l f u n c t i o n i n g , when o r g a n i z e d i n t o n i n e c a t e g o r i e s o f f a m i l y f u n c t i o n i n g , showed-; c h a r a c t e r i s t i c s of a n - . u ^ i m e r i s i o n a l s c a l e . T h i s s u p p o r t e d t h e . h y p o t h e s i s of an i n t e r d e p e n d e n c e o f f u n c t i o n i n g w i t h i n the f a m i l y group and o u t s i d e o f i t . (10, p.108) - S c h e d u l e s and q u e s t i o n n a i r e s . d e v e l o p e d " The s c h e d u l e used i n t h e t h e s i s was c o l l e c t e d w i t h l.B.M. p r o c e s s -i n g i n mind, w i t h r e s p e c t t o t h e o r g a n i z a t i o n o f d a t a c o l l e c t i o n . The s c h e d u l e i n c l u d e d the f o l l o w i n g d a t a ; (a) I d e n t i f y i n g i n f o r m a t i o n -- name, case number e t c . (b) P r o f i l e s c o r e s ( c ) The e l e v e n c h a r a c t e r i s t i c s found t o d i s t i n g u i s h between two groups a t d i f f e r e n t l e v e l s o f f u n c t i o n i n g . (see A p p e n d i x A f o r example) L e v e l o f R e s e a r c h D e s i g n S i n c e t h e A r e a D e v e l o p m e n t - P r o j e c t ' s . b a s i c r e s e a r c h p u r p o s e was t o d i s c o v e r whether t h e r e was a c a s u a l r e l a t i o n s h i p between I n t e g r a t e d F a m i l y S e r v i c e s and movement i n f a m i l y f u n c t i o n i n g , a . " c a r e f u l l y p r e p a r e d c o n t r o l group t y p e o f r e s e a r c h design-was d e v e l o p e d t o a s s e s s t h e ext e n d t o w h i c h t h e r e s u l t s o b t a i n e d m i g h t have o c c u r r e d i n the absence o f the p r o j e c t (17,, A p p e n d i x p.5) The f i e l d e x p e r i m e n t d e s i g n i n v o l v e d one t r e a t m e n t and two c o n t r o l g r o u p s , each w i t h 100 f a m i l i e s ; t h e t r e a t m e n t groups r e c e i v e d I n t e g r a t e d Family. S e r v i c e s and b o t h c o n t r o l groups r e c e i v e d the u s u a l : m u l t i -agency s e r v i c e s . The t r e a t m e n t group and one c o n t r o l group p o p u l a t i o n were l o c a t e d i n South V ancouver. Because of p o s s i b l e r e s e a r c h " c o n t a m i n -a t i o n " o f t h e South Vancouver c o n t r o l group by v i r t u e o f i t s w o r k e r s b e i n g 30. l o c a t e d i n the same b u i l d i n g as the t r e a t m e n t w o r k e r s , a second c o n t r o l group was chosen i n E a s t V ancouver, a p a r t o f the c i t y w h i c h has demographic c h a r a c t e r i s t i c s s i m i l a r t o t h o s e i n South Vancouver. I n t h e t e s t i n g o f t h e t h r e e h y p o t h e s e s p r o p o s e d above, data*was u t i l i z e d on f i f t y o f the one hundred t r e a t m e n t f a m i l i e s and. on a t o t a l o f f o r t y - n i n e c o n t r o l f a m i l i e s from b o t h South and E a s t Vancouver. There were p r o f i l e r a t i n g s (measurement o f the l e v e l o f f a m i l y f u n c t i o n i n g on the G e ismar-Ayres s c a l e ) a t a t w e l v e month r e v i e w p e r i o d f o r t h i r t y - t w o t r e a t -ment and t h i r t y c o n t r o l f a m i l i e s and r a t i n g s a t an e i g h t e e n month r e v i e w p e r i o d f o r a n o t h e r e i g h t e e n t r e a t m e n t and n i n e t e e n c o n t r o l f a m i l i e s . The s m a l l sample s i z e was due t o the n o n - a v a i l a b i l i t y of d a t a , a t t h a t t i m e , on t h e r e m a i n i n g f i f t y t r e a t m e n t and one hundred and f i f t y - o n e c o n t r o l f a m i l i e s . There, has been a number o f l i m i t a t i o n s of t h e A.D.P. ••s' s t u d y w h i c h have a b e a r i n g on t h e p r e s e n t r e s e a r c h p r o j e c t . One o f t h e s e r e l a t e s t o t h e phenomenon of. " I n t e g r a t e d F a m i l y S e r v i c e s " . The l a c k of a c a r e f u l d e l i n e a t i o n . o f t h e s p e c i f i c i n g r e d i e n t s o f I n t e g r a t e d F a m i l y S e r v i c e s and t h e p r e s e n c e o f v a r i a b i l i t y due t o w o r k e r s t y l e l e a d t o c o n f u s i o n r e g a r d i n g the v a r i a b l e b e i n g t e s t e d . (The A.D.P. i s aware o f t h i s l i m i t a t i o n and i s c u r r e n t l y t r y i n g t o f a c t o r out the i m p o r t a n t a s p e c t s o f I n t e g r a t e d F a m i l y S e r v i c e s . ) A l s o of n o t e : I n t h e t o r i g i n a l r e s e a r c h d e s i g n , t w e n t y - f i v e of t h e t r e a t m e n t f a m i l i e s and t w e n t y - f i v e o f t h e South c o n t r o l f a m i l i e s were t o have a c c e s s t o Neighbourhood S e r v i c e s . Because o f the absence of s u f f i c i e n t numbers of p r o j e c t f a m i l i e s r e c e i v i n g Neighbourhood S e r v i c e s t h r o u g h o u t the d u r a t i o n o f the p r o j e c t and the d i f f i c u l t y i n a s s e s s i n g the e x t e n t t o w h i c h p r o j e c t f a m i l i e s u t i l i z e d t h e Neighbourhood S e r v i c e s , the e f f e c t of t h i s mode o f t r e a t m e n t has n o t been c o n s i d e r e d . However, t h e Neighbourhood S e r v i c e s may have a b e a r i n g on the f a m i l y ' s s o c i a l f u n c t i o n i n g , p a r t i c u l a r l y i n the a r e a d e s i g n a t e d "Use of Community R e s o u r c e s " . Under the p r e s e n t 31. study, d e s i g n , t h i s e f f e c t would e r r o n e o u s l y be a t t r i b u t e d t o t h e I n t e g r a t e d F a m i l y S e r v i c e s . A n o t h e r l i m i t a t i o n of the A r e a Development P r o j e c t ' s s t u d y stems from t h e f a c t t h a t the b e g i n n i n g r a t i n g s of the l e v e l o f f a m i l y f u n c t i o n i n g were based on d i f f e r e n t amounts o f i n f o r m a t i o n f o r t r e a t m e n t and c o n t r o l f a m i l i e s . C o n t r o l p r o f i l e s were w r i t t e n on the b a s i s of the r e f e r r i n g a g e n c i e s 1 , f i l e i n f o r m a t i o n p l u s one i n t e r v i e w . Treatment p r o f i l e s were w r i t t e n u s i n g i n f o r m a t i o n from f i l e s , d i s c u s s i o n w i t h v a r i o u s agency w o r k e r s , and from two months ' i n t e r v i e w i n g c o n t a c t w i t h t h e f a m i l y . I t i s c o n c e i v a b l e t h a t the l i m i t e d amount of d e s c r i p t i v e and f a c t u a l d a t a on the c o n t r o l groups c o u l d h i n d e r a t t a i n m e n t of a t r u e assessment o f f a m i l y f u n c t i o n i n g . I t m i g h t a l s o be n o t e d t h a t " t h e t w e l v e month i n t e r v a l a c t u a l l y c o v e r s a p e r i o d o f e i g h t t o f i f t e e n months, arid the e i g h t een.month i n t e r v a l s i x t e e n t o twenty-one months. Treatment f a m i l i e s averaged a s h o r t e r p e r i o d t h a n C o n t r o l b ecause o f the way i n w h i c h t h e two groups were s c r e e n e d i n t o the P r o j e c t . " ( 1 7 , . v i , p.18) There i s some q u e s t i o n o f t h e v a l i d i t y o f the A.D.P.'s f i n d i n g s t h a t the e l e v e n c h a r a c t e r i s t i c s , l i s t e d p r e v i o u s l y , d i s c r i m i n a t e between " p o o r l y f u n c t i o n i n g " and " b e t t e r f u n c t i o n i n g " f a m i l i e s . The q u e s t i o n a r i s e s because t h e f a m i l i e s were a s s i g n e d t o the c a t e g o r i e s o f f u n c t i o n i n g n o t on t h e b a s i s of p r o f i l e s c o r e s , b u t a c c o r d i n g t o w o r k e r ' s g l o b a l j u d g -ment a t one p o i n t i n t i m e . (A.D.P. e x p e c t s t o do the c o m p a r i s o n a g a i n , t h i s t i m e u s i n g p r o f i l e s c o r e s as t h e c r i t e r i a f o r s e l e c t i o n of the p o o r l y f u n c t i o n i n g and b e t t e r f u n c t i o n i n g f a m i l i e s . ) P l a n of D a t a A n a l y s i s The d a t a r e l a t e d t o the t h r e e h y p o t h e s e s were a n a l y s e d by means o f c h i s q u are and t h e K o l m o g o r o v - S m i r n o f f t e s t , ( 1 6 ) u s i n g the 107c, l e v e l o f 3 2 . c o n f i d e n c e * . . H y p o t h e s i s I I I i n v o l v e d a t h r e e - v a r i a b l e a n a l y s i s , so t h a t the t r e a t m e n t v a r i a b l e was h e l d c o n s t a n t w h i l e each o f t h e e l e v e n f a m i l y c h a r a c t e r i s t i c s was examined i n r e l a t i o n t o change i n f u n c t i o n i n g . S a m p l i n g P r o c e d u r e s The seven m a j o r s o c i a l w e l f a r e a g e n c i e s i n Vancouver i d e n t i f i e d a l l c u r r e n t l y a c t i v e cases o f f a m i l i e s w i t h c h i l d r e n under f o u r t e e n and r e s i d i n g i n t h e South or E a s t Vancouver A r e a s . The g e o g r a p h i c b o u n d a r i e s were d e f i n e d by the A r e a Development P r o j e c t . Cases were s e l e c t e d f o r the p r o j e c t i f th e y met the o p e r a t i o n a l r e s e a r c h c r i t e r i a o f a f a m i l y , c u r r e n t p r o b l e m , m u l t i p l i c i t y and c h r o n i c i t y o f agency c o n t a c t ( d e f i n e d e a r l i e r ) and t he c r i t e r i o n o f t h e - " w o r k e r c h e c k " i . e . t h e w o r k e r ' s judgment as t o whether the f a m i l y was " m u l t i - p r o b l e m " . ( 1 7 , i v , p . 1 5 ) u s i n g a d e f i n i t i o n based on " c l e a r and p r e s e n t danger t o c h i l d r e n " and " f a i l u r e i n t h e c h i l d r e a r i n g f u n c t i o n " . ( 1 7 , i v , p . 1 0 ) S i n c e a n o t h e r 257o were needed t o en s u r e a t o t a l o f 3 0 0 cases ( 1 0 0 f a m i l i e s i n each o f t h e two c o n t r o l groups and the one t r e a t m e n t g r o u p ) , e i t h e r t h e c r i t e r i o n o f c u r r e n t a c t i v i t y w i t h two or more a g e n c i e s or t h a t o f " d o u b l e c h r o n i c i t y " was a p p l i e d . Double c h r o n i c i t y r e f e r s t o f a m i l i e s h a v i n g r e g i s t e r e d w i t h t h e f i r s t agency a t l e a s t t h r e e y e a r s p r e v i o u s and th e p a r e n t s o f the man o r woman h e a d i n g t h e p r e s e n t f a m i l y h a v i n g a h i s t o r y of a t l e a s t t h r e e agency c o n t a c t s . ( 1 7 , i v , p . 1 5 ) Cases were randomly a s s i g n e d t o the South Vancouver Treatment and C o n t r o l g r oups. See A.D.P. volume IV pages 1 5 - 1 8 ( 1 7 ) f o r problems i n r e t a i n i n g a l a r g e enough Treatment p o p u l a t i o n and t h e n e c e s s i t y o f m o d i f y i n g t h e c r i t e r i a f o r case s e l e c t i o n t o d i s r e g a r d m u l t i p l i c i t y and c h r o n i c i t y and c o n c e n t r a t e on "problem f u n c t i o n -i n g " . * An a r t i c l e by J.K. S k i p p e r , A.L. Guenther and G. Waas ( t h e A m e r i c a n S o c i o l o g i s t , Feb. 1 9 6 7 , p p . 1 6 - 1 8 ) r e j e c t s t he " s a c r e d n e s s o f . 0 5 " . l e v e l o f s i g n i f i c a n c e . We have u t i l i z e d t h e 10% l e v e l o f c o n f i d e n c e i n o r d e r t o a v o i d Type I I e r r o r i n our a n a l y s i s . 33. CHAPTER IV STUDY FINDINGS DESCRIPTIVE DATA.ON.STUDY FINDINGS The adequacy o f the d a t a r e l a t i n g t o H y p o t h e s i s I I I was l i m i t e d by the l a r g e number o f n o n - r e s p o n s e s . T h i s was p a r t i c u l a r l y so r e g a r d i n g the c h a r a c t e r i s t i c s o f F a t h e r ' s E d u c a t i o n and A d d i t i o n a l T r a i n i n g - i n b o t h t h e s e c a t e g o r i e s t h e r e were 387, n o n - r e s p o n s e s . On the whole t h e r e was a 17.357, non-response r a t e , w i t h a range o f between 8 - 3 7 number o f non-responses f o r each c h a r a c t e r i s t i c ; 13 b e i n g the median.and 17.45 the mean. F o r p u r p o s e s o f d e t e r m i n i n g whether t h e r e i s a r e l a t i o n s h i p between t h e s e f a c t o r s and movement i t i s n e c e s s a r y t h a t t h e r e s h o u l d be a f a i r l y even n u m e r i c a l d i v i s i o n between those p o s s e s s i n g the c h a r a c t e r i s t i c and t h o s e n o t p o s s e s s i n g i t . On the whole t h i s was t r u e o f most o f the c h a r a c t e r i s t i c s . However, i n the m a j o r i t y . o f f a m i l i e s the f i r s t . c h i l d was n o t b o r n p r i o r to m a r r i a g e (77.57.), f a m i l i e s had n o t moved r e s i d e n c e i n the l a s t 12 months (647,), and the f a t h e r d i d n o t have a d d i t i o n a l t r a i n i n g (667,). I n - a d d i t i o n , j u d g i n g from the l a r g e number o f n o n - r e s p o n s e s t o the q u e s t i o n s on e d u c a t i o n and t r a i n i n g o f f a t h e r , most o f t h e f a m i l i e s would appear to be o n e - p a r e n t f a m i l i e s . FINDINGS ON THE HYPOTHESES H y p o t h e s i s I : I f m u l t i r r p r o b l e m f a m i l i e s r e c e i v e i n t e g r a t e d f a m i l y s e r v i c e s t h e r e w i l l be more improvement and/or l e s s r e g r e s s i o n i n f a m i l y f u n c t i o n i n g t h a n i f m u l t i - p r o b l e m f a m i l i e s r e c e i v e o r d i n a r y s e r v i c e s . S t a t i s t i c a l a n a l y s i s o f the d a t a on the r e l a t i o n s h i p between t r e a t -ment and changes i n f a m i l y f u n c t i o n i n g i n d i c a t e d t h a t H y p o t h e s i s I c o u l d n o t be a c c e p t e d u s i n g the 107,.level o f c o n f i d e n c e . See T a b l e I . 34. T A B L E T . - The R e l a t i o n s h i p o f Treatment to Changes i n F a m i l y F u n c t i o n i n g Treatment ' P e r i o d Sample S i z e (N) C h i S q u a r e * P r o b a b i l i t y 12 months .Treatment 32 C o n t r o l 30 T o t a l : N • = 62 .619 . 8 0 > p > . 7 0 18 months Treatment 18 C o n t r o l 19 T o t a l : N = 37 3.62 .20> p > . 1 0 T o t a l 12 months p l u s 18 months N = 99 1.88 . 5 0 > p > . 3 0 * Degrees o f freedom = 2 i n a l l c a s e s . A t 12 months t h e r e was no s i g n i f i c a n t d i f f e r e n c e between Treatment and C o n t r o l groups w i t h r e s p e c t t o movement. The Kolmogorov-Smirnov T e s t , w h i c h u t i l i z e s t h e maximum d i f f e r e n c e between 2 c u m u l a t i v e d i s t r i b u t i o n s i n c a l c u l a t i n g c h i s q u a r e , would i n d i c a t e s l i g h t l y more t r e a t m e n t f a m i l i e s t h a n c o n t r o l f a m i l i e s m a n i f e s t e d " r e g r e s s i o n " o r "no change". A f t e r 18 months the d i f f e r e n c e between those r e c e i v i n g i n t e g r a t e d f a m i l y s e r v i c e s and t h o s e n o t was much g r e a t e r . However, o n l y a t the 207> l e v e l o f c o n f i d e n c e c o u l d i t be s t a t e d t h a t t r e a t m e n t ( i n t e g r a t e d f a m i l y s e r v i c e s ) p r o d u c e s more change t h a n o r d i n a r y s e r v i c e s . On the b a s i s o f the K o lmogorov-Smirnov T e s t , w h i c h p i c k s o u t the g r e a t e s t d i f f e r e n c e t o o c c u r a t a r e g r e s s i o n o f one s t e p or more on the 7 - p o i n t s c a l e , i t c a n be s t a t e d t h a t the Treatment group tended to show l e s s r e g r e s s i o n t h a n the C o n t r o l group. R e l a t i v e l y l a r g e d i f f e r e n c e s a l s o o c c u r r e d a t t h e l e v e l o f p o s i t i v e movement o f 2 o r more s t e p s , so t h a t t h e r e i s a t r e n d toward the Treatment group show-I n t e r p r e t a t i o n s o f the Kolmogorov-Smirnov t e s t c i t e d h e r e a r e s o l e l y des-c r i p t i v e i . e . c a n n o t be c o n s i d e r e d s t a t i s t i c a l l y s i g n i f i c a n t s i n c e no c h i s q u a r e met the 107, l e v e l o f c o n f i d e n c e i n g more improvement t h a n the C o n t r o l Group. E x a m i n a t i o n o f the d a t a f o r a l l f a m i l i e s measured, r e g a r d l e s s o f whether a t 12 or 18 months, r e v e a l e d a l a c k o f s t a t i s t i c a l s i g n i f i c a n c e i n the h y p o t h e s i z e d r e l a t i o n s h i p between i n -t e g r a t e d f a m i l y s e r v i c e s and changes i n ' f a m i l y f u n c t i o n i n g . The p r o b a b i l i t y was between t h a t f o r the 12 month and the 18 month group, as m i g h t be ex-p e c t e d by, the s i m p l e p r o c e s s o f the r e s u l t s a t 12 and a t 18 months b a l a n c i n g o u t one a n o t h e r . The Kolmogorov-Smirnov t e s t i n d i c a t e s t h a t the Treatment group shows, more p o s i t i v e change of. a c o n s i d e r a b l e amount (4 o r more s t e p s up the s c a l e ) t h a n the C o n t r o l g roup. I n summary, H y p o t h e s i s I must be r e j e c t e d ,at the 107o. l e v e l o f con-f i d e n c e but. t h e r e would appear t o be a t r e n d , e s p e c i a l l y , a f t e r 18 months, i n the d i r e c t i o n o f the Treatment group showing b o t h "more improvement" and " l e s s r e g r e s s i o n " t h a n the C o n t r o l g roup. As n o t e d i n C h a p t e r I I I , many f a m i l i e s i n the Treatment group r e -c e i v e d c o n s i d e r a b l y , l e s s t h a n the f u l l . 1 2 o r 18 months s e r v i c e , so t h a t i t i s d i f f i c u l t t o compare A r e a Development P r o j e c t r e s u l t s w i t h t h o s e o f the S t . P a u l F a m i l y C e n t r e d P r o j e c t , where most o f the movement o c c u r r e d a f t e r 12 months o f Treatment. H y p o t h e s i s I I : B o t h t h o s e m u l t i - p r o b l e m f a m i l i e s r e c e i v i n g i n t e g r a t e d f a m i l y s e r v i c e s and t h o s e r e c e i v i n g o r d i n a r y s e r v i c e s w i l l show more movement and/or l e s s r e g r e s s i o n i n " i n s t r u m e n t a l " as opposed t o , " e x p r e s s i v e " a r e a s o f f a m i l y f u n c t i o n i n g . A m o d i f i e d c h i s q uare (16, p. 63) was used t o t e s t the r e l a t i o n -s h i p between- d e g r e e o f movement.as measured by, the G e i s m a r - A y r e s s c a l e and The m o d i f i e d c h i s q uare t a k e s i n t o a c c o u n t the assumed c o r r e l a t i o n . o r l a c k o f independence o f the 2 measures. 36. " t y p e " o f movement (movement i n e i t h e r " i n s t r u m e n t a l " o.dr " e x p r e s s i v e " a r e a s o f f a m i l y f u n c t i o n i n g ) . TABLE I I . - The R e l a t i o n s h i p between Degree and Type o f Movement i n F a m i l y F u n c t i o n i n g R e s e a r c h Groups Sample S i z e N C h i Square P r o b a b i l i t y Treatment 50 1.60 .30> p > .20 C o n t r o l 49 2.94 ..10>p>.05 Treatment & C o n t r o l 99 4.38 . 0 5 > p ^ . 0 2 I t was found t h a t H y p o t h e s i s I I c o u l d be p a r t i a l l y a c c e p t e d s i n c e b o t h the C o n t r o l group and the Treatment and C o n t r o l groups combined met the s t a t i s -t i c a l t e s t a t the . 1 0 % . l e v e l o f c o n f i d e n c e . -H y p o t h e s i s I I I : Those f a c t o r s found t o be d i s c r i m i n a t i n g between l e v e l s o f f u n c t i o n -i n g a t one p o i n t i n t i m e , w i l l be s i g n i f i c a n t l y a s s o c i a t e d w i t h movement i n f a m i l y f u n c t i o n i n g when i n t e g r a t e d f a m i l y s e r v i c e s a r e p r o v i d e d b u t n o t when o r d i n a r y s e r v i c e s a r e the method o f t r e a t m e n t . The t h i r d h y p o t h e s i s , w h i c h p r o p o s e d a r e l a t i o n s h i p between s e l e c t e d f a m i l y h i s t o r y f a c t o r s and change a s s o c i a t e d w i t h treatment, was t o t a l l y r e -j e c t e d . F i n d i n g s s u g g e s t e d t h e r e was no r e l a t i o n s h i p between the p o s s e s s i o n o f t h e s e f a c t o r s - and movement i n f a m i l y f u n c t i o n i n g , e i t h e r w i t h o r w i t h o u t i n t e g r a t e d f a m i l y s e r v i c e s . The c h i sq u a r e s f o r each o f the 11 c h a r a c t e r -i s t i c s , s e t a g a i n s t each o f the 4 t y p e s o f movement ( s e e Chap t e r I I I ) f o r The f a c t o r o f c h i l d r e n o f more t h a n one u n i o n i n the home was i n a d v e r t e n t l y o m i t t e d from the s t a t i s t i c a l a n a l y s i s . b o t h Treatment.and C o n t r o l groups were seen by i n s p e c t i o n t o be n o n s i g n i f i -c a n t . However t h e r e were two e x c e p t i o n s : (a) x =. 3 . 9 4 , . 1 0 ^ p ^ . 0 5 show-i n g a r e l a t i o n s h i p f o r the Treatment group between fewer t h a n 4 c h i l d r e n i n 2 the home and no change i n f a m i l y f u n c t i o n i n g and (b) x = 2 . 9 3 , . 1 0 ^ " p ^ . 0 5 showing a r e l a t i o n s h i p f o r the C o n t r o l group between a l a r g e number o f c h i l d -r e n (more t h a n 3 ) . and n e g a t i v e o r no change and a l s o a r e l a t i o n s h i p between few c h i l d r e n ( l e s s t h a n 4 ) and p o s i t i v e change. I n o r d e r t o u t i l i z e i n a n a l y s i s a l a r g e r sample, d a t a on the T r e a t -ment and C o n t r o l groups were combined, movement was d i c h o t o m i z e d i n t o "no change" o r " r e g r e s s i o n " as opposed to " p o s i t i v e change" and a n a l y s e s were done r e l a t i n g t h i s movement to the s e l e c t e d f a m i l y , h i s t o r y , f a c t o r s . I t was f e l t t h a t i f the s e v e n f a c t o r s were a l l s e n s i t i v e to change, t h e n the p e o p l e t h a t f e l l above the median ( i . e . t h o s e showing p o s i t i v e change) s h o u l d be d i f f e r e n t i n t h e s e f a c t o r s . As c a n be seen from T a b l e I I I , no c h i s q u a r e s were s i g n i f i c a n t a t the 107o. l e v e l . TABLE I I I . - The R e l a t i o n s h i p o f S e l e c t e d F a m i l y H i s t o r y F a c t o r s to Change i n F u n c t i o n i n g D u r i n g a P e r i o d . o f 12 t o 18 Months (Treatment and C o n t r o l Groups Combined) F a m i l y - H i s t o r y F a c t o r s Sample S i z e (N) C h i Square P r o b a b i l i t y ** 1. M o t h e r 1 s E d u c a t i o n T 43 C . 36 T o t a l 79 .194 .70>p > .50 2. F a t h e r ' s E d u c a t i o n 37 25 62 1.56 • 3 0 > p >.20 3. F a t h e r ' s A d d i -t i o n a l T r a i n i n g ( E d u c a t i o n a l o r V o c a t i o n a l ) 34 .28 62 .133 . 8 0 > p ^ . 7 0 4. F a t h e r ' s O c c u p a t i o n 47 40 87 .45 .70>p;>.50 5. D i f f e r e n c e i n age between p a r e n t s 48 .38 86 .03 .90>pp>.80 6. M o t h e r ' s age a t M a r r i a g e 47 38 85 .563 .50>p >.30 7. T o t a l Number o f C h i l d r e n under 19 i n Home 50 42 92 . .783 • 5 0 > p > . 3 0 8. Source o f i n -come p a s t 12 mo. 49 41 90 2.5 ,.20>p >.10 9. R e s i d e n t i a l M o b i -l i t y . - moves i n l a s t 12 mo. 50 . 37 87 2.40 . 20 >p >. 10 10. 1 s t C h i l d B o r n p r i o r t o M a r r i a g e 46 34 80 .0088 .98>p >.95 11. Mother under. 20 a t B i r t h 1 s t C h i l d 49 39 88 .79 .50>p >.30 * d f = 1 i n . a l l c a s e s ** Counted as 1 c h a r a c t e r i s t i c by the A.D.P. There i s a p o s s i b i l i t y t h a t t h e s e 11 f a c t o r s m i g h t not r e l i a b l y d i f f e r e n t i a t e between l e v e l s o f f u n c t i o n i n g and t h e r e f o r e they c o u l d not be e x p e c t e d to d i f f e r e n t i a t e between c a p a c i t i e s f o r change. I t was n o t e d i n C h a p t e r I I I t h a t the l a c k o f p r e c i s e d e f i n i t i o n s o f the " p o o r l y " and " b e t t e r " f u n c t i o n i n g groups between w h i c h the " c h a r a c t e r i s t i c s " were s a i d t o d i f f e r -e n t i a t e poses a s e r i o u s l i m i t a t i o n on the r e l i a b i l i t y o f the d a t a . The v a l i d i t y o f the a c t u a l c a t e g o r i z i n g i n t o s u c h , a r e a s as " s k i l l e d " and Uun-s k i l l e d " o r "income S.A." and "income i n a d d i t i o n t o o r o t h e r t h a n S.A." m i g h t be q u e s t i o n e d e s p e c i a l l y s i n c e the l a s t mentioned c a t e g o r y c o u l d i n -c l u d e b o t h t h o s e e a r n i n g o n l y the o c c a s i o n a l b a b y s i t t i n g money or r e c e i v i n g unemployment i n s u r a n c e and t h o s e on S.A. f o r o n l y a few months ou t o f the p a s t y e a r . Complete d a t a w i l l be a v a i l a b l e a t the S c h o o l o f - S o c i a l Work, the U n i v e r s i t y o f B r i t i s h C o l u m b i a . 40. CHAPTER V I n t h i s s e c t i o n , a summary o f some o f the i m p l i c a t i o n s w h i c h have a r i s e n from the r e s u l t s o f our s t u d y w i l l be e x p l o r e d . T h i s w i l l be done b o t h i n r e f e r e n c e t o the I n t e g r a t e d F a m i l y S e r v i c e f o c u s o f t h i s t h e s i s and t o the i s s u e s o f i n t e r e s t i n v o l v i n g the community. I t i s emphasized t h a t t h i s r e s e a r c h has touched o n l y on l i m i t e d a r e a s and, as s u c h , the most v a l i d c o n t r i b u t i o n to be g a i n e d i s from p o i n t -i n g o u t the t r e n d s w h i c h can be o b s e r v e d a t t h i s t i m e . I t has r e c e n t l y been d e c i d e d a t the A r e a Development P r o j e c t to e x t e n d the p e r i o d o f I n -t e g r a t e d F a m i l y S e r v i c e t r e a t m e n t f o r a y e a r beyond the o r i g i n a l c l o s i n g d a t e . T h i s means t h a t our s t u d y i s a t the i n t e r i m p e r i o d i n the o v e r a l l l e n g t h o f the P r o j e c t . I t i s o n l y when the b a s i c d a t a have been c o m p l e t e l y c o l l e c t e d , a n a l y z e d and a s s e s s e d t h a t c o n c r e t e p r o p o s a l s f o r f u r t h e r r e s e a r c h can be o u t l i n e d . T h e r e f o r e , o n l y t e n t a t i v e s u g g e s t i o n s f o r f u r t h e r a r e a s o f r e -s e a r c h a r e g i v e n h e r e . As was examined i n C h a p t e r F o u r , the a n a l y s i s o f the f i r s t hypo-t h e s i s t h a t t h e r e would be more improvement and/or l e s s r e g r e s s i o n i n the t r e a t m e n t f a m i l i e s p r o v e d to approach s t a t i s t i c a l s i g n i f i c a n c e o n l y a f t e r e i g h t e e n months. I n . c o m p a r i s o n , the S t . P a u l Study o b s e r v e d t h a t the g r e a t e s t movement o c c u r r e d w i t h i n the f i r s t t w e l v e months o f the t r e a t -ment. T h i s time f a c t o r seems to be an e x t r e m e l y i m p o r t a n t v a r i a b l e w h i c h , as p o i n t e d o u t p r e v i o u s l y , was n o t c o n t r o l l e d s u f f i c i e n t l y i n t h e . A r e a De-velopment. P r o j e c t ' s method o f d a t a c o l l e c t i o n . T h i s a f f i r m s the n e c e s s i t y f o r a p r e t e s t p e r i o d . The change o f r a t e r s , the w o r k e r s w i t h d i f f e r e n t e x p e r i e n c e s and o r i e n t a t i o n s , and a f r e q u e n t l a c k o f i n f o r m a t i o n on the *Norma J e a n M u n r o , " F a c t o r s A s s o c i a t e d W i t h S t r e n g t h s o f . S e r v i c e To F a m i l i e s I n The S t . P a u l P r o j e c t . " U n p u b l i s h e d M.S.W. T h e s i s , M i n n e s o t a , 1964. c o n t r o l f a m i l i e s , a l l c o n t r i b u t e d t o t h i s i l l - d e f i n e d l e n g t h o f t i m e . Thus the d i s c r e p a n c y between the e a r l i e r movement o b s e r v e d i n the S t . P a u l s t u d y and the f i n d i n g s o f t h i s t h e s i s s t u d y , may i n f a c t , n o t be so g r e a t . I t s h o u l d a l s o be no t e d t h a t the t r e a t m e n t group showed b o t h more " s i g n i f i c a n t " movement ( d e f i n e d as improvement o f f o u r o r more u n i t s on the s c a l e o f f a m i l y , f u n c t i o n i n g ) and l e s s r e g r e s s i o n t h a n the c o n t r o l group i n o v e r a l l movement a t e i g h t e e n months. T h i s s u g g e s t s the p o s s i b l e e x i s t e n c e o f a p r e l i m i n a r y " s t a b i l i z a t i o n p e r i o d " d u r i n g w h i c h the r e l a t -i o n s h i p between.the wor k e r and the f a m i l y was b e i n g d e v e l o p e d . T h i s t h e n p r o v i d e d the n e c e s s a r y b a s i s f o r g r e a t e r movement a t - a l a t e r d a t e . I t i s f e l t t h a t a r e s t u d y s h o u l d be u n d e r t a k e n , w i t h the same t h e o r e t i c a l approach a t a l a t e r time when the l i m i t s o f the time o f t r e a t -ment c a n be more c l e a r l y . d e f i n e d . T h i s would make i t p o s s i b l e t o examine whether o r n o t t h e r e i s t h i s " s t a b i l i z a t i o n p e r i o d " i n the t r e a t m e n t p r o -c e s s as w e l l as to i n v e s t i g a t e the p o s s i b i l i t i e s o f o t h e r s u c c e e d i n g s t a g e s . T h i s c o u l d be a v a l i d a r e a of. s t u d y because o f i t s t r e a t m e n t i m p l i c a t i o n s . The f o r e g o i n g seems c o n g r u e n t w i t h the t r e n d s i n d i c a t e d i n f i n d -i n g s o f the second h y p o t h e s i s . I t was found t h a t improvement i n f u n c t i o n -i n g i n the i n s t r u m e n t a l a r e a s was g r e a t e r t h a n i n the e x p r e s s i v e a r e a s i n the b e g i n n i n g phases o f t r e a t m e n t . T h i s c o n f i r m s the t h e o r e t i c a l r a t i o n a l e t h a t : t h e w o r k e r - c l i e n t r e l a t i o n s h i p i s i n i t i a l l y b u i l t around c o n c r e t e forms o f a s s i s t a n c e . I t . i s f u r t h e r s u g g e s t e d t h a t t h i s a c c o u n t s f o r the e x i s t -ence o f the p r o p o s e d " s t a b i l i z a t i o n p e r i o d " . ' The l a c k o f any. a p p a r e n t d i f f e r e n t i a t i o n . w h e n the t r e a t m e n t and c o n t r o l groups were compared i n t h e s e a r e a s , seems t o be due to the l i m i t -a t i o n s o f the sample s i z e . A l t h o u g h i t would be o f i n t e r e s t t o re-examine t h i s h y p o t h e s i s when da.ta on a l a r g e r s t u d y p o p u l a t i o n c o u l d be a v a i l a b l e , r e s t u d y i s n o t c o n s i d e r e d t o be v a l i d . The r e a s o n . f o r t h i s i s t h a t a t a l a t e r d a t e , improvement c o u l d a i s o be e x p e c t e d i n : t h e e x p r e s s i v e a r e a s to the same e x t e n t o r g r e a t e r t h a n i n the i n s t r u m e n t a l a r e a s . Improve-ment i n i n s t r u m e n t a l f u n c t i o n i n g i s c o n s i d e r e d to be o n l y the f i r s t . a r e a i n the o v e r a l l c o n t i n u u m o f f a m i l y f u n c t i o n i n g . The t h i r d h y p o t h e s i s t h a t t h o s e f a c t o r s w h i c h d i s c r i m i n a t e be-tween l e v e l s o f f u n c t i o n i n g a t one p o i n t i n time a r e r e l a t e d t o movement, pr o v e d t o be n e g a t i v e . However, i t . i s n o t f e l t t h a t an approach t h a t . f o -c u s e s on d e v e l o p i n g an "Index o f F a m i l i e s a t R i s k " s h o u l d be d i s c a r d e d c o m p l e t e l y . A l t h o u g h d i f f e r e n t i a t i o n between l e v e l s o f f u n c t i o n i n g a t one p o i n t i n time c a n be made, t h i s does n o t seem t o be c o n d u c i v e t o p r e -d i c t i n g how the f a m i l y w i l l r e spond t o t r e a t m e n t . I t i s s u g g e s t e d t h a t i t i s n e c e s s a r y to< l o o k a t such l e v e l s o f f a m i l y f u n c t i o n i n g w i t h i n the l a r g e r c o n t e x t o f the s t a g e o f the f a m i l y d e v e l o p m e n t a l c y c l e . * F o r example, the f a c t o r o f Whether o r n o t the f a t h e r has r e c e i v e d some form o f o c c u p a t i o n a l t r a i n i n g w i l l have v a r y i n g s i g n i f i c a n c e d e p e n d i n g on whether o r n o t he i s e n t e r i n g the l a b o r f o r c e o r n e a r i n g r e t i r e m e n t age. T h e same i m p l i c a t i o n s c o u l d be h e l d as t o whether o r n o t e d u c a t i o n a l u p g r a d i n g i s f e a s i b l e . I n a d d i t i o n , as was mentioned e a r l i e r i n the C a s e l o a d A n a l y s i s , t h e r e a r e p a t t -e r n s o f agency c o n t a c t s w h i c h , a r e e v i d e n t w i t h m u l t i^-problem f a m i l i e s . I t i s s u g g e s t e d t h a t t h e s e p a t t e r n s m i g h t be r e l a t e d t o s t a g e s or " c r i s e s " i n f a m i l y development. F o r example, o f t e n the f i r s t agency c o n t a c t i s around m a r i t a l c o n f l i c t , and l a t e r , around economic needs and problems i n c h i l d - r e a r i n g . F u r t h e r s t u d y c o u l d be u n d e r t a k e n to a t t e m p t t o d e f i n e more c l e a r l y , t h e s e s t a g e s o f f a m i l y development and t o examine whether o r n o t *Duva11, E v e l y n M i l l i s , F a m i l y • D e v e l o p m e n t . J . B. L i p p i n c o t t Co., New Y o r k , 1957, p r o v i d e s a v a l u a b l e d i s c u s s i o n o f the s t a g e s i n the f a m i l y l i f e c y c l e and the problems t o be f a c e d a t each s t a g e . t h e s e s t a g e s a r e r e l a t e d to the type o f improvement and/or r e g r e s s i o n o b s e r v e d . I n b r o a d terms, the h y p o t h e s i s o f the t r e a t m e n t program i s t h a t p r o v i d i n g the b a s i c s o c i a l s e r v i c e s t h r o u g h one w o r k e r would have a meas-u r e a b l e i m p a c t on i n c r e a s i n g the adequacy o f the s o c i a l f u n c t i o n i n g o f t h e s e m u l t i - p r o b l e m f a m i l i e s . One a s p e c t o f t h i s , w h i c h has been concen-t r a t e d on h e r e , i s the measurement o f change i n f a m i l y f u n c t i o n i n g . How-e v e r , t h i s can n o t be c a r r i e d on i n a vaccuum b u t r a t h e r the t r e a t m e n t meth od i t s e l f must a l s o be examined. The A r e a Development P r o j e c t s t a f f , a t p r e s e n t , are a t t e m p t i n g to d e f i n e the components o f t h i s i m p o r t a n t e x p e r i -m e n t a l v a r i a b l e . I t i s r e c o g n i z e d t h a t a t t e m p t s to d e f i n e the p r o c e s s o f t r e a t m e n t b r i n g s up the i s s u e s o f how t o e v a l u a t e , by r e s e a r c h , worker s t y l e , s k i l l s , , and p e r s o n a l i t y v a r i a b l e s w h i c h must be g i v e n some c o n s i d e r -a t i o n . The r e s u l t s o f t h i s t h e s i s can o n l y emphasize the n e c e s s i t y o f exam i n i n g t h e s e d i f f i c u l t a r e a s . W h i l e i t i s beyond the scope o f t h i s t h e s i s t o examine the im-p l i c a t i o n s from the p o i n t o f v i e w o f the o r g a n i z a t i o n o f community s e r v i c e s and o v e r a l l w e l f a r e p o l i c y , i t i s f e l t t h a t i t i s n e c e s s a r y t o b r i e f l y d i s -c u s s how the r e s u l t s would be r e c e i v e d by the community.which i s the u l t i -mate consumer o f the s e r v i c e . Communities tend t o use d e m o n s t r a t i o n p r o -j e c t s as a means b o t h t o advance t h e i r knowledge and u n d e r s t a n d i n g o f s o c -i a l p roblems and as a means o f b r i n g i n g about s o c i a l change. Many e x i s t -i n g a g e n c i e s have been aware o f unmet needs i n the community b u t have been u n a b l e t o document the problems w i t h s u p p o r t i n g d a t a i n o r d e r t h a t r a t i o n a l p l a n n i n g may be u n d e r t a k e n . " R e s e a r c h c a n n o t d e f i n e what s h o u l d be r e c o g -n i z e d as a s o c i a l need, however i t c a n c l a r i f y i s s u e s and assemble r e l e v a n t d a t a . " (17, i v , p. 48) 44. From the r e s u l t s o f t h i s s t u d y the t r e n d s s u g g e s t t h a t a l t h o u g h movement can be o b s e r v e d , i t i s n o t t o the degree w h i c h the community would see as j u s t i f y i n g the e x p e n d i t u r e i n v o l v e d . F o r example, up t o t h i s t i m e i n the p r o j e c t no c a s e has been c l o s e d . I n t h e eyes of the community t h i s m i g h t s i g n i f y t h a t t r e a t m e n t has n o t been s u c c e s s f u l . However, even though the f a m i l y may show improvement i n t h e i r o v e r a l l f u n c t i o n i n g o f t e n many of the p roblems f a c e d a r e due t o l a c k of adequate r e s o u r c e s . Workers i n the p r o j e c t have e x p r e s s e d t h e i r c o n c e r n about the p r o b l e m o f low incomes, w i t h i t s a t t e n d a n t s t r e s s e s o f b u d g e t i n g and d e b t s . The s h o r t a g e of adequate h o u s i n g i s an i n c r e a s i n g l y u r g e n t p r o b l e m and can be a major f a c t o r i n the f a m i l i e s p o o r f u n c t i o n i n g . A l s o of c o n c e r n a r e p h y s i c a l and m e n t a l i l l n e s s e s , as w e l l as the need f o r v o c a t i o n a l t r a i n i n g f o r a d o l e s c e n t s who have been " s c h o o l d r o p - o u t s " . As can be s e e n , t h e s e problems a r e o u t s i d e o f the d i r e c t s e r v i c e s extended t o the c l i e n t . I t i s t h e r e f o r e s u g g e s t e d t h a t r e s e a r c h a t t e m p t s s h o u l d be made t o f a c t o r out t h o s e a r e a s of f u n c t i o n i n g w h i c h a r e most a f f e c t e d by I n t e g r a t e d F a m i l y S e r v i c e s as opposed t o t h o s e a r e a s w h i c h r e f l e c t t h e l a c k of adequate r e s o u r c e s . "A d e m o n s t r a t i o n t e s t i n g whether more s o c i a l w o r k e r s o f f e r i n g g r e a t e r i n d i v i d u a l s e r v i c e s w i l l r e h a b i l i t a t e and g i v e more s e l f - r e s p e c t t o w e l f a r e r e c i p i e n t s w i l l not mean much i f the w e l f a r e r e q u i r e m e n t s t h e m s e l v e s h u m i l i a t e and degrade r e c i p i e n t s . . . " ( * ) (*) An e x c e l l e n t d i s c u s s i o n o f the a s s e t s o f a d e m o n s t r a t i o n p r o j e c t may be found i n R e i n , M a r t i n and M i l l e r , S.M. " S o c i a l A c t i o n On The I n s t a l l m e n t P l a n " , T r a n s a c t i o n S o c i a l S c i e n c e and Modern S o c i e t y Jan./Feb. 1966 V o l . 3/No. 2 pp. 31-38. 45. B I B L . I O G R 1. A y r e s , B., L a S o r t e , M.A., 2. B e l l , N.W., V o g e l , E.F., 3. B l a l o c k Dr., H.M., 4. B j e r r i n g , J . , Hogan, R., 5. 6. 7. Geismar, L.L., A y r e s , B. , 8. A P H Y C a s e l o a d A n a l y s i s ^ ..An- A n a l y s i s o f the H i s t o r y of Agency C o n t a c t s i n the F a m i l y C a s e l o a d s o f Seven M a j o r H e a l t h and W e l f a r e A g e n c i e s . Community Chest 3nd C o u n c i l s o f the G r e a t e r Vancouvef A r e a , September, 1965. A Modern I n t r o d u c t i o n t o The F a m i l y . The M a c m i l l a n Conipany o f Canada, L t d . T o r o n t o . , 1960. S o c i a l S t a t i s t i c s . M c G r a w - H i l l Book Co. L t d . , T o r o n t o , 1960. GI UBC M V T A B . . . M u l t i v a r i a t e C o n t i n g e n c y T a b u l a t i o n s . B j e r r i n g & Hogan, U.B.C. Computing C e n t e r , R e v i s e d 1966. C o o r d i n a t i o n of S e r v i c e s . . . T h e C h a l l e n g e o f our Community. Co-o r d i n a t i o n o f S e r v i c e s Committee o f t h e F a m i l y and C h i l d W e l f a r e D i v i s i o n , Community Chest and C o u n c i l s of the G r e a t e r Vancouver A r e a , May, 1957. A R e p o r t o f Recommendations on Co- o r d i n a t i o n o f S e r v i c e s i n the Van-. . couver A r e a . S o c i a l P l a n n i n g S e c t i o n , Community Chest and C o u n c i l s of the G r e a t e r Vancouver A r e a , J u n e , 1959. F a m i l i e s i n T r o u b l e . . . A n A n a l y s i s o f B a s i c S o c i a l C h a r a c t e r i s t i c s o f 100 F a m i l i e s Served by The F a m i l y Centered. P r o j e c t . G r e a t e r S t . P a u l Community Chest and C o u n c i l s , I n c . , S t . P a u l , M i n n e s o t a , 1960. M e a s u r i n g F a m i l y F u n c t i o n i n g . . . A Manual on a Method f o r E v a l u a t i n g The S o c i a l F u n c t i o n i n g o f D i s o r g a n -i z e d F a m i l i e s . F a m i l y C e n t e r e d P r o j e c t , S t . P a u l , M i n n e s o t a , 1960. P a t t e r n s , o f Change i n P r o b l e m : F a m i l i e s . F a m i l y Centered.. P r o j e c t G r e a t e r S t . P a u l Community Chest and C o u n c i l s I n c . , S t . P a u l ,•. M i n n e s o t a , J u l y , 1959. 46. "A Method F o r E v a l u a t i n g the S o c i a l F u n c t i o n i n g o f F a m i l i e s Under Treatment", S o c i a l Work. V o l . 4, No. 1, 1959. Geismar, L.L., L a S o r t e , M., U n d e r s t a n d i n g The M u l t i - P r o b l e m  F a m i l y . . . A C o n c e p t u a l A n a l y s i s and E x p l o r a t i o n in> E a r l y I d e n t i f i c a t i o n . A s s o c i a t e d P r e s s * New Y o r k , 1964. Nye, I . , B e r a r d o , F.M., Emerging C o n c e p t u a l Frameworks i n  F a m i l y A n a l y s i s . M a c M i l l a n & :Co., L t d . , New York,. 1966. O v e r t o n , A., T i n k e r , K.H., E t A l , Casework Notebook. F a m i l y C e n t e r e d P r o j e c t , G r e a t e r S t . P a u l Community Ches t and C o u n c i l s , I n c . , S t . P a u l , M i n n e s o t a , 1957. S c h l e s i n g e r , B., The- M u l t i - P r o b l e m F a m i l y . ...A Review and-Annotated B i b l i o g r a p h y . The U n i v e r s i t y o f To r o n t o P r e s s , Second E d i t i o n , T o r o n t o , 1965. S e l l t i z , C , J a h o d a , M . , D e u t s c h , M., Cook, S.W., Re s e a r c h Methods I n . S o c i a l R e l a t i o n s , R e v i s e d . Henry H o l t &.Co., I n c . , T o r o n t o , 1959. S i e g e l , S., N o n p a r a m e t r i c S t a t i s t i c s F o r The  B e h a v i o r a l S c i e n c e s . M c G r a w - H i l l Book Co. L t d . , New Y o r k , 1956. A r e a Development P r o j e c t , V a n c o u v e r . . . Research. A d m i n i s t r a t i o n & De m o n s t r a t i o n . S t a f f . ( i ) , A d m i n i s t r a t i o n and Organ-i z a t i o n . The A r e a D e v e l o p -ment P r o j e c t , P r o g r e s s R e p o r t , 1965, V o l . 1. ( i i ) I n t e g r a t e d Family, S e r v i c e s . The A r e a Development P r o j e c t , P r o g r e s s R e p o r t , 1965, V o l . I I . ( i i i ) N e ighbourhood S e r v i c e s . The A r e a Development P r o j e c t , P r o g r e s s R e p o r t , 1965, V o l . I I I . ( i v ) R e s e a r c h . The A r e a D e v e l o p -ment P r o j e c t , P r o g r e s s R e p o r t , 1965, V o l . I V . (v) Summary. The A r e a Development P r o j e c t , P r o g r e s s R e p o r t , 1965. ( v i ) P r o g r e s s R e p o r t , 1966.• The A r e a Development P r o j e c t . APPENDIX A SCHEDULE FOR DATA COLLECTION The f o l l o w i n g s c h e d u l e f o r d a t a c o l l e c t i o n was p r e p a r e d w i t h com-p u t e r p r o c e s s i n g i n mind. F o r each e a s e , the i n f o r m a t i o n was r e c o r d e d and the a p p r o p r i a t e row n o t e d o p p o s i t e each column number. I n f o r m a t i o n Column Row Case number 1,2,3 n/ a Group: Treatment o r C o n t r o l 4 (1) Treatment (2) C o n t r o l Treatment p e r i o d 5 (1) 12 months (2) 18 months S c o r e f o r o v e r a l l movement 6 * See below S c o r e f o r " e x p r e s s i v e " movement 7 **HSee below S c o r e f o r " i n s t r u m e n t a l " movement 8 ** See below M o t h e r ' s e d u c a t i o n 9 (1) grade 8 o r l e s s (2) grade 9 (3) grade 10 o r more F a t h e r ' s e d u c a t i o n . 10 Same as above F a t h e r ' s a d d i t i o n a l t r a i n i n g 11 (1) some (2) none F a t h e r ' s o c c u p a t i o n 12 (1) U n s k i l l e d l a b o r (2) O t h e r Age d i f f e r e n c e o f p a r e n t s 13 (1) l e s s t h a n 5% y e a r s (2) 5% y e a r s o r more M o t h e r ' s age a t m a r r i a g e 14 (1) mother under 20 y e a r s (2) mother 20 o r more T o t a l number o f c h i l d r e n 19 y e a r s and under i n the home 15 (1) 3 or l e s s (2) 4 (3) 5 or more C h i l d r e n o f more tha n one u n i o n i n the home 16 (1) yes (2) no Source o f income i n the l a s t 12 months 17 (1) s o c i a l a s s i s t a n c e o n l y (2) o t h e r R e s i d e n t i a l m o b i l i t y : number o f moves l a s t 12 months 18 (1) none (2) one (3) 2 or more F i r s t c h i l d b o r n p r i o r t o m a r r i a g e 19 (1) Yes (2) No Mother under 20. a t b i r t h o f • f i r s t c h i l d 20 (1) Yes (2) No * O v e r a l l Movement ** " E x p r e s s i v e " and " I n s t r u m e n t a l " Movement Scor e Row S c o r e Row - 7 1 -1.1 t o -0.9 1 - 6 2 -0.8 to -0.6 , 2 - 5 3 -0.5 to -0.3 3 - 4 4 -0.2 to -0.0 4 - 3 5 +0.1 to +0.3 5 - 2 6 +0.4 to +0.6 6 - 1 7 +0.7 to +0.9 7 - 0 8 +1.0 to +1.2 8 9 +1.3 to +1.5 9 + 2 A +1.6 to +1.8 A + 3 B +. 4 C + 5 D + 6 E + 7 . F + .8 G + 9 H +10 I 

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