Interventions | Family

Intensive Home-Based Treatment (IHBT), as noted other places on this site, is a mental health service designed to meet the needs of youth with serious emotional disturbances who are at risk of out-of-home placement or who are returning home from placement.

The goal of IHBT is to provide the necessary mental health services and supports to enable youth to live in their homes in the least restrictive, most normative setting possible. IHBT services are provided in the home, school and community where youth live and function. These services focus on the mental health issues that put the youth at risk, while promoting positive development and health family functioning.

In doing this, a crucial question arises: Are there sufficient youth and family supports in place? Some resources to help include the following:

FAMILY CONTEXT: Set Stage for Change
Among the goals in helping youth in recovery and their families is creating a home environment that:
– Promote family environment that nurtures resiliency
– Decreases family conflicts; Promote collaborative problem solving
– Rebuilds bonds and relationships
– Increases positive family communication
– Increases supervision and monitoring
– Create youths and family safety net of resources and supports
– Identifies and addresses relational dynamics that impact youth behaviors and emotions

In helping facilitate the IHBT approach, the following tools are intended for use by IHBT providers. Our vision is to help the helpers through support, technical assistance, and resources. We welcome sharing tools you have created as well.

FAMILY THERAPY: Systemic Hypothesis incorporates each person’s reality and perspectives; identifies family themes, includes family-of-origin factors when relevant; includes thoughts and feelings as well as behaviors; allows family members to take risks and experiment with interventions for change; provides opportunity for families to understand their systemic hypothesis as well as take responsibility to change it; is constantly changing with new information; and moves families from first-order to second-order change for true sustainability. DOWNLOAD Family Therapy: Systemic Hypothesis Tool

Interventions can occur at any step throughout the systemic hypothesis, but the earlier the better. By using circular questioning, the therapist can add more to the process pattern, and foster family buy-in to change. The same content pattern may occur, but with different topic issues (i.e., late for curfew, kid is verbally disrespectful, etc.). The process of the family pattern will remain the same (i.e., youth is not held accountable, lack of co-parenting in the executive subsystem, ineffective communication, negative behavior serves a function of getting parents to interact, etc.). Remember, the therapist may have several systemic hypotheses at a time, and they are temporary, flexible explanations which are open to constant revisions with new relational information and family system change. DOWNLOAD Family Therapy Systemic Hypothesis: Application to Families Tool

The  Structuring Family Change Conversation is designed to assist therapists and families in understanding the ongoing “stuck” patterns, moving the family system from a focus on content (issues) to process (patterns) while also promoting ideas about family ‘change’ and obtaining feedback from supervisor/team-related to the change needed to meet therapeutic treatment goals.

The purpose of the tool and the rationale of the tool/strategy is to 1.Set the stage for initial small change steps.2.Have the family work together toward mutual change. It is designed for population/symptom of focus for: 1. All youth/families. 2. Caution should be utilized for families with extremely high levels of conflict. Additional preparation and active coaching is necessary in these circumstances.

When to use it? Use it when trying to understand the family system, to gather more information about relational interactions, to create/answer systemic questions related to current issues, to encourage families to change their narrative and create opportunities for positive change. – When approaching the Systemic Hypothesis: Application to Families questions to consider include: What is the initial (or working) systemic hypothesis observed? What circular questions are needed to fill in the arcs of your systemic hypothesis? It is designed to be used during phases of IHBT, notably to be used within the first two weeks of treatment to set the stage for family change, but can be used throughout the treatment cycle. DOWNLOAD Structuring Family Change Conversation Tool

Rainbow Connection
Rainbow Connection is a Family Values Assessment Activity, a fun activity designed to help families identify and explore strengths, individual family member personality traits, unearth perceived weaknesses and facilitate communication with the goal of arriving at common values unique to their family system.
DOWNLOAD Rainbow Connection Text

Rainbow Connection IHBT Tool Framework
Families of two or more can participate. This is a useful activity in treatment planning and initial assessment. It can be re-utilized at the treatment plan review and at discharge to help the family assess how far they have moved toward their common goals such as better communication,respect for each other and other values they have identified to work on in treatment. Each question corresponds with a numbered ribbon on the rainbow. Have the family sit around a table with a pen or pencil. Each family member will write their response to the numbered statement or question in the colored ribbon. DOWNLOAD Rainbow Connection IHBT Tool Framework

Rainbow Connection Template
They will then pass the rainbow onto the next family member who will fill in their response. When completed by each member, the therapist will explore and discuss with the family group. The goal is to use the discussion around the information gathered to arrive at what each member feels are their most important family values. These will be written in the Pot of Gold. It is helpful to provide the family a ‘refrigerator copy’ to help them remember the exercise. DOWNLOAD Rainbow Connection Template

Family Sculpting Framework | Download Family Sculpting Technique
Family Sculpting is a family assessment tool designed to help family members gain perspective and insight into their family dynamics. These observations and insights can become effective aides to therapy.

Proximity (distance) and other spatial factors (where chairs are placed, where people stand) are used to sculpt a three dimensional representation of the family. The arrangement and placement of everyone will reveal family structure, emotional themes, conflicts, distancing and alienation as well as other valuable assessment information.

Adolescents have a tendency to view this technique favorably as they are provided with a chance to express feelings about the family non-verbally. The method is eclectic lending itself to nearly any theory of intervention or psychotherapy practice the clinician may subscribe.

Sculpting can also be used to promote communication and family collaboration. Families are more likely to own the representation they have seen, the issues they have actively participated in and any corrective measures worked so.
Download Family Sculpting Framework | Download Family Sculpting Technique

Family Collaborative Drawing
The Family Collaborative Drawing tool is designed to help youth and family express, clarify and learn about their emotions and interactions with other family members in ways which may lead them to think, act and feel in more creative and healthy ways. It is designed for IHBT youth and families and can be used for assessment and/or as a treatment tool.

Download PDFs: Family Collaborative Drawing Technique | Family Collaborative Drawing Technique Questions to consider for Interpretation

This is an effective tool to use with families that may be ‘stuck’. With the help of pictures created by those in the family system cooperatively drawing in a structured way, themes may emerge leading family members to being able to put words on feelings they were previously unable to describe. The ‘family picture’ can facilitate the participants in expressing many layers of experience, the many aspects, levels and viewpoints of a situation at the same time.

The tool is designed for the outcome of family members being able to begin to identify and begin to process underlying issues in communication, interpersonal relational patterns and challenge their assumptions about one another in a safe non-threatening environment. is presented by The Center for Innovative Practices | Part of the Begun Center for Violence Prevention
at Case Western Reserve University’s Mandel School of Applied Social Services
Campus Location: 11235 Bellflower Road Room 375  | Cleveland, OH 44106
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