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Working with children and their
multi-stressed families
-Interventions for integrating children at risk and
educating adults24-25 October 2013, Bucharest
International Conference on Adult Education: Transforming the
educational relationship: intergenerational and family learning for
the lifelong learning society

Elena-Iulia Mardare
University of Bucharest, Faculty of Sociology and Social Work - eimardare@sas.unibuc.ro
Justification
•

Parents stressed

their children adopt different behaviors

Intervention at the family level

change a child’s behavior

help the family to get stress coping skills
•

An objective of specialists (educators, family counselors, social
workers etc.) in child protection - evaluation and reduction of the
impact of stress on families

•

Educational models are needed to:
-prevent and combat the phenomenon of failure to adapt to stress for
family members
-increase the capacity and resources useful for families to cope with
these challenges and to prevent their entry in crisis.
Questions


What are the psychosocial factors implied in analyzing the
phenomenon of family stress?



How are affected children from a multi-stressed family and what
are their needs?



What kinds of educational and social services are appropriate to
increase children and multi-stressed family quality of life and to
strenght childrens solidarity and creativity ?
Objectives
1. the problem of children at risk from multi-stressed families
(establishing a diagnose of risk psychosocial factors implied in
children and their multistressed families)
2. developing an intervention methodology to decrease :
- the risk of behavioral disorders
- the risk for a multi-stressed family to become a dysfunctional
one
3.

social services role in supporting families to manage stress in
their lives.
Stress and family stress
•

The term of stress has enjoyed growing popularity

•

The number of articles on stress and mental disorders
increased rapidly

•

Family stress represents the imbalance (real or imagined)
between:
1. demands faced by the family
2. the family's ability to adapt to those demands (McCubbin,
I.H., Sussman, B.M., Patterson J.M. 1983)
Stressed family
• Madsen W. proposes an alternative to the traditional description of
struggling families
• suggesting to specialists:
- to see family members as distinct from issues in their lives
- to discover resources available beyond these issues
• the concept of stressed family is a more appropriate label and
defines :
- the difficult reality of families lives
- the capabilities, skills and resources that families
can access to face this pressure or stress
Family stress
 Many families experience a number of symptoms in a given time
 Distress occurs when the family is living with these events
continuously over a long period of time

-

Parental stress is associated with :
parent's individual emotional problems (anxiety, depression etc.)

-

attributes of the child (behavior problems etc.)

-

dysfunction in the parent-child relationship
Parental stress
•

causes damage in the quality and effectiveness of parental behavior
(Deater-Deckard, K., 2004) such as:
- reduction in the expression of warmth and affection
- harsh methods of discipline
- increased expression of hostility in the relationship with the child
- poor parental behavior consistency
- complete withdrawal from parental role
- emotional and behavioral problems of parents (aggression,
noncompliance, anxiety and chronic anger)
- the occurrence of abuse or child maltreatment
Children’s needs in stressed families
•

Family disstress have a major impact on:
- children's development
- theirs social relations, behavior,emotions

•

Impact on :
a. young children :
-recurrent diseases
-extremely irritable
-may adopt hyperactive behaviors
b. School-age children: school performance
c. Older children : problems with school performance, behavior
problems in school or leave school.
•

In assisting parenting resources, the educator examines the ability
of parents to meet the basic needs of children

•

For raising a healthy child it is need guiding limits and loving,
compassionate care.

•

Relationships that a child will have in later life are built on previous
experiences that a child has with his parents

•

The child who did not received early educational interactions with
his parents will have difficulty in building friendships and in
overcoming the ups and downs that should be expected in future
relationships with his peers (Brazelton T.B., Greenspan S.I., 2013)
Adapting to family events
•

a complex, dynamic, multidimensional process

•

each family member having its own :
-dynamics of emotional and behavioral adjustment
-resources and coping strategies

•

involve, in varying degrees, all family members
Individual and family educational
interventions for stress
management
•

The desired outcome for children and families is to regain and
maintain the best physical, emotional and vocational condition.

•

Stress management strategies and methods have one of the
following objectives:
to identify, avoid or eliminate stressors
to recognize and minimize negative emotions
to reduce the intensity of emotions and build emotional reserves
relaxation response in the body and reduce exposure to stress
changes in lifestyle and building of reserves in the body

-
Interventions for family stress
management
•

Health education with families

•

Social work and family counseling

•

Family therapy

•

Support groups
Health education
•

Health education is a multidisciplinary approach that aims to :
-change health risk factors through lifestyle changes
-improve functional capacity, self-confidence
-reduce psychological distress
•

Health education programs, primarily addressed to children and
their families, are very few in Romania
•

A very important method in adaptation to stress is :
identifying emotions
expressing them
restore emotional
reserves

•

Only a person in emotional balance can look towards needs of
others, showing solidarity

•

Health education which targets multi-stressed families refers to
emotional health which means that a person:
is able to cope with stress as to keep emotional balance in
stressful situations
remain flexible
negotiate or make concessions in conflict situations

-
Family health education
•

In dealing with stressful situations, health education services concern two major
components:

1. The educational content – a philosophical dimension (What we know?)
- what kind of information is necessary for a better understanding and awareness of
the phenomenon of family stress
- refers to the information content provided by psychological and sociological health
sciences
- provides knowledge about the history and research on stress family and human
health

1

2

2. The educational process - a practical dimension (What we could do ?)
- aimed at forming behaviors and skills using behavioral sciences
- skills and resources that can be useful in adapting to stress
​
- training techniques for developing individual and family resources
(Bedworth A.E./Bedworth D.A., 1992)
Educational process
• Health education should be :
-easily understandable
-individualized to meet specific needs
• Using several ways, depending on :
- the educational objectives
- needs and learning styles of the target children/parents
• The methods used in the practice of health education can be
focused :
- on the educator (teacher, social worker, counselor etc.), some of
which are: lecture, demonstration, case study and simulation.
- on groups of participants such as brainstorming, small group work,
role-playing technique or aquarium.
•
-

Learning at children is based on the use of:
games
books
stories
simple words

•
-

For preschool level children is recommended to use educational
methods such as:
role playing
imitation
involvement (asking questions)
simple explanations using psychomotor skills and discussions

•

For teenagers collaboration and problem solving

•

Adult (independent and self-centered) learning has more success if
they:
-use their experience to solve problems
-collaborate, talk or to perform certain activities.
Health promotion
•

Goals achieved through the public information aimed in a particular
community

•

local authorities can plan and provide health education strategies for
-the entire community
-specific community groups (children, youth, parents)

•

use of media and other techniques

•

these educational strategies for health promotion can be included at
the primary level counseling and social services for children, youth
and families in the community
Social work and social counseling
•

Family counseling is practiced in local welfare departments

•
•

Social workers are participating in marital and family counseling in a variety
of agencies and organizations, both public and private.
Meanwhile, social workers - an important role in private agencies and family
counseling services which are offered to improve the quality of life for
families (Skidmore, A.R., Thackeray, G.M., Farley, O.W. 1997)

•

Social counseling and the teaching/learning process take place as a whole

•

The process of social counseling made by social worker includes the steps
of :
1. initial evaluation of learning needs
2. social/psychosocial diagnose
3. planning for learning
4. implementation of the plan
5. evaluation of the results of teaching/counseling process
Family Counseling
•

A type of intervention with children and families affected by stress

•

A type of brief psychotherapy that can help the families or their
individual members to
gain better relationships
promote understanding among family members

-

•

assumes sharing information, sending and receiving of knowledge,
ideas and theses that are important for successful communication
within the family and in resolving problems.
•

Families may have many coping skills to stress

•

For example, the family members are satisfied with their current way of
life when:
do things together as a family
they are careful that each family member improves self-esteem
the family develops community support networks
family members respect each other lifestyle choices

•

Family counseling should include the entire husband-wife-children
group.

•
-

For example, a family counselor can help parents :
become aware of the child's emotional and behavioral reactions
to know how to speak to children about parents problems without
exacerbate feelings of guilt or loyalty sharing
keep their personal worries and concerns for themselves and not
overload children with emotional inadequate disclosures or
responsibilities.

-
Parental counseling
•

a family counseling component

•

set of preventive measures and direct support to family members
aimed to increase proper care and education of parents.

•

In assisting parenting resources, a counselor examines parents'
ability to meet the basic needs of their children

•
-

provides favorable actions to :
strengthen parental roles in education
to maintain family cohesion, mainly in the sphere of concerns with
facing the educational function and building attitudes and parenting
and family skills
Family therapy
• Is required:
- if the stress is not resolved
- if chosen coping strategies are inadequate
- when individual and family resources are scarce
- family stress progresses into family crisis
•
-

-

Family therapy services were established and developed
in developed countries
in the civil service system for families
have expanded into the public system
can be achieved by the family through complex services provided by
multidisciplinary teams consisting of family therapists, doctors,
social workers, psychologists, lawyers etc.
offer today increasingly focus on
* a comprehensive bio-psycho-social approach to problems
* how these issues affect relationships and behaviors within families
•

The family stress management counseling is a cooperative
process.

•

Therefore, before deciding if a family needs help and could get
adequate support from a family therapist, the counselor will
have to build a relationship with family members in order to
understand their worries, asses the magnitude of their
difficulties, needs, skills, resources and weaknesses.

•

Family therapy is :
- a restructuring of family relationships
- which is done in time
- with systematic actions
- based on specific techniques that grant interpersonal skills
- that allow full development of the family members.
(Nichols P.M., Schwartz, C.R., 2005 )
Collaboration
* involves recognition of the expertise of all parties involved
* family members are the best experts in their lives
* when this experience is known and clarified, they are able to change
* counseling which involving respect :
- process of knocking on the door and wait to be invited in, rather than
to destroy the door to enter by force and then expect to be received
with open arms (Alan Jenkins,1996)
-

collaborative process that emphasizes abilities, skills and knowledge
of both parties
•

Counselors have expertise in creating contexts that support
family members in finding their opportunities and developing
resources to cope with problems

•

"watch people more compassionately and less suspiciously“

•

Appreciative alliance expression refers to the position that
allows family members to experience the fact that the specialist
is on their side (Epston D., 1999)
•

The objectives of family therapy are:

-

effective resolution for problems faced by the family in everyday life
dealing with situations of transition in the life cycle of the family and
facilitating adaptation to changes imposed by these
assisting individuals to be aware of certain needs, emotions, negative
thoughts, behaviors and problematic situations
listening, understanding and accepting feelings of inadequacy of the people
involved in the counseling process
identifying the causes of problematic situations, as well as finding alternative
solutions
promoting family well-being in harmony with their needs
improving the family environment
solving communication disruptions
finding best approach regarding the common tasks and role, improving
functionality of the system
clarifying the issues affecting the family that require a concerted group effort
to be solved
children can learn to do well in school, to verbalize their feelings
family can learn constructive ways to support them, removing those who
undermined functionality and caused anxiety

-
Support groups
•

Another kind of intervention with multi-stressed family

•

A support group is an indispensable method of helping
clients/families to deal with loads of issues while adapting to new
and unexpected situations

•

A support group is an essential method to help children/families face
the task of adapting to new situations

•

Is an educational process that focuses on development and social
adaptation of an individual through voluntary association in a group
and using this association as having the significance of other
socially desirable finalities
•

is a tool that helps children with behavioral disorders to prepare for
reintegration and participation in community life

•

parents can be directed to community support groups to help them
cope with their emotions and reactions, subsequently providing
maximum understanding for their children

•

the purpose of the group can be described based on the following
aspects:
declaration of the problems, symptoms and present concerns
identification of the aspects of normal development of a child
a goal of all group members to become better informed and prevent
problematic behaviors by acquiring clear information or by learning
problem solving skills (Malekoff A., 2004)

-
Conclusions
•
•
•

The medical and social systems of Romania present gaps such as lack of
specific forms of support for multi-stressed families
the rudimentary health education among a significant part of the population
results in reduced usage of preventive services
some of the priorities in the field of stress management care may be the
following:
- education of children from multi-stressed families through development of
educational and counseling programs that encourage healthy lifestyles with
a focus on maintaining health
-awareness regarding the needs of children
-change of attitude towards stress from considering it something
unavoidable towards regarding it as a distress that could be prevented
-use of multiple channels to transmit messages
-education of professionals by developing continuous educational programs
for family physicians, educators, social workers, family therapists who
provide preventive and counseling services, including how these programs
can be integrated into their practice
-training of parents and specialists to improve networking and
communication skills with children etc.
Solidarity and creativity
•

two important features of a society in which family education and
intergenerational learning are key interventions

•

can be hardly found ​ in families that fail to manage stressors that put
pressure on them

•

can be developed only in families who preserve authentic relationships
based on love and mutual respect

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Working with Children and their multistressed families

  • 1. Working with children and their multi-stressed families -Interventions for integrating children at risk and educating adults24-25 October 2013, Bucharest International Conference on Adult Education: Transforming the educational relationship: intergenerational and family learning for the lifelong learning society Elena-Iulia Mardare University of Bucharest, Faculty of Sociology and Social Work - eimardare@sas.unibuc.ro
  • 2. Justification • Parents stressed their children adopt different behaviors Intervention at the family level change a child’s behavior help the family to get stress coping skills
  • 3. • An objective of specialists (educators, family counselors, social workers etc.) in child protection - evaluation and reduction of the impact of stress on families • Educational models are needed to: -prevent and combat the phenomenon of failure to adapt to stress for family members -increase the capacity and resources useful for families to cope with these challenges and to prevent their entry in crisis.
  • 4. Questions  What are the psychosocial factors implied in analyzing the phenomenon of family stress?  How are affected children from a multi-stressed family and what are their needs?  What kinds of educational and social services are appropriate to increase children and multi-stressed family quality of life and to strenght childrens solidarity and creativity ?
  • 5. Objectives 1. the problem of children at risk from multi-stressed families (establishing a diagnose of risk psychosocial factors implied in children and their multistressed families) 2. developing an intervention methodology to decrease : - the risk of behavioral disorders - the risk for a multi-stressed family to become a dysfunctional one 3. social services role in supporting families to manage stress in their lives.
  • 6. Stress and family stress • The term of stress has enjoyed growing popularity • The number of articles on stress and mental disorders increased rapidly • Family stress represents the imbalance (real or imagined) between: 1. demands faced by the family 2. the family's ability to adapt to those demands (McCubbin, I.H., Sussman, B.M., Patterson J.M. 1983)
  • 7. Stressed family • Madsen W. proposes an alternative to the traditional description of struggling families • suggesting to specialists: - to see family members as distinct from issues in their lives - to discover resources available beyond these issues • the concept of stressed family is a more appropriate label and defines : - the difficult reality of families lives - the capabilities, skills and resources that families can access to face this pressure or stress
  • 8. Family stress  Many families experience a number of symptoms in a given time  Distress occurs when the family is living with these events continuously over a long period of time - Parental stress is associated with : parent's individual emotional problems (anxiety, depression etc.) - attributes of the child (behavior problems etc.) - dysfunction in the parent-child relationship
  • 9. Parental stress • causes damage in the quality and effectiveness of parental behavior (Deater-Deckard, K., 2004) such as: - reduction in the expression of warmth and affection - harsh methods of discipline - increased expression of hostility in the relationship with the child - poor parental behavior consistency - complete withdrawal from parental role - emotional and behavioral problems of parents (aggression, noncompliance, anxiety and chronic anger) - the occurrence of abuse or child maltreatment
  • 10. Children’s needs in stressed families • Family disstress have a major impact on: - children's development - theirs social relations, behavior,emotions • Impact on : a. young children : -recurrent diseases -extremely irritable -may adopt hyperactive behaviors b. School-age children: school performance c. Older children : problems with school performance, behavior problems in school or leave school.
  • 11. • In assisting parenting resources, the educator examines the ability of parents to meet the basic needs of children • For raising a healthy child it is need guiding limits and loving, compassionate care. • Relationships that a child will have in later life are built on previous experiences that a child has with his parents • The child who did not received early educational interactions with his parents will have difficulty in building friendships and in overcoming the ups and downs that should be expected in future relationships with his peers (Brazelton T.B., Greenspan S.I., 2013)
  • 12. Adapting to family events • a complex, dynamic, multidimensional process • each family member having its own : -dynamics of emotional and behavioral adjustment -resources and coping strategies • involve, in varying degrees, all family members
  • 13. Individual and family educational interventions for stress management • The desired outcome for children and families is to regain and maintain the best physical, emotional and vocational condition. • Stress management strategies and methods have one of the following objectives: to identify, avoid or eliminate stressors to recognize and minimize negative emotions to reduce the intensity of emotions and build emotional reserves relaxation response in the body and reduce exposure to stress changes in lifestyle and building of reserves in the body -
  • 14. Interventions for family stress management • Health education with families • Social work and family counseling • Family therapy • Support groups
  • 15. Health education • Health education is a multidisciplinary approach that aims to : -change health risk factors through lifestyle changes -improve functional capacity, self-confidence -reduce psychological distress • Health education programs, primarily addressed to children and their families, are very few in Romania
  • 16. • A very important method in adaptation to stress is : identifying emotions expressing them restore emotional reserves • Only a person in emotional balance can look towards needs of others, showing solidarity • Health education which targets multi-stressed families refers to emotional health which means that a person: is able to cope with stress as to keep emotional balance in stressful situations remain flexible negotiate or make concessions in conflict situations -
  • 17. Family health education • In dealing with stressful situations, health education services concern two major components: 1. The educational content – a philosophical dimension (What we know?) - what kind of information is necessary for a better understanding and awareness of the phenomenon of family stress - refers to the information content provided by psychological and sociological health sciences - provides knowledge about the history and research on stress family and human health 1 2 2. The educational process - a practical dimension (What we could do ?) - aimed at forming behaviors and skills using behavioral sciences - skills and resources that can be useful in adapting to stress ​ - training techniques for developing individual and family resources (Bedworth A.E./Bedworth D.A., 1992)
  • 18. Educational process • Health education should be : -easily understandable -individualized to meet specific needs • Using several ways, depending on : - the educational objectives - needs and learning styles of the target children/parents • The methods used in the practice of health education can be focused : - on the educator (teacher, social worker, counselor etc.), some of which are: lecture, demonstration, case study and simulation. - on groups of participants such as brainstorming, small group work, role-playing technique or aquarium.
  • 19. • - Learning at children is based on the use of: games books stories simple words • - For preschool level children is recommended to use educational methods such as: role playing imitation involvement (asking questions) simple explanations using psychomotor skills and discussions • For teenagers collaboration and problem solving • Adult (independent and self-centered) learning has more success if they: -use their experience to solve problems -collaborate, talk or to perform certain activities.
  • 20. Health promotion • Goals achieved through the public information aimed in a particular community • local authorities can plan and provide health education strategies for -the entire community -specific community groups (children, youth, parents) • use of media and other techniques • these educational strategies for health promotion can be included at the primary level counseling and social services for children, youth and families in the community
  • 21. Social work and social counseling • Family counseling is practiced in local welfare departments • • Social workers are participating in marital and family counseling in a variety of agencies and organizations, both public and private. Meanwhile, social workers - an important role in private agencies and family counseling services which are offered to improve the quality of life for families (Skidmore, A.R., Thackeray, G.M., Farley, O.W. 1997) • Social counseling and the teaching/learning process take place as a whole • The process of social counseling made by social worker includes the steps of : 1. initial evaluation of learning needs 2. social/psychosocial diagnose 3. planning for learning 4. implementation of the plan 5. evaluation of the results of teaching/counseling process
  • 22. Family Counseling • A type of intervention with children and families affected by stress • A type of brief psychotherapy that can help the families or their individual members to gain better relationships promote understanding among family members - • assumes sharing information, sending and receiving of knowledge, ideas and theses that are important for successful communication within the family and in resolving problems.
  • 23. • Families may have many coping skills to stress • For example, the family members are satisfied with their current way of life when: do things together as a family they are careful that each family member improves self-esteem the family develops community support networks family members respect each other lifestyle choices • Family counseling should include the entire husband-wife-children group. • - For example, a family counselor can help parents : become aware of the child's emotional and behavioral reactions to know how to speak to children about parents problems without exacerbate feelings of guilt or loyalty sharing keep their personal worries and concerns for themselves and not overload children with emotional inadequate disclosures or responsibilities. -
  • 24. Parental counseling • a family counseling component • set of preventive measures and direct support to family members aimed to increase proper care and education of parents. • In assisting parenting resources, a counselor examines parents' ability to meet the basic needs of their children • - provides favorable actions to : strengthen parental roles in education to maintain family cohesion, mainly in the sphere of concerns with facing the educational function and building attitudes and parenting and family skills
  • 25. Family therapy • Is required: - if the stress is not resolved - if chosen coping strategies are inadequate - when individual and family resources are scarce - family stress progresses into family crisis • - - Family therapy services were established and developed in developed countries in the civil service system for families have expanded into the public system can be achieved by the family through complex services provided by multidisciplinary teams consisting of family therapists, doctors, social workers, psychologists, lawyers etc. offer today increasingly focus on * a comprehensive bio-psycho-social approach to problems * how these issues affect relationships and behaviors within families
  • 26. • The family stress management counseling is a cooperative process. • Therefore, before deciding if a family needs help and could get adequate support from a family therapist, the counselor will have to build a relationship with family members in order to understand their worries, asses the magnitude of their difficulties, needs, skills, resources and weaknesses. • Family therapy is : - a restructuring of family relationships - which is done in time - with systematic actions - based on specific techniques that grant interpersonal skills - that allow full development of the family members. (Nichols P.M., Schwartz, C.R., 2005 )
  • 27. Collaboration * involves recognition of the expertise of all parties involved * family members are the best experts in their lives * when this experience is known and clarified, they are able to change * counseling which involving respect : - process of knocking on the door and wait to be invited in, rather than to destroy the door to enter by force and then expect to be received with open arms (Alan Jenkins,1996) - collaborative process that emphasizes abilities, skills and knowledge of both parties
  • 28. • Counselors have expertise in creating contexts that support family members in finding their opportunities and developing resources to cope with problems • "watch people more compassionately and less suspiciously“ • Appreciative alliance expression refers to the position that allows family members to experience the fact that the specialist is on their side (Epston D., 1999)
  • 29. • The objectives of family therapy are: - effective resolution for problems faced by the family in everyday life dealing with situations of transition in the life cycle of the family and facilitating adaptation to changes imposed by these assisting individuals to be aware of certain needs, emotions, negative thoughts, behaviors and problematic situations listening, understanding and accepting feelings of inadequacy of the people involved in the counseling process identifying the causes of problematic situations, as well as finding alternative solutions promoting family well-being in harmony with their needs improving the family environment solving communication disruptions finding best approach regarding the common tasks and role, improving functionality of the system clarifying the issues affecting the family that require a concerted group effort to be solved children can learn to do well in school, to verbalize their feelings family can learn constructive ways to support them, removing those who undermined functionality and caused anxiety -
  • 30. Support groups • Another kind of intervention with multi-stressed family • A support group is an indispensable method of helping clients/families to deal with loads of issues while adapting to new and unexpected situations • A support group is an essential method to help children/families face the task of adapting to new situations • Is an educational process that focuses on development and social adaptation of an individual through voluntary association in a group and using this association as having the significance of other socially desirable finalities
  • 31. • is a tool that helps children with behavioral disorders to prepare for reintegration and participation in community life • parents can be directed to community support groups to help them cope with their emotions and reactions, subsequently providing maximum understanding for their children • the purpose of the group can be described based on the following aspects: declaration of the problems, symptoms and present concerns identification of the aspects of normal development of a child a goal of all group members to become better informed and prevent problematic behaviors by acquiring clear information or by learning problem solving skills (Malekoff A., 2004) -
  • 32. Conclusions • • • The medical and social systems of Romania present gaps such as lack of specific forms of support for multi-stressed families the rudimentary health education among a significant part of the population results in reduced usage of preventive services some of the priorities in the field of stress management care may be the following: - education of children from multi-stressed families through development of educational and counseling programs that encourage healthy lifestyles with a focus on maintaining health -awareness regarding the needs of children -change of attitude towards stress from considering it something unavoidable towards regarding it as a distress that could be prevented -use of multiple channels to transmit messages -education of professionals by developing continuous educational programs for family physicians, educators, social workers, family therapists who provide preventive and counseling services, including how these programs can be integrated into their practice -training of parents and specialists to improve networking and communication skills with children etc.
  • 33. Solidarity and creativity • two important features of a society in which family education and intergenerational learning are key interventions • can be hardly found ​ in families that fail to manage stressors that put pressure on them • can be developed only in families who preserve authentic relationships based on love and mutual respect