DATE: July 1993
EDITION: Volume VI, Number 2
CONTENTS
Jodie Kliman and David Trimble
Carolyn Attneave died on June 20, 1992. She was 72. Although her health had been poor for some years, her death came as a shock. Lung cancer, diagnosed a year ago, seemed to go into remission, metastasized to her brain, and then took her quickly. She left two children, Dorothy Jackson and Philip Attneave, a daughter-in-law, Penny Berk, a brother, James Lewis, and many friends, colleagues, and students. Too many of us in her far-flung network lost her before we even knew she was leaving us. It is sadly ironic that she taught us so much about the psychological importance of social networks but was so private about her own impending death. Belatedly, we say goodbye and thank Carolyn for all she has meant in our professional and personal lives. Carolyn was many times a pioneer. In World War II, she was the youngest commissioned officer and in the first class of women (SPARS) in the Coast Guard. She entered psychology when it was a male province. She was one of the first in family therapy.
Long before it was fashionable, she addressed the family and community experiences of people of female and multi-cultural leaders in family therapy and community psychology and one of the first psychologists of note color and the poor, in Native American reservations, rural hamlets, and inner cities. The daughter of a Swedish-American father and a Delaware Indian mother, she was one of the first mental health professionals to honor and use community, tribal relations and spiritual practice among Native Americans.
Carolyn was drawn to General Systems Theory in graduate school at Stanford in the late 1940s to early 1950s. GST interested her partly because it provided a new theoretical foundation for her Native American respect for the relationships among all the phenomena of the world. As an intern, Carolyn noted that children being tested behaved differently in their parents' presence. This recognition led to her later innovations of having parents observe through mirrors while their children were being tested and of having one cotherapist work with children while another sat behind the mirror with the parents.
Carolyn may be best remembered for her ground-breaking work in network intervention (or network therapy, a term she disliked). In the mid-1960s, she began utilizing the social networks of Native-Americans, African-Americans, and poor whites to compensate for inadequate mental health and social services in Oklahoma--before most of us had even heard of family therapy. Her work flowed naturally from childhood summers immersed in rural tribal life with her grandmother and grandfather, a Tribal Chairman, and the life she and her children created with their "fictive" families during their peripatetic life after her divorce from psychologist Fred Attneave.
In 1970, during a brief stay at Philadelphia Child Guidance, she began a rich collaboration with Ross Speck, who, with Joan Speck and Uri Rueveni, was also doing network intervention. Ross and Carolyn's (1973) Family networks: A way toward retribalization and healing in family crises introduced the network approach into family therapy. The field has never been the same since they gave us the radical news: just as individuals' difficulties and strengths are embedded and can be treated in the context of their families, so families' difficulties and strengths are embedded and can be treated in the context of their social networks.
Boston was Carolyn's home from 1969-1974. She taught at the Boston Family Institute and was field director for a Department of Mental Health-Department of Labor contract. In the latter capacity, she trained indigenous community workers and retrained staff at state hospitals to apply and integrate their respective knowledge bases in new jobs in emerging community mental health centers. At the Harvard School of Public Health, she evaluated mental health services provided nationally by Indian Health Services.
Carolyn helped found Boston City Hospital's Minority Training Program (now the Center for Multi-Cultural Training in Psychology). This psychology internship and service program serves an inner-city population and trains multi-cultural interns. The program, and its self-evaluation model, use a network approach. Its many part-time supervisors (ourselves included) define themselves as a network.
Carolyn led training seminars in family and network therapy through SFTR and the Massachusetts Psychological Association's Professional School for Psychologists. Through the latter group, David met and studied with Carolyn. She actively encouraged my efforts to learn and apply the network approach in community practice in the Greater Lynn area(John Garrison, who was already doing network intervention at Greater Lynn Community Mental Health Center, also attended Carolyn's seminar.). Despite my earnest, youthful efforts to become this grand and imposing figure's acolyte, Carolyn briskly and collegially disposed of my efforts to treat her as a guru. Her support helped me become a network interventionist in my own right.
From Boston, Carolyn moved to the University of Washington in Seattle, where she taught from 1975-1987. She began with a joint appointment as Director of American Indian Studies and professor of psychology. She then became a full-time psychology professor, teaching network therapy and ethnicity and family therapy, and developing an annotated Bibliography of North American Indian mental health (Kelso & Attneave, 1981). Her sabbatical year at St. Vincent College in Pennsylvania, where she studied the school's transition to coeducation and took spiritual sustenance, was profoundly important to her. It was at this peaceful place that Carolyn chose to be buried. She retired soon after her sabbatical, first teaching part-time, then not at all, reading voraciously and, sadly for her network, dwelling increasingly within.
Carolyn was remarkably productive. Many of her provocative and exciting writings about networks, community psychology, and Native American mental health are cited in her autobiographical chapter (Attneave, 1990). She trained network therapists around North America and abroad for many years. Carolyn co-founded the Society of American Indian Psychologists, which meets at American Psychological Association (APA) conventions, and was active in the Association for Indian Affairs. She helped culturally sensitize APA, (whose 1992 Psychologist of the Year award, decided before her death, was bestowed posthumously), NIMH, and the World Federation for Mental Health. She was Psychiatric Outpatient Centers of America's first woman president. She enriched family therapy, helping charter the American Family Therapy Association (AFTA) and the American Board of Family Psychology. Carolyn also was on the board of the American Orthopsychiatric Association (Ortho), the 1950s birthplace of family therapy meetings. Her Ortho association is especially important to the two of us: we became colleagues, fell in love, and married, thanks to that association. Illness kept Carolyn from a network panel Uri Rueveni had organized for Ortho in 1980. Ross and Joan Speck suggested inviting their protegee, Jodie, to replace Carolyn on the panel, which already included Carolyn's student, David. We have always been grateful to Carolyn for getting sick just that one time. We wish she had not gotten sick again.
Reading Carolyn's (1990) autobiographical chapter clarified our understanding of Carolyn's impact on our respective professional lives. Carolyn's community network therapy approach helped David integrate his own intuitive ancestral knowledge (after generations of Protestant ministry) into his practice, utilizing spiritual as well as secular resources. It brought a spiritual component to Jodie's network and community practice, which had developed in a community organizing context
It is hard to end this reminiscence; it is hard to let its subject go. We hope Carolyn would have enjoyed our respect and gratitude, but we suspect she would have laughed at us for getting so damned serious. She was a creative and energetic synthesizer of ideas; she was adventurous, feisty, and great fun to be around. She was quirky, too. We still puzzle over her wedding gift to us: a lovely porcelain canister of Japanese tea and a single matching teacup. We will probably always puzzle over her. She was an enigma, a weaver of many webs of ideas, searches, commitments, connections and separateness, our friend and teacher. We will always appreciate and miss her.
Attneave, C. (1990) A maverick finds an identity. In F. Kaslow (Ed.). Voices in family psychology. Volume I. (pp. 1747). Newbury Park, California: Sage Publications.
Kelso, D. & Attneave, C. (1981). Bibliography of North American Indian mental health. Denver: Center for American Indian Mental Health, Department of Psychiatry, University of Colorado Medical School.
Speck, R. B: Attneave, C. (1973) Family network: A way toward retribalization and healing in family crises. New York: Pantheon Books.
[This is the second in a series of reports on ongoing network intervention projects Jodie Kliman and I discovered preparing our chapter on network therapy for Mony Elkaim's forthcoming Les therapies familiales: Principales approaches. Paris: Les Editions du Seuil.]
In 1987, Herman Baars, Hans Uffing, H. Phillipsen, M. de Vries, and G. Dekkers of the Department of Social Psychiatry at the University of Limburg, Maastricht, The Netherlands working in collaboration with the Community Psychiatric Services of the Community Mental Health Center in Maastricht, began studies of the social networks of chronic psychiatric patients and of geriatric patients, scheduled to run from 1990 to 1992. The Social Network Project is also working on a study of fibromyalgic patients, scheduled from 1990-1993, and a study of forensic psychiatric patients, scheduled from 1992-1994.
The Project applies ideas from Ross Speck, Carolyn Attneave, and Gerald Erickson (who visited and consulted with the group) to the Dutch social and cultural context. Their approach is also informed by Dutch social psychiatrist A. Querido's (1970) theory of "social homeostasis." In Querido's framework, a person becomes embedded in dependent relationships with the human service system through a process of "displaced social functioning," reflecting failed social integration between client and personal network. The Project seeks remedies, specific to each case, to restore the client's network as a "vital social environment" which can meet the client's needs.
In their original study of 60 chronic psychiatric patients, the Project gathered data on network size, variety, density, and accessibility, comparing these subjects with a normal control group. Assuming that mental health providers often do not identify patient network resources, they compared their network data with mental health service providers' information about subjects' social networks at the start of treatment.
The Project's (1990) Sociale netwerk-stratagieen in de sociale psvchiatrie is a "manual for therapists who want to help the patients' social environment in order to accomplish his/her social integration."
From the materials I received in English from Herman Baars and Hans Uffing, I can provide the following summary of the Social Network Project approach: Network intervention is organized by careful investigation and analysis of resources and difficulties in the client's situation. The Project examines the network's structural characteristics, including: overall size and distribution of size among the three sectors of relatives, friendly relations, and social services; heterogeneity of network composition; accessibility of network connections; and density. They look at the functional elements of affective and material needs, need for consensus, and need for social stability. They examine the linkage characteristics of initiative, frequency and types of contacts, and length and origins of relationships.
The materials I have in English give few details of the actual intervention efforts to restore the network as a "vital social environment." They do provide guidelines for intervention goals (Baars, Uffing, Dekkers, 1989), including: restoring a "size which does not deviate too much from the cultural context in which people are living," as well as a well-balanced segmentation of size, e.g., building up the segments of relatives and friendly relations and increasing differentiation of roles in these segments, while diminishing the size of the community services segments. Restoring heterogeneity (e.g., of age, sex, marital status, work, education, and life style) increases opportunities for meeting multiple needs, alternatives for behavior, and the likelihood of sharing specific experiences with network members. Restoring accessibility helps clients overcome geographical, practical, emotional/relational, and other obstacles to ready contact with network members. Restoring a rather dense social network opens up channels of communication, sometimes by the example of the clinician's willingness to discuss problem issues openly among network members, as an important means of establishing and enhancing mutual relationships in the network.
The single case example in the English-language materials describes a family, new to the community, with a father out of work. Mother, father, and daughter all had health problems. The family came to the attention of the social worker because of a medical recommendation that the daughter go to Switzerland for treatment of her asthma and recurrent bronchitis. The social worker quickly learned that an older child had earlier died at an asthma center, and the family could not tolerate another such separation. The actual intervention was modest; the social worker encountered a large, generous, and supportive farm family who agreed to take in the girl while she recovered her health, continuing to attend the school where she had her only ties outside of her small household. The parents visited regularly, and, through this initial connection, began establishing a web of relationships in the community. After six months, the girl had recovered and returned home, her parents' health problems had resolved, and father was back at work. The power in the above example was not in any dramatic technical move on the part of the clinician, but rather in the sophisticated analysis of the breakdown of social integration for the girl and her parents, the search for a solution based on that analysis, and measurement of progress by the criteria of social integration.
I want to learn more about the particular intervention techniques which our Dutch colleagues use. Do particular methods prove to work better with particular populations or problems? I invite responses for NETLETTER!
REFERENCES
Baars, H., Uffing, J., & Dekkers, G. (1989). Social network intervention and mental health problems.(Cahier 1). Maastricht: University of Limburg, Department of Social Psychiatry.
Baars, H., Uffing, J. & Dekkers, G. (1990). Sociale netwerk- stratagieen in de sociale psvchiatrie. Antwerp: Bohn Stafleu Van Loghum.
Querido, A. (1970). Multiple equilibria. Werk in vitvoering. Leiden: Kroese
Lugtig, G., & Fuchs, D. (1992). Building on the strengths of local neighborhood social network ties for the prevention of child maltreatment: The Final report of the neighborhood parent support project. Winnipeg, Manitoba: Child and Family Service Research Group, Faculty of Social Work, University of Manitoba.
The Neighborhood Parenting Support Project in Winnipeg contributes substantially to the field of network intervention, with community network intervention strategies to prevent child abuse and neglect, and a theoretical approach integrating network analysis and intervention. The Project adds conceptual richness and sophistication to the community network intervention approach (Attneave, 1969, Trimble and Kliman, 1981).
The Report gives a history of the demonstration project to reduce child maltreatment in one of two high-risk urban neighborhoods. It details methods for studying the neighborhoods, a systematic strategy for using network intervention to achieve Project goals, an account of the Parenting Support Worker's activities, and the Project's outcomes and conclusions. (An Executive Summary and Appendix are also available separately from Don Fuchs and Don Lugtig, who are listed in the accompanying NETLETTER DIRECTORY).
PROJECT HISTORY
In the early 1980s, Fuchs and Lugtig at the University of Manitoba School of Social Work sought to improve child and family services by using social networks and natural helping systems. Their work converged with Province of Manitoba policy goals of reducing its child protective caseload by switching from a centralized, authoritarian protective model to a localized, collaborative family services model. Child and Family Service of Central Winnipeg and various other formal service organizations provided support for the Project, including space for a Neighborhood Resource center.
Don Warren evaluated the Project and conducted ethnographic studies of the neighborhoods involved. The first Neighborhood Parenting Support Worker was Shirley Rodecker. Therese Costes replaced her in October, 1989, at the intervention's formal beginning. Carolyn Attneave, Benjamin Gottlieb, Julia Halevy, Diane Pancoast, and David Trimble provided consultation, as did child development specialist James Garbarino, a pioneer in ecological approaches to child maltreatment. The Project's Final Report was completed in May, 1992; data analysis continues.
Just as the Project got under way, Winnipeg's political and policy climate shifted dramatically. In 1989, the community-based Child and Family Services of Central Winnipeg centralized its intake system. In 1991, the Province took control of Winnipeg's child and family service system, combining six regional agencies into one, unsuited to community-based service delivery or to meshing informal with formal service delivery at the neighborhood level.
THE COMPARISON NEIGHBORHOODS
Neighborhoods A and B in central Winnipeg were both ethnically diverse, with high levels of poverty, psychological distress, and resident turnover. Roughly 20% of the households were families with children. Neighborhood A showed higher levels of stress, but lower risk of child maltreatment than Neighborhood B. It also had larger support networks, more neighborhood involvement, and more optimistic attitudes about neighborhood support, whereas Neighborhood B residents appeared to identify more narrowly with family and ethnic groups than with their neighborhood. Although the Project intended to intervene in both neighborhoods, with strategies designed for the differences between them, funding problems thwarted plans for comparison studies of other matched, control neighborhoods. Thus, Neighborhood A became the demonstration neighborhood, with Neighborhood B serving as control.
CONCEPTUAL APPROACH
Lugtig and Fuchs drew on ecological models of childhood and parenting (Belsky, 1980, 1984; Bronfenbrenner, 1979; Garbarino, 1980). They cited four components of the parent-child system: parent personality, parent support system, childcare demand, and neighborhood context. The model predicts risk for ineffective parenting when at least two components are more stressful than supportive. The Project focused on parent support system and neighborhood context, noting that parents at risk for child maltreatment tend to have either small, sparse, unsupportive networks, or small, dense networks which reinforce negative childrearing values and maltreatment. It follows that increasing network size and diversity and improving the flow of supportive content through the links should reduce child maltreatment risk. The team's concept of neighborhood context was based on Garbarino and Sherman's (1980) and Warren's (1978, 1980) work. Garbarino and Sherman studied two equally impoverished neighborhoods with quite different rates of child maltreatment. The neighborhoods had different levels of support and stress, apparently mediated by different social network/support patterns and service agency programs.
The Project aimed to increase size, reach, and diversity of personal and parenting networks, thus preventing families' entering the child protective system. A Parenting Support Worker would hook up parents with existing informal and formal neighborhood support structures; train parents to understand their own networks and improve relational skills; build and strengthen supportive relational structures in the neighborhood; and integrate and mediate between the informal and formal support systems at the neighborhood level.
The Neighborhood intervention schema involved identifying central figures, liaisons, brokers, gatekeepers, and boundary spanners, as well as natural helpers. The Support Worker was to enhance the effectiveness of natural helpers, connect clusters and cliques with individuals and with each other, and develop new clusters and cliques.
The Network structural change schema involved increasing (or,in cases of demand overload, decreasing) network size, and changing network density. These changes involved reactivating latent ties and adding new ones; linking clusters or components; weakening or extinguishing toxic ties; and connecting unconnected ties. Methods for transforming ties included the 'following, applied differently in different network sectors, according to specific network structural change goals:
Strengthening ties- improving resource flow by unblocking pathways, increasing reciprocity through shared activities and mutual support, reducing stress by diverting resource flow from overstressed linkages to other ties or changing the number of content strands, and increasing intensity and durability of the tie by increasing frequency of contact.
Weakening ties- decreasing shared activities and resource exchange, and diminishing intensity by decreasing frequency of contact
Extinguishing ties- gradually diminishing and stopping resource flow, by redirecting the flow to other ties and reinforcing discontinuance of flow in problematic relationships.
Activating latent ties- re-establishing contact by reintroducing former friends and supports, evoking shared history, bringing each other up to date, and recognizing shared current concerns. Reinforcing linkage and maintaining the tie by frequent contact and shared, reciprocal activity.
Establishing new ties- making contact through the Support Worker's introduction; discovery of shared concerns and interests; reinforcing and maintaining ties by frequent contact and shared activities, often in the context of some setting or program.
CONSULTATION, COACHING, CONNECTING, CONVENING, AND CONSTRUCTION
The Project's Consultation approach was informed by Collins' and Pancoast's (1976) natural helper model of collaboration between equals, each of whom has something to offer the other. The consultant understands the utility of social networks for parenting, and has network intervention skills. The consultee knows the neighborhood and parenting environments, and their particular challenges, opportunities, and constraints. Staff began the Project by approaching people to ask what it was like to parent in the neighborhood. This respectful consulting stance helped establish the Project's legitimate place in a neighborhood suspicious of yet another imported study and service program innovation.
Coaching involved the Support Worker helping parents map and apply social network ideas to their networks, and suggesting linkage strategies to change their networks. The Support Worker also coached natural helpers and service providers, teaching network ideas, mapping and brainstorming schemes to transform neighborhood networks. Coaching could be provided individually, or in small training workshops for parents or providers. The Worker offered encouragement and taught skills through role play, symbolic modeling, and cognitive-behavioral interventions.
Connecting required the Worker to bring parties together and support their ongoing contact. Connecting was useful for the shy and withdrawn people, or those intimidated by particular contacts, e.g., with a formal service provider. It required sensitivity to a situation's demands for relative activity or passivity; initiating logistical arrangements, facilitating, expanding or redirecting conversation, or mediating conflicts; and moving back as relationships developed.
Convening involved assembling problem-solving network sessions (Garison, 1974) or therapeutic network assemblies (Speck & Attneave, 1973); or facilitating social, recreational, or informational gatherings. Sessions and assemblies were for problem resolution. Gatherings provided opportunities for building new linkages among persons with common interests or concerns, and for linking formal with informal helpers. The Support Worker either initiated these gatherings, or gained access to already established occasions.
Construction of entirely new networks of people with common needs or interests (e.g., self-help groups) and of enlarged or reconstructed personal networks, integrated all the intervention strategies described above.
APPLICATION: COMMUNITY NETWORK THERAPY
The narrative captured the personal involvement required by community network therapy, recalling for me my own experience using network intervention in a community setting (Trimble & Kliman, 1981). Such work is highly particular, inevitably engaging the intervenor in intense and emotionally significant relationship of trust, obligation, support and exchange with community members.
At first, staff spent long hours hanging out in neighborhood restaurants, laundromats, and community-based centers such as the West Broadway Family and Day Care Centre, in order to "habituate" Neighborhood residents to them and to their program objectives. The Support Worker followed up, positioning herself in natural neighborhood "behavior settings", locating and linking up with natural helpers and informal helping networks, central figures, and formal service providers. As neighborhood residents became familiar with her and trusted that she was concerned with parent support, not intrusive child protection, she joined in community activities and established consulting relationships. Developing relationships required repeated, non- intrusive encounters. She began to get referrals from both residents and service providers, and to provide coaching, connection, and construction services to isolated parents. Over time, she shifted from participant to facilitator of a parents' group run by the Family Centre. The Project's Neighborhood Resource Centre, originally perceived as a competitor with the Family Centre, was late welcomed for providing space for the Family Centre during Centre renovations.
The Support Worker established her own neighborhood-based network, which provided access to parents in need and fed back information about her impact on neighborhood residents. Over the two-year course of the Project, she had helping contacts, ranging from relationships which persisted the length of the Project to one or two encounters, with over 100 parents in the neighborhood. Many service contacts occurred on the street, as she moved between settings. (I remember with pleasure my own experience of these chance, productive encounters for information exchange and intervention.) She strengthened, enlarged, and connected natural helping networks, and extended the reach of natural helpers. Connecting neighborhood resident into denser structures could create predictable problems with strife, competition, polarization, and gossip, required active mediation and repair by the Support Worker.
Field experience produced a typology of neighborhood activists: boundary spanners and natural helpers. Boundary spanners were Characterized as either "informal spanners" or "informal- formal spanners". Both types were friendly and outgoing, met people easily, and invited new contacts to socialize quickly. Informal spanners got to know a lot of people quickly, and readily connected the people they met with other people. However, instead of becoming central figures of small clusters, they made too many demands on new ties, burning them out quickly and moving on to new ones. Their disarming, engaging style and willingness to approach strangers made these boundary spanners excellent resources for finding isolated parents. Informal-formal spanners crossed easily between formal and informal support systems. They made fewer undue demands on ties, moving easily in and out of encounters, bearing information and making connections. These neighborhood pulse-takers often gave Support Worker useful feedback about her impact in the neighborhood. Their referrals tended to snowball, as parents referred others for Project service.
The Support Worker established consulting/coaching relationships with three types of natural helpers: those who directly helped neighbors; those who acted as referral agents and advocates between residents and agencies; and "cluster-specific" natural helpers whose supportive activities were restricted to small, interconnected personal network structures of which they were members.
The local office of Child and Family Services and other formal agencies also made referrals, including some parents whose limited social skills, suspiciousness, and/or extreme neediness interfered with development of new linkages. In such cases, a relationship with a professional service provider (whose role permitted a sustainable, asymmetrical, and unidirectional flow of support), proved essential to intervention by the Support Worker, who could not maintain an individual treatment caseload. In the treatment relationship the parent could develop capacities for trust, self-confidence, and social skills for healthier relationships.
The Support Worker started several projects to develop and reinforce support in the neighborhood, including: a neighborhood information and resource brochure, a mother's babysitting cooperative, a babysitter training course, a peer counseling course, and a network skills course. Her work uncovered a number of strains between the neighborhood and its formal service providers. To address these strains, the Project arranged for Julia Halevy to conduct an assembly of 28 parents and agency representatives. The assembly reduced strain, empowered residents in their relations with agencies, and surfaced and resolved neighborhood reserve about the Project's Neighborhood Resource Center.
OUTCOME MEASUREMENT
Unfortunately, I found the outcome measures unsatisfying. Some problems may have come from the Project's ambitious scope and the inevitable constraints on achieving all one's goals in a research-demonstration project. They used an Independent Intervening-Dependent Variable model for hypothesis-testing, which was too linear to fit the social systemic effects under study, and required more rigorous operationalization and measurement than currently available in social support research. Further, the model itself seemed to contaminate the variables: available social support to parents was listed as an intervening variable, and contextual sources of support as an independent variable.
Data analysis was difficult to follow, and the Report often did not provide statistical significance tests for reported differences. Many statistics reported were from the Parenting Support Survey, which integrated a variety of measures (some validated on very different populations) which were not clearly explained. The reader therefore could not judge whether the difference between two numbers (e.g., "risk," "support," "stress") was either meaningful or statistically significant.
The complexity of the comparative framework was daunting. Data were taken from the Parenting Support Survey (PSS), administered to samples from Neighborhoods A and B in July, 1989 and July, 1991. Key scales from the PSS were also administered to a cohort of 17 of 26 families who agreed to be tracked. Another 9 families mapped their networks several times. PSS measures included: risk for child maltreatment; stress; support; stress/support ratio; and size, content, and composition of the parenting support network. Comparisons within and between each neighborhood were made along two axes: high- versus low risk parents and parents who were agency clients and those who were not agency clients. The comparisons were not clearly presented, and it was a strain to wrap my mind around differences by neighborhood in the effects of support and network variables on the different cell groups, particularly when I was unconvinced by the evidence for the differences.
One finding appeared to support a neighborhood-wide Project impact. Child maltreatment risk went down in both neighborhoods; it was roughly equivalent in both neighborhoods in 1989 and 1991. Throughout, both Neighborhood A's support and stress levels and its support/stress ratio were higher than Neighborhood B's, but the difference between support/stress ratios was greater in 1991. In 1989, A's ratio was .708 and B's was .630. In 1991, A's ratio was .712 and B's was .574. Differences between ratios are easier to grasp than differences between unfamiliar survey instrument scores. However, it remains to be demonstrated that the Support and Stress scales can legitimately be combined in ratio form, and no test of statistical significance was reported.
The change over time of the size of the difference between support ratios in the two neighborhoods does suggest that the Project facilitated development of social support, buffering the effects of stress, thereby raising the threshold of stress needed to yield a given level of risk. Thus, Neighborhood B, despite a lower level of stress, has the same level of child maltreatment as Neighborhood A. The higher level of support. and the more favorable support/stress ratio. buffer the higher stress in Neighborhood A.
Can we reasonably expect any intervention program to affect social support systems enough to reduce child maltreatment in just two years, particularly in a neighborhood whose social disadvantage and high turnover make it so vulnerable to forces outside local control? Indeed, findings showed that both neighborhoods went through a lot of change in the variables under study. How valid was the comparison between these two neighborhoods? Some findings suggest that the two neighborhoods are becoming increasingly different, with Neighborhood B providing less and less parenting support. Do these changes reflect the intervention, or the impact of hard times on Neighborhood B. whose relatively isolated ethnic enclaves lose cohesion under stress? The research questions might better be addressed by spending more time in a single neighborhood and comparing it with a better matched control neighborhood, and/or working with a larger sample of neighborhoods, permitting statistically sound outcome studies.
Outcome measures of individuals, rather than neighborhoods, were more intelligible and persuasive. These included a study of the mapping cohort, individuals who received network intervention services and agreed to map their networks at beginning and end of the intervention period. In this group, parents at high risk for child maltreatment showed the strongest effects of network intervention. Personal network size increased 65.8%. Reported availability of information and advice, parenting, emotional, and concrete support increased, as did the number of enduring relationships. Network diversity increased, both through increased numbers of friendships (particularly with neighbors), more neighbors, and more professionals; and from relative reduction of household/family ties. Family relationships characterized as "very close" and/or as "almost always critical" decreased. Warren tracked an intervention cohort and compared them with Neighborhood A parents who had not received services. The intervention cohort showed less risk of problematic parenting and child maltreatment than the control group, were less likely to move, reported experiencing violence or witnessing family violence less often, and demonstrated increased capacity for social support.
At the Project's conclusion, Warren also interviewed 10 professionals directly familiar with the Project and the neighborhood. They consistently endorsed the Project and its Support Worker as exceeding their initial expectations and as making their own work more productive. They were disappointed that the Project was not larger, and that it was closing after only two years. Although informants noted some difficulties with early personnel turnover and vagueness in initial presentation of Project goals, they saw the Project as enhancing family stability and continuity in an unstable neighborhood. They cited cases of increased parental competence, community involvement, and mutual social support. They generally urged both more of the same and expanding the network intervention model to other populations at risk in the neighborhood. In addition, they described the network assembly conducted by Julia Halevy as having revitalized the burned-out leadership of the local Family Centre.
I recommend the Report to any network interventionist interested in preventing child maltreatment, or in applying the network approach to community settings. I hope the Project's valuable work will be edited down and organized into a book for wider dissemination.
REFERENCES
Attneave, C. (1969). Therapy in tribal settings and urban network intervention. Family Process. 8. 192-210.
Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist, 35, 320-335.
Belsky, J. (1984). The determinants of parenting: A competence model. Child Development, 55, 83-96.
Bronfenbrenner,U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.
Collins, A., & Pancoast, D. (1976). Natural helping networks: A strategy for prevention. Washington, D.C.: National Association of Social Workers.
Garbarino, J. A. (1980). Preventing child maltreatment. In R. Price & P. Polister (Eds.), Prevention in mental health. Beverly Hills, CA: Sage.
Garbarino, J. A., & Sherman, D. (1980). High-risk neighborhoods and high-risk families: The human ecology of child maltreatment. Child Development, 51, 188-198.
Garrison, J. (1974). Case studies in the screening-linking planning conference. Family Process. 13. 337-353.
Speck, R., & Attneave, C. (1973). Family networks. New York: Pantheon.
Trimble, D., & Kliman, J. (1981). Community network therapy:
Strengthening the networks of chronic patients. International Journal of Family Therapy, 2, 269-289.
Warren, D. (1978). Explorations in neighborhood differentiation. The Sociological Quarterly.
Warren, D. (1980). Support systems in different types of neighborhoods. In J. Garbarino & S. Stocking (Eds.), Protecting children from abuse and neglect. San Francisco: Jossey-Bass
Claudia Blumberger of Community Occupational Therapists and Associates (COTA) in Toronto reports that their network intervention activities continue to expand. They have just hired their fifth network therapist, a graduate student in applied psychology (which Claudia is also studying). COTA is working with hostels to reconnect homeless mentally ill men with their families. Collaborative arrangements with hospitals include Alzheimer's, head-trauma, and adolescent patients in new service programs. In April, 1993, COTA convened about 75 service providers and consumers for the Anne Coppard Memorial Lecture. (Anne directed the COTA network projects. for many years; her passing was sadly noted in NETLETTER, VI, 1.) Dr. Sandra Messner, Medical Director of the Cancer Detection Clinic at Women's College Hospital, gave a lecture on breast cancer prevention.
Claudia reports a policy climate of funding cutbacks and bureaucratic intervention which has become only too familiar to NETLETTER readers. Ontario has already announced major forthcoming funding cuts for mental health, with further cuts rumored for the future. The Province has invited all interested parties to cooperate in drawing up a "social contract" to resolve Ontario's substantial Provincial debt.
In this uncertain setting, Claudia and Dr. Carol Cohen, who directs community outreach services for the elderly at Sunnybrook Medical Health Sciences Center in Toronto, have been exploring the possibility of convening a social network intervention conference in May, 1994. The grandest conception would be to hold two days of presentations for health, human service, and public policy professionals, followed by a "postsymposium day" including the senior network interventionists and network analysts presenting at the general conference. All is still in a preliminary discussion stage. Given the strained state of the Ontario health services economy, it is a tall order to convene the general conference, which could very well end up costing rather than making money. Convening experts, perhaps sponsored by COTA, may be more likely. Funding might be sufficient to gather a number of North American experts, but not enough to pay transportation costs for others from Europe or elsewhere. If so, I hope that some of NETLETTER's overseas readers could secure funding to make the trip; this could be a step toward the establishment of direct international dialogue which Hermann Baars at the University of Limburg in Maastricht has proposed NETLETTER (VI, 1).
Two settings, COTA in Toronto, and the University of Limburg in Maastricht, have now expressed interest in convening an international conference, and I am optimistic that one will take place in the fairly near future. Let me start a process of brainstorming, which I hope would continue in correspondence to NETLETTER and carry into the conference itself:
A conference could assemble network analysts and network therapists to address integration of academic and clinical knowledge. The sponsor might persuade clinicians and academics to submit reading lists including fundamental sources on network analysis and network intervention. Each participant would undertake to read three works from his/her nonspecialist field, so that network therapists would read works from network analysis, and vice versa. Some time at the gathering might be devoted to discussing ideas and questions generated by the reading. This process could yield a definitive reading list for specialists in each area to understand the other. Network analysts and network interventionists could discuss, from their perspectives, the most important research questions in network intervention, and describe the forms such research might take. I would be particularly interested in hearing from network analysts about concepts from network analysis which network interventionists do not use, and the potential utility of such concepts. Perhaps some brave soul could take on the daunting task of examining all the different methods network interventionists have used in measuring client networks, and suggest how to establish some order in that domain. I'd like to hear what ideas or techniques network interventionists have invented in their particular settings, and to find out whether or not these "innovations" are already in use in other settings. I'd also like to hear about the relative fitness/unfitness of current network intervention approaches to particular clinical and cultural populations and settings, and see whether or not it is possible to start a classification system matching particular intervention approaches to particular problems in particular populations in particular settings. I'd like us to have fun together.
Let's hear from other NETLETTER readers on how such a gathering of experts could spend their time.
The Annual Conference of The American Orthopsychiatric Association (Ortho) once again provided network therapists an opportunity to share their work. We were all North Americans this lime, missing the Swedish and Norwegian contributions of previous years. Claudia Blumberger of COTA from Toronto, Don Lugtig of the Neighborhood Parenting Support Project from Winnipeg, Manitoba, and Larry Ruhf, formerly of Mount Tom Institute from Holyoke, Massachusetts, were faculty for "Network therapy: Cases in context," on May 22, 1993, in San Francisco. Jodie Kliman was an active informal faculty member. I moderated, with a format emphasizing case descriptions to illustrate program settings and dramatize the experience of network intervention.
Claudia Blumberger described a meeting of family members and staff from several agencies around a 32 year old schizophrenic woman with multiple hospitalizations, currently residing in a group home and attending a community program. Having built relationships with identified patient (IP), family members, and community staff, Claudia was positioned to convene a meeting whose manifest agenda was to "celebrate" the IP's currently doing well in the community. From Claudia's account of the meeting, it was clear that the balance of participants (the combination of closer and more distant relationships) in the group made it possible to observe the escalating emotional reactivity in the family, and to comment on the patterns gently and supportIvely. This process helped change family reactivity patterns, and, perhaps more significantly, illuminated individual and family issues for community agency staff, who would continue to deal with IP and family over time.
Don Lugtig (whose Neighborhood Parenting Support Project's Final Report is reviewed in this issue)presented the case of an extremely isolated parent who had been hiding in her home from members of her abusive family of origin at the start of the intervention. He made dramatic use of network maps to show how this woman's network enlarged and diversified, and to demonstrate how she had become positioned in natural helping networks in the neighborhood.
Larry Ruhf used a circle similarity exercise to generate shared emotional experience among faculty and audience. We gathered in a circle, then stepped forward into an inner circle as we fit each category announced, e.g., having traveled a certain distance to the conference, having attended a network assembly, having lost a parent, etc. He then gave us an intriguing challenge: He had just left Mt. Tom and was starting a position directing clinical services for a network of community residences for chronically mentally ill residents. He asked us for ideas to help him design network intervention programs for this setting. His request sparked a lively and fertile discussion of community network therapy strategies, engaging an audience of professionals who clearly had come to learn how to do network intervention.
It was a fairly small audience of about a dozen. Surveyed informally for their learning objectives, most declared their interest either in strengthening their existing network intervention skills, or in learning how to start doing network therapy. About half slipped away during the break, reflecting, I think, some disappointment that we did not get down to concrete details of network intervention sooner in our presentations. The remaining group came alive once we began brainstorming with Larry. Having learned from this experience, I plan to make next year's Ortho session much more of a training experience, rather than a presentation of the participants' programs. After introducing faculty, reviewing network therapy concepts and techniques, and doing a "retribalization" exercise, I will facilitate a process of teaching and consultation. I plan to convene the same faculty next year; if any NETLETTER readers would like to join, please let me know right away" Ortho next meets in Washington, D. C., from April 27 to 30, 1994. Readers interested in attending should write to American Orthopsychiatric Association, 19 West 44th Street, Suite 1616, New York, New York, 10036.
Richard Nutter, a Social Work professor at the University of Calgary who attended, shared a brainstorming idea one could use current home computer software technology to create a psychoeducational program enabling a family to generate their own network maps by entering information about network members and the content and quality of the relationships among them. The software could then generate a two-dimensional display which best fit the data. Specific suggestions for changing network membership or relationships could be entered, providing instant visual feedback about implications for network structure. Are any readers interested in developing and sharing such a program?
From Uri and Mira Rueseni...Mira and I have enjoyed reading the NETLETTER. We found it to be informative and useful. Your summary of the intervention we did was good; since then Mark and I have published this piece in Contemporary Family Therapy.
The last year has been quite active for me. I am teaching a 3 credit course each summer titled: Family and Social Networking. Each student is required to become familiar with one of the network intervention models and to develop a miniproject in which they can demonstrate the usefulness of these approaches in family or community settings. In addition, Mira and I have done a large-scale demonstration of networking at the Free University of Guadalahara in Mexico where we were invited to help start a family therapy program. The faculty, staff, and students loved the idea and claim that they would like to try it in their own settings.
In our recent trips to Tokyo, Beijing, Moscow, and Saint Petersburg we have not found any indication that the network idea and concepts have been used there. On the other hand, I have conducted a large-scale demonstration of network intervention with 250 participants who attended a two-day conference on the Treatment and Prevention of youth violence. The issue was sexual and physical abuse in a family. Many were involved and were interested to try modified versions in their own agencies.
From Larry Ruhf...l am looking forward to joining the Ortho panel in San Francisco in May, 1993.
I just received a copy of Live Fyrand's new book on social network therapy, published in Norwegian. Our Mount Tom Team has in article in this book that I submitted as principal author.
I'm still working at CHO clinic and have occasion to attempt small network interventions, especially with DSS [child protective] cases.
From Ross Speck...On October 16,1 met with a Union Institute Ph.D. committee in Seymour Saransen's office at Yale. Also on the committee was Lee Hornacki (right hand man of Ivan Illich). It was stimulating...Seymour reminded me that I spoke in his department on Networks 25 years ago. I had forgotten. I am closing my practice and increasing my time at Union.
From Julia Halevy...I've actually continued to do quite a bit with network intervention over the past years and never seem to find a minute to talk about it.
First of all, I started a new Masters degree training program in marriage and family therapy at Antioch in 1989. The program is very exciting and has a focus on larger systems. Therefore, included in the curriculum is a required course on network intervention. The students have carried the subject into their internship sites and many have had the occasion to use it there. Additionally, a couple of years ago I did some training in Rhode Island at an internship site that wanted to incorporate network intervention into its array of services working with child abuse issues.
As you probably know, I did do some consulting to the Winnipeg project and continue to be in sporadic correspondence with the Dons. Hopefully, the Canadian government and/or some of the provincial governments will begin to utilize the information that came out of their wonderful work. Over the past two years I've been training a clinician at Hospice of Cheshire County to use network intervention with families of people who are dying. I've provided consultation, training and supervision as well as conducted networks for the project. The project is funded by United Way, and the woman I trained, Marylouise Alther, presented a workshop at the ADEC (Association for Death Education Counseling) conference in Boston this year. She's written a paper from a hospice perspective and I'm working on writing one from a network perspective.
In May I was able to turn over directorship of the now 3-year old MFT program to someone else and have retained my role as department chair. So, onto the next project. I'm in the process of setting up a first "urban neighborhood clinic," located in a community organization, staffed with student interns supervised by yours truly, to provide free services to the urban poor. The underlying principle is that academic institutions can use their resources to provide needed services. One of the services I hope we can offer is, of course, network intervention.
I feel as if I really need to get to writing about what I'm doing, but I never seem to get a breather as there is so much to do.
While I didn't submit a workshop to this year's AAMI T conference for the first time in several years, I'll be going out to Seattle to the National Association of Family Based Services conference in December to give a workshop there on network intervention. I'm told to expect a larger and more enthusiastic audience there.
From Branko Gacic...It was my pleasure to read here in Africa your letter and NETLETTER. I am temporarily with my daughter's family who live and work in Zimbabwe [168 Upper East Road, Harare, Zimbabwe tel. (263-4) 720.383]. I will stay the next two months here. Thank you very much for an excellent, condensed review of my professional activities over the last two decades. However, I feel free to make one remark: In 1973 I started alone and independently without any knowledge about family and/or network therapy. A few years later I met the work of pioneers-founders in the network approach and since then I highly respect them, both professionally and personally particularly Ross Speck!
Thirteen years ago, I surveyed the field of network intervention (Trimble, 1980). At that time, a variety of technical innovations had appeared in the literature, emerging out of family therapy and organizational development. Speck and Attneave's work (Speck & Attneave, 1973) received the most attention, and their students proved to be most persistent in pursuing social context intervention in mental health and human service practice. Ross Speck drew the term and concept of "network" from Elizabeth Bott's (1955) early study of the relationship between family network structure and conjugal roles, and I expanded the term "network therapy" (which both Speck and Attneave disliked, preferring "network intervention") to embrace the variety of social system intervention approaches with which I was acquainted at the time. The early network intervention approaches made little use of the conceptual framework developing in academic social network analysis, instead using "network" as a loose metaphor; the emphasis was on particular techniques (e.g., full-scale assembly, network session, team problem-solving, intersystems conference, etc.). Theory was derived primarily from general and family systems theory. As network therapists began to use network mapping methods, they incorporated structural concepts such as size, density, directionality, multiplexity, nodes, sectors, clusters, diversity, etc.
In a fairly short time, network intervention has become grounded in examination and analysis of client's social networks, and diagnosis of the network has become more important than mastery of a particular technique of "network therapy." The Dutch Social Network Project, like other recently emerging network intervention enterprises (e.g., the Neighborhood Parenting Support Project in Winnipeg, and COTA in Toronto), illustrate the maturation of the field. The power in the example cited in the accompanying article on the Dutch Social Network Project was not in any dramatic technical move on the part of the clinician, but rather in its sophisticated analysis of breakdown of social integration for a physically ill girl, search for a solution based on that analysis, and measurement of progress by criteria of social integration.
I am sure that, among the readers of NETLETTER around the world, there are conceptual and technical innovations to be shared. Please consider corresponding with NETLETTER about your work. I will continue to seek out current practitioners of network intervention, so that NETLETTER serves to keep all of us current about progress in the field.
REFERENCES
Bott, E. (1955). Urban families: Conjugal roles and social networks. Human Relations. 8, 345-383.
Speck, R., & Attneave, C. (1973). Family networks. New York: Pantheon.
Trimble, D. (1980). A guide to the network therapies. Connections. 3(2). 9-22.
-This issue, Volume VI, Number 2, was intended for publication in 1992. The vicissitudes of personal life, including the unexpected sudden death by heart attack of my first wife, 47, the mother of my two older children, disrupted NETLETTER's intended publication schedule. For subscribers, I am counting this issue as the end of the 1992 subscription year. In the future, a "year" subscription will be two (or, possibly, three) issues.
-Included with this issue is a Directory of NETLETTER subscribers, together with an update from correspondence which came in after I photocopied the Directory.
-In the next issue, I will review a paper
by Mary Youngquist, and a new book by Marc Galanter (1993), Network therapy
for drug and alcohol abuse: A new approach in practice (Basic Books). I'll
continue the series on network intervention around the world, from the chapter
Jodie Kliman and I prepared for Mony Elkaim's Les therapies familiales: Principales
approaches. Please to send in your correspondence and contributions.
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