Review of the Literature

The review of the literature is divided into 5 parts:

The First School-Based Counselor
School Counseling/School Psychology Literature Advocating a Family Emphasis
Family Therapy Literature Advocating a School Emphasis
School Social Work Literature and Special Education Literature,
Summary

Alfred Adler: The First School-Based Family Counselor

The earliest example of SBFC is that of Alfred Adler in the 1920's (Rosenberg, 1971). Adler frequently conducted family counseling interviews in school auditoriums before an audience of teachers, mental health workers, and parents. This approach was consistent with his philosophy that a child should not be treated in isolation and that those involved with children would learn in an audience-demonstration format. We see here the elements both of a systems theory and an emphasis on prevention (through education). It could be argued that the first family counseling was conducted by Adler and that it was School-Based Family Counseling. Other Adlerians, especially Dreikers, have emphasized both school and home intervention (Dreikers, 1958, 1965, 1968).

The primary literature on School-Based Family Counseling exists in two main areas: the school counseling/school psychology literature and the family counseling literature. There is also a minor emphasis in the school social work and the special education literature. Within each of these areas a review of the literature shows a growing awareness of the need for an interface between schools and families in order to help children.

School Counseling/School Psychology Literature Advocating a Family Emphasis

The value of a family systems approach when working with a child on a school problem has been attested to by a large number of school counselors and school psychologists (Amatea & Finnette, 1981, 1984; Basal, 1989; Braden & Sherrard, 1987; Bundy & Gumaer, 1984; Capuzzi, 1981; Capuzzi & North, 1984; Carson, 1987; Cooper & Upton, 1990; Downing, 1983; Fine & Gardner, 1991; Fine & Holt, 1983; Ford, 1986; Johnston & Zemitzsch, 1988; Klein, R., 1981; McComb, 1981; McDaniel, 1981; Paget, 1987; Palmo, Lowry, Weldon & Scioscia, 1988; Peeks, 1989, 1993; Piercy, 1972; Ryan, Barham & Fine, 1985; Smith, 1977; Tucker & Bernstein, 1979; Wendt & Zake, 1984; Wilcoxon, 1986; and Wilcoxon & Comas, 1987; and Young, 1979).

An important, early article on SBFC by Friesen (1979) is visionary in its call for school counselors to embrace family counseling. Friesen, who was an early practitioner of SBFC, developed one of the first outreach SBFC programs in a school district through a university-school partnership (between the University of British Columbia and Richmond School District). Friesen (1977) recommends that School-Based Family Counselors use four basic approaches to working with families: family life education, family enrichment, family consultation, and marital and family counseling.

Fine and Gardner (1991) contend that having a developmental and family systems orientation is more important for the elementary school counselor than a specific set of techniques. Ford (1986) argues that because of growing problems experienced by families and declining parent involvement in schools, learning about family counseling is a necessary next step in the professional development of school counselors, teachers, and principals. Carlson and Sincavage (1987) conducted a survey of 110 members of the National Association of School Psychologists and reported that family variables were seen as highly relevant to children's school problems. Johnston and Zemitzsch (1988) describe the dangers of school intervention programs that focus exclusively on the individual student and ignore the student's other subsystems (family, peer, and community). They advocate a family systems approach that addresses all these subsystems (including the school subsystem) and suggest that school psychologists should begin using family counseling instead of referring students to outside agencies. Goodman and Kjonaas (1984) conducted a SBFC pilot project and concluded that school counselors can, with proper training, do family counseling. A similar conclusion is made by Hinkle who makes a case that school counselors are in a unique position to appreciate, and to utilize, a family systems approach (Hinkle, 1992, 1993). According to Hinkle, many school counselors find family counseling more effective than lengthy individual counseling in the school setting. Even when a referral to a community agency is warranted, the school counselor is more likely to make a successful referral if she/he first conducts a family interview. Nicoll (1992) describes a brief family counseling/family consultation model for school counselors that can be used within the parent-teacher conference setting.

Merrill, Clark, Varvil, Sickle, and McCall (1991) describe what may be a model approach for implementing a program in SBFC that is based on retraining of existing school mental health professionals. Over a nine-year period school psychologists and school social workers in the Topeka Public Schools have participated in the SBFC program. Co-therapy teams use a problem solving family systems approach with an average of two families a year. Team members are closely supervised by an experienced family therapy supervisor. The SBFC team members also participate in a bi-monthly seminar that focuses on learning family therapy skills. Data for a five-year period showed that 137 families had been served.

The school counseling/school psychology literature also contains articles describing the value of a family approach in dealing with a wide variety of specific student situations: disruptive students (Ewashen, 1988; Williams, 1988); gifted students (Colangelo, 1988; Lester & Anderson, 1981; Zuccone & Amerikaner, 1986); stepfamilies (Kosinksi, 1983; Medler, 1985; Poppen & White, 1984); learning disabled students (Perose & Perosa, 1981); drinking violation (Ford, 1986); academic difficulties (Stone & Peeks, 1986; Taylor, 1982); depression (Stark Brookman & Frazier, 1990); single parent families (Weiers, 1986); alienated students (Kramer, 1977); married students (O'Brian, 1976); developmentally immature students (Campion, 1984); elective mutism (Lazarus, Gavilo, & Moore, 1983); and parental abuse and neglect (Griggs & Gale, 1977).

Bobele and Conran (1988) and Colapinto (1988) describe some of the difficulties that arise when school personnel refer students' families to outside agencies for family counseling. There is a danger of the therapist becoming triangled into a conflict between the school and the family and focusing on the family prematurely rather than viewing the problem as one within the larger school-family system.

Family counseling approaches used by school counselors and school psychologists include: divorce group counseling with children (Bundy & Gumaer, 1984; Graver, 1987; Prokop, 1990); parent conferences (Bowman & Goldberg, 1983; Conrad, 1989; Dawson & McHugh, 1987); and conjoint family counseling (Albaum, 1990; Arciniega & Newton, 1981; Casey & Buchan, 1991; Carlson & Sincavage, 1987; Conoley, 1987; Dawson & McHugh, 1986; Dombalis & Erchul, 1987; Dowling & Taylor, 1989; Ewashen, 1988; Fine & Gardner, 1991; Ford, 1986; Golden, 1986, 1988; Goodman & Kjonaas, 1984; Peeks, 1989; Stone & Peeks, 1986; Smith, 1989; Stark, Brookman & Frazier, 1990; William & Hugman, 1982). Some of the family counseling approaches used by school counselors and school psychologists are: Electic Systems Therapy (Sawatzky, Eckert & Ryan, 1993); Structural Family Therapy (Carlson & Sincavage, 1987; Fish & Jain, 1988; Goodman & Kjonaas, 1984); Strategic Family Therapy (Amatea, 1989; Conoley, 1987; Lewis, 1986; McDaniel, 1981; Stone & Peeks, 1986); Adlerian (Arciniega & Newton, 1981; Kern & Carlson, 1981; Nicoll, 1984); Multiple Group Family Therapy (Dombalis & Erchal, 1987); Psychodynamic and Gestalt Family Therapy (Smith, 1978); Family of Origin Therapy, Humanistic Family Therapy, and Behavioral Family Therapy (Ford, 1986) and Parent Training (Beutler, 1979; Carr & Carr, 1974; Stapp & Whittlesey, 1972). This represents a broad range of traditional family therapy approaches being applied in the school setting.

One of the earliest descriptions of a SBFC program is provided by Kramer (1977) who describes a family counseling program for alienated secondary school students. The program, at Berkeley High School in California, is supervised by the principal and counselor and is staffed by licensed family therapists. Barksdale (1979) describes a collaborative program between a school district and a community mental health agency. Over two years an outreach SBFC program was developed at one elementary school, then extended in the second year to four additional schools.

Sloan (1986) carried out a randomized control group study of the effectiveness of group counseling of elementary age children, in combination with brief telephone consultation with parents, and found no significant differences between treatment and control groups on self-esteem or behavioral dependent measures. A weakness of the study was that traditional family counseling and parent consultation were not used and only very limited telephone contact with parents was made over a relatively short (12 week) period. Although both treatment and control groups showed significant improvement from pre-test to post-test, there was evidence of contamination in that three of the nine control group teachers sought consultation for problem students during the study.

Blechman, Taylor, and Schrader (1981) utilized a randomized control group design to investigate the effectiveness of family problem-solving (contingency contracting between parents and children, guided by a problem-solving game) and found it superior to a home note comparison group and the control group in helping academically weak children improve mathematics skills.

The literature describes six main benefits of SBFC for schools: improved academic functioning of the students receiving SBFC, lessening of students' emotional and behavioral problems, decreased classroom disruption of other students, improved functioning of the students at home, improved relationships between schools and families with children having school problems, and cost effectiveness (for schools involved in SBFC delivered by a universityschool partnership) (Albaum, 1990; Stone & Peeks, 1986). Dowling and Taylor (1989) point out that parents experience SBFC as more accessible and less threatening than going to a traditional clinic. Carter (1992) has suggested that parents experience less threat with SBFC because the focus of the counseling is academic - "helping the child succeed at school" - rather than dealing exclusively with "family problems." This definition of the family counseling as school-focused reframes family counseling for the parents and family in a way that makes it more socially acceptable. Quirk, Fine and Roberts (1991) point out that the potential resistance of teachers to parents being more involved in academic decisions is lessened by the family counselor being a part of the school team.

The literature also identifies several problems in the implementation of SBFC. Wendt and Zake (1984) discuss the advantages of training school psychologists in family dynamics and family therapy, but point out that the family systems approach is complex and requires extensive coursework. This has important implications for in-service training and university curricula. Golden (1983) suggests that family therapy is too complex for school counselors, although school counselors can make brief interventions with functional families. Although the literature reviewed above contradicts Golden's position (there are many studies of school counselors using family therapy techniques effectively), Golden's article indicates the importance of adequate training in family therapy for school counselors. Alessi (1989) states that practicing family therapy in schools involves more complex ethical issues than those usually encountered in private, outpatient practice. Hansen, Green and Kutner (1989) indicate that when school psychologists increase their involvement with families, ethical issues related to competence and to responsibility and welfare of consumers are raised. Fine and Holt (1981) identify five obstacles to the school psychologist using family counseling: the school psychologist's competence to do family counseling, resistance to using family counseling, the absence of research in SBFC, difficulties in identifying the client system, and the complexity of system dynamics. Quirk, Fine, and Roberts (1991) describe a number of difficulties associated with family-school systems interventions; school personnel resisting a wider systems focus that includes the family and community; the need for school counselors to do evening work (to accommodate parents); and ethical dilemmas arising from viewing the teacher as a client as opposed to a consultee. Samis (1993) surveyed 249 elementary school counselors and found that they had a preference to do individual counseling with children and teacher consultation rather than to do parent consultation. This suggests that many elementary school counselors might be reluctant to do family counseling.

Woody (1989) describes the need for curriculum revision in universities to help school psychologists learn SBFC and anticipates that professional defensiveness might be the result. This would seem to be a normal process in the revisioning of any professional role. Stone and Peeks (1986) describe how some counselors not trained in family systems thinking may have difficulty shifting away from an "individual" psychological way of conceptualizing.

Family Therapy Literature Advocating a School Emphasis

The ratio of articles in the family therapy literature advocating a school emphasis compared to the number of articles in the school counseling/school psychology literature advocating a family emphasis, is about 1:4. This suggests that school counselors and school psychologists are more involved with families than family therapists are involved with schools.

Nevertheless, there is a growing awareness among family therapists that family systems theory, which is the dominant paradigm in family therapy, implies not only working with the other members of a child's family, but also working with all the subsystems of which a child is part (including the school subsystem). Ron, Rosenberg, Melnick and Pesses (1990) point out that often family therapy alone is insufficient because the child is caught between the dysfunctional interaction between home and school. Intersystems intervention is required in such cases. McGuire, Manghi and Tolan (1989) recommend that the family therapist conceptualize school behavior problems as part of a home-school system problem. Lusterman (1988) describes a case study in which the circumplex model is used to map the dynamics occurring in a child's family and school. McDaniel (1981) emphasizes the importance of collaboration between family therapists and school counselors. McGuire and Lyons (1985) describe a community agency-based program to which 17 families were referred by schools because of an underachieving child. After treatment 83% of the children in these families had improved in grades and in classroom behavior. Phillips (1975) was one of the earliest family therapists to recommend that marriage and family counseling be provided through public schools as a way of reaching out to the community.

Wetchler (1986) describes a macrosystemic model of family therapy treatment of school problems in which the school and family are viewed as the locus of the problem and treatment consists of the therapist working with the child in each subsystem separately first, and then rejoining the two subsystems in a more functional relationship. Taylor (1986) describes how children can get triangled into a "go-between" role between parents and teachers when ambivalence exists between the home and school systems. Guerin and Katz (1984) describe five types of problems common to the family with a child experiencing school problems (the child-centered family): emotional vulnerability in the family, conflict with a parent, conflict with a teacher or principal, an enmeshed relationship with a teacher that promotes peer resentment, and parent-teacher conflict. In addition, there are five types of triangles that can be involved in a child's school-related problems: parent-parent-child, parent-sibling-child, sibling-sibling-child, parent-child-teacher, and grandparent-parent-child.

Family therapy approaches used to intervene in school systems include: Strategic Family Therapy (O'Connor & LaSala, 1988; WebbWatson, 1988) Behavioral (Social Learning) Family Therapy (Horne & Walker, 1984); Adlerian Family Therapy (Baideme, Kern & Taffel-Cohen, 1979), and Structural/Strategic Family Therapy (Dicocco, Chalfin & Olson, 1987; Wetchler, 1986). Golden (1990) recommends that brief family consultation be given to families that are functional on five criteria: parental resources, chronicity, communication, parental authority, and rapport with therapist. Several family therapists have described the use of family therapy to help improve children's academic/school problems (Andrey, Burille, Martinez & Rey, 1978; Freund & Cardwell, 1977; Igarashi, 1992); (McGuire & Lyons, 1985; Reimondi, Lockwood & Brannigan, 1981; Wetchler, 1986).

Vazquez-Nuttal, Avila-Vivas and Morales-Barreto (1984) describe the advantages of using a family therapy approach with Latino school children because of the strong emphasis on the family in Latino families.

Santa-Barbara (1979) conducted an outcome study on the effects of brief family therapy on 279 families. Eighty therapists participated in the study and there was a six month follow-up. There were no significant improvements in children's academic performance, compared to control subjects, but there was a significant decline in descriptive school behavior.

The family therapy literature also contains several descriptions of School-Based Family Counseling programs that are university-school partnerships in which graduate family counseling students carry out traineeships/internships in schools (Albaum, 1990; Friesen, 1974; Gerrard, 1993; Hillis, Gerrard, Soriano, Girault, Carter & Hong, 1991; Smith, 1989).

Some of the difficulties in implementing a family systems therapy approach in schools are: a lack of parental cooperation and disparities between home and school behavior (Feldman, Peer, & Altman, 1984).

While the family therapy literature on family-school intervention is sparse compared to the school counseling/school psychology literature, it contains parallel themes emphasizing the value of intervening in both family and school in order to help children with difficulties at school.

School Social Work Literature and Special Education Literature Advocating a Family Emphasis

In the School Social Work literature, Long (1988) describes the importance of understanding the families of latch key children in order for school personnel to help those families. Wattenberg and Kagle (1986) describe their study of 83 families referred out by school social workers for family therapy. Dicocco, Chalfin and Olson (1987) describe a family therapy program that is a partnership between a community family counseling agency and a public school system. Although in none of these studies is family systems theory emphasized as an integral part of the school social worker's role, there is an awareness of the importance of family variables affecting schoolchildren.

The authors of four articles argue for SBFC as being an important part of the School Social Worker's role (Fine & Jennings, 1985; McCard, 1987; Millard, 1990 (a); Millard, 1990 (b)). Blatt and Staff (1977) describe a collaborative relationship between a child guidance center and an elementary school which resulted in the development of an outreach family therapy mini-clinic in the school. McDonald-Joy (1977) advocates a Montessori schooling approach for the children of alcoholics as a way of raising the children's self-esteem and thereby enhancing treatment of the parent(s) and overall family functioning. This study is interesting because it makes a case for an educational intervention with the child as having an important systems effect on the rest of the family.

In the Special Education literature there are a limited number of references to SBFC as being a valuable part of the Special Education specialist's role. Farago (1988) advocates the use of siblings in therapy as a way to help school children. Dawson and McHugh (1986) describe the use of a family systems approach in a school to reduce attendance problems among children with emotional and behavioral problems. Dawson and McHugh (1987) describe case studies of students whose problems are exacerbated by teacher-parent communication difficulties and give examples of how teachers can make home visits as part of a family systems approach to changing students' behavior. Sixteen students participating in the Youth in Psychoeducational Services (YIPS) program received family counseling, in addition to academic and behavioral treatment: 58% showed improvement on a behavior rating checklist, 93% improved in reading achievement, 86% improved in spelling, and 71% improved in reading (District of Columbia Public Schools, 1981).

Summary

In all five areas of literature reviewed - School Counseling, School Psychology, Family Therapy, School Social Work, and Special Education - there are descriptions of School-Based Family Counseling as being integral to the role of the mental health professional working in the schools. In addition, there is a secondary theme of family variables being critical for understanding the problems of children in schools. The literature suggests that not only are there important practical reasons for using a family systems approach in schools, but also important theoretical reasons. Fine (1991) makes a strong case for a systems-ecological theoretical perspective on home-school interventions that integrates school, family, peer, and community systems.