DATE: May 21, 1988
EDITION: Volume III, Number 1
David Trimble, Editor
Jodie Kliman, Associate Editor
CONTENTS
---Thanks to Barry Wellman for his note on the NETLETTER in the Winter, 1987 edition of CONNECTIONS.
---Terri Eblen reports that the network therapy project at United Social and Mental Health Services in Willimantic, Connecticut has not been funded to continue. She continues to work at the agency, and reports that some colleagues remain interested in network applications.
---Jodie and I recently had the pleasure of a visit from Live Fyrand and her husband, Odd Ariel Haugen, who administers a hospital in Norway. Odd joined Live for her tour of network therapy projects in North America; they joined us after several days with the Mount Tom team. We heard about the Nordic Seminar on Social Networks and her ongoing projects. She agreed to write a report on her North American travels for the NETLETTER. She is beginning to give some thought to the idea of convening an international conference on social network intervention.
---Ross Speck reports a rumor that Paul Fink, President of American Psychiatric Association, is writing a book on social network intervention. Mony Elkaim has invited Ross to an international family therapy congress in Brussels, May 18-20, 1989. Ross will do a network presentation, and will endeavor to set up a seminar with European colleagues to learn about their work, particularly with adolescents. He recently lectured on network therapy at the Family Institute of Philadelphia, the Robert Wood Johnson School of Medicine in New Jersey, the Fairmount Institute, and Jefferson Medical College. He will give the keynote talk at the annual meeting of the Pennsylvania Association for Marriage and Family Therapy on April 19.
---Paul Schoenfeld last summer completed a year long training program for the Berkshire Area of the Massachusetts Department of Mental Health, with about 15 mental health professionals attending ten three-hour seminars. There will be follow-up seminars this fall and winter. "I think," says Paul, "that out of the crew of 15, we may have garnered 3-4 practicing network therapists."
---Paul Ruff reports that he has completed his M.A. and has moved from Family Networks to the Wilder Child Guidance Clinic. He is hoping for opportunities to practice network intervention in his new setting; apparently his experience with social networks was a factor in his getting the position. Please keep us posted, Paul, and please help the NETLETTER to establish a new contact person at Family Networks, now that you and Mary have both departed.
---Benjamin Gottlieb and Anne Coppard have published their paper, Using social network therapy to create support systems for the chronically mentally disabled, in Canadian Journal of Community Mental Health, 1987, 6, 117-131. I reviewed the manuscript of this paper in NETLETTER, II, vol. 1 (April, 1987). I think it is an important contribution, for a number of reasons. It has a good review of the current literature on social support and social networks; it describes an intervention strategy and sets goals which are explicitly grounded in that literature; and it describes plans for program evaluation.
---On March 30, at the American Orthopsychiatric Association Conference in San Francisco, Carolyn Attneave, Anne Coppard, Gerald Erickson, Elizabeth Hemley van der Velden, and Jodie Kliman discussed current practice in network intervention on a workshop panel which I moderated. Carolyn reported on the Nordic Seminar, and described the remarkable variety of health and social service settings where Live Fyrand is working to establish the social network approach. Anne reported on the COTA enterprise, describing their careful methods to assess client networks and to set goals designed to enhance social support. Using network maps, she described the general goals of the project to increase network size (particularly the non-kin sector), create at least two distinct clusters, and to "minimize the encapsulation of a patient's social network in someone else's network"(quoting Gottlieb and Coppard). Gerry, as usual, gave us the long view on the field. He noted two currents of practice with social networks, the more person-centered therapeutic approach, and the more sociocentral "action" approach which focuses more on building and sustaining support networks. As examples of the latter in Canada, he spoke of a provincial foster care project, which assesses and intervenes into all parties' networks, using the professional as a consultant to the networks, a county project for distressed farm families, Don Lugtig's child abuse prevention project, utilizing natural helpers and working on intersystem integration, and other projects designed to develop and strengthen the support systems of high risk populations. He ended with the tantalizing suggestion that network intervention may be leading the way into a new paradigm shift, beyond the systemic stance of the family therapists. Liz Hemley van der Velden described the evolution of the Mount Tom team since the arrival of Kathryn Kaminsky. The team has moved more in the direction of what I have called "community network therapy," developing and utilizing its position in the community for dissemination of the network approach. In addition to convening network assemblies, the team now does consultation and education with other components of the Mount Tom Institute for Human Services, with a regularly scheduled meeting to discuss cases. They are utilizing assessment meetings for network assemblies as interventions in themselves (see Mary Youngquist's paper on this approach, enclosed with this issue). They are tuning in more to the networks of service providers in the community, and maintaining contact with some of the client networks they have worked with over the years. They are beginning to utilize the network approach to help people with AIDS. Liz summarized their maturation as involving "less interest in closure, and more pragmatism." Paul Ruff was unfortunately detained at the last minute by a family medical emergency. Jodie Kliman stepped in and talked about integrating the network approach into one's current clinical practice, a presentation which was gratefully received by the audience of about 40, who appeared eager to learn how to use the network approach themselves. I just received the evaluations from the Ortho office; they were generally positive. The most frequent criticism was in the form of a demand for more "how to do it" information; most people with this comment suggested a course or institute next year.
---I am hoping to hear soon from Gunnar Forsberg about the completion of his group's final report on their child welfare project in Botkyrka.
---VIEWS in this edition continues discussion of the issue of why it has been so difficult to establish network intervention in mental health practice in the United States.
---Paul Schoenfeld comments, "I too am concerned about the lack of development in network therapy as a clinical tool. I think we will be more successful if we focus on applications that are likely funding sources, or where funding is more available (chronic mentally ill, children and adolescents, minority populations, drug and alcohol abuse, AIDS). I think that if we write grants to develop programs and conduct research, as I did at Mt. Tom, that we will develop more quickly than if we focus on training and conferences. Also, I think if we are more specific at conferences, then we may attract more people." Evidence for Paul's point on developing programs is the fact that the two main (if not only) centers of activity in the United States are Mount Tom and Family Networks, both of which are funded programs.
---Jodie and I spent a good deal of time discussing the problems involved in implementation in the U.S. with Live and Odd during their visit. It was helpful, if somewhat painful, to hear their gentle, persistent questions as to why, when network intervention holds out so much promise for so many human service problems, it is not more widely employed in the United States. These questions led into talk about living in such conservative times in this country, and challenged us to account for the success of Reaganism. Odd and Live's persistance and optimism helped us to overcome some of our own despair over the problem of dissemination of the network approach, and we ultimately arrived at some conclusions. It is possible to think strategically about recent changes in health and human service policy, for example Diagnosis-Related Groups and other policy initiatives which place strong pressure on institutions to control their costs. Identifying such institutions, one can begin to pitch network intervention as a way of reducing hospitalization costs. The Mount Tom group has already published research showing reduced service costs for psychiatric patients who have had network assemblies (Schoenfeld, Halevy, Hemley-van der Velden, and Ruhf, 1986, Long-term outcome of network therapy, Hospital and Community Psychiatry, 37(4), 373-376.). Another strategic consideration is to identify populations for which there is funding available for innovative programming (e.g. adolescents, drug abusers, elderly, people with AIDS). As you can see, these conclusions echo Paul Schoenfeld's suggestions.
In Boston, our Network Consultants actually developed a proposal based on these strategic considerations, offering network intervention to help health maintenance organizations cut their costs of hospitalizing their adolescent members. As it turned, we discovered that no one in our group had the time available to do the networking required to get our proposal considered by any of the local HMOs. We offer our proposal to NETLETTER readers, and encourage you to utilize it in any way you choose for your own marketing efforts.
---I have often suggested that the problem with dissemination in the U.S. is that we no longer even to pretend to be a welfare state, and that network intervention will flourish in countries with strong social welfare policies, citing the examples of Canada, Sweden, and Yugoslavia. Our conversations with Peter Farrel during his visit last year suggests that it is not enough just to have strong social welfare policy. Peter works for the National Health Service in Great Britain, and he has found that system so entrenched in bureaucratic preservation of distinct professional domains that their is no room for work with prevention, let alone an innovation like network intervention. He describes a system driven by the counting of units of treatment, with little vision of public health policy. Given the pounding that the National Health Service is currently getting from the Thatcher government, it is unlikely that they will soon become more flexible and willing to change their vision.
---I have just received a preprint of an article Gerry Erickson wrote for the Journal of Marital and Family Therapy; I will review it for NETLETTER after its publication in July.
---I am still hoping to get reviews from readers; my offer stands to forward Mony Elkaim's book to a French-speaking reader. I recently acquired Families and Social Networks, edited by Robert Milardo, Sage Publications, 1988. I would be delighted if some reader submits a review before I write mine, which might be sometime next year the way my work is going!
--Ross Speck has requested an up-to-date bibliography on social network intervention; the most recent one I have I picked up from Anne Coppard at Ortho. Many of her references are specific to the population she is working with; does anyone have any leads on a more general recent bibliography? Please pass the word; it would be very helpful if the NETLETTER could get a bibliography which can be reprinted for circulation to readers.
---Thanks to Mary Youngquist for the enclosed paper, Network assessment as therapeutic intervention. It's good to have an illustration of a phenomenon which many of us have noted, that is, the dramatic therapeutic effect which planning an assembly can have, whether the assembly is ultimately convened or not. Most of us have seen the benefits for the index patient and family; I suspect that there are also "ripple effect" benefits for the network as well.
---As noted above, Network Consultants are happy to share with NETLETTER readers our proposal to provide network intervention services to health maintenance organizations to reduce their adolescent hospitalization costs. Let us know of your marketing successes!
---I have done all that I can to get a U.S. publisher to translate NATVERKSTERAPI from Swedish to English. Carolyn Attneave still has it in mind to approach the Scandinavian languages department at University of Washington about translating NATVERKSTERAPI and also Live Fyrand's ACTIVITET OG ANSVAR I EGET BOMILJO.
---Jodie Kliman is giving some thought to developing network intervention strategies for the family and friends of people with AIDS. Mount Tom has already embarked on this enterprise, and Jodie recently had the opportunity to attend an assembly conducted by Mount Tom for an AIDS patient at a hospice. I hope that NETLETTER can soon print some reports on this work; let's use these pages as a clearinghouse for people's thoughts and experiences on working with the networks of people with AIDS.
---Just a reminder to Peter Farrell and to Live Fyrand of my request that each of them write up an account of their travels in North America searching out that rare creature, the network interventionist.
---This letter comes out later than intended; at least for the next few years it looks that I will average about two or three per year. If I start to get substantially more correspondence from readers, I will get out more issues per year.
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