The community counseling model is utilized to develop a plan of action that will assist a family in moving toward healing and recovery. Two counseling sessions have been conducted and based on the information gleaned, a cohesive treatment strategy has been developed for the entire family using the community counseling approach. Best practices in traumatology are considered and cultural considerations are presented. A Biblical worldview of people and their inherent value is the cornerstone upon which all considerations of resources for the family are presented. The ecological perspective in community counseling calls for a critical evaluation of the multiple effects that could be causing the presenting issues (Stelzner & Wielkiewicz, 2015). In light of this paradigm, a consideration of context which includes the individual family as well as the family in the context of community leads to a wide variety of resources presented for the family to move forward in healing and recovery (Stelzner & Wielkiewicz, 2015).
Introduction to the Williams family
The Williams family is composed of Jeff, Sandy, Jacob, and Leo. Jeff and Sandy have been married 21 years. Jeff owns his own used car business and Sandy has been a teacher’s aide at a local elementary school for 10 years. Jacob is 18 years old and Leo is 15 years old. Jacob was diagnosed with Asperger’s syndrome several years ago.
Case Conceptualization
Sandy called for an appointment, citing family issues and couple conflict between her and her husband. Jeff has been enduring financial difficulties due to his business struggling during the downturn in the economy. These financial difficulties are putting extra pressure on the family and adding to the anxieties already present. Jeff has taken up drinking when he gets home from work until he goes to bed, with very little recollection of his behavior or conversations during those times. This has caused conflict between him and Sandy. Adding to this conflict is that Jeff reacts angrily towards Jacob’s behavior as it is related to his disorder, while Sandy becomes angry and sad with Jeff for his reactions toward Jacob. The couple feels lonely and alienated from family and friends and they believe it is due to Jacob’s disorder. They also feel the school system has not done enough to help either of their sons.
Additionally, the children are suffering. Jacob suffers from depression and overall sadness. He is present in counseling but disengaged and silent, staring at the floor and rocking back and forth. He feels alone, misunderstood, and struggles with any kind of social engagement. He has been socially alienated due to his awkwardness over the last 4-5 years. Attempts to engage him in therapy result in him becoming agitated and screaming. Jeff and Sandy do not understand Jacob’s behavior, lack of social skills, and lack of empathy. Leo is also distant and disengaged from his family. Attempts to engage him in therapy result in short, disengaged comments. He reports increasing frustration over the last few years. His grades in school have also been declining, going from a B to a D average over the last couple of years. He also has very few close friends.
Community Counseling Services Provided
Several services are available for the family, both directly from the counselor as well as in collaboration with organizations in the community. Working directly with the family, the counselor can provide Listening Visits (LV), biopsychosocial education, conflict resolution, empowerment, and cultural awareness. In collaboration with organizations in the community, the counselor can aid in making connections with the family and a local church, alcoholics anonymous, financial management, the school system, and an Asperger’s connect group. All of the services considered are rooted in recognition of a trauma-informed approach. Of critical importance regardless of services provided is the adherence to a cross-cultural informed approach, in which the counselor is willing to humbly abandon assumptions and seek to understand the individuals in the family (Lee, 2015).
Direct Services Provided
Listening Visits
Every member of the Williams family is coping with Jacob’s diagnosis and subsequent changes in family life differently. To aid with understanding and coping with the emotions they are experiencing, an approach such as LV could be beneficial, especially for Sandy (Brock et al., 2017). With this approach the counselor can incorporate visits to the family for which the only goal would be to listen to their concerns and respond empathically. Not only would it be beneficial in improving the sadness and depressive symptoms of the family, but LV could also help the counselor understand the family dynamics better and therefore offer a more competent treatment strategy (Brock et al., 2017). In doing this, the counselor can also offer to meet the extended family and provide psychosocial education and environment needed to increase comfort in the social situation in the home.
Biopsychosocial Education
Parents who have a child with autism spectrum disorder (ASD) tend to experience greater levels of stress, have a lower level of satisfaction in their marriage, and undergo high demands in childcare (Rankin et al., 2019). Yet, it was also found that when parental responsibilities are distributed in an equal manner among the mother and father, levels of stress are decreased and marital satisfaction increases (Rankin et al., 2019). Although the majority of research on paternal involvement in families with children with ASD is limited to young children rather than adolescents as with the Williams family, it may nonetheless be beneficial to inform the family, especially Jeff, of the role of fathers in children with ASD (Rankin et al., 2019). For example, it may be beneficial for both fathers and children with ASD to improve paternal involvement in interventions, especially when teaching fathers how to encourage social skills and engagement in their children (Rankin et al., 2019).
Conflict Resolution
Much of the conflict experienced in the family is very likely due to repeated trauma from Jeff’s alcoholism and Jacob’s diagnosis. Rounsaville et al. (2014) stated that children of alcoholics (COAs) can have significant personality disorders, however when fathers entered treatment and abstained from drinking and attended Alcoholic Anonymous (AA) meetings, children returned to levels of functioning compared to those without an alcoholic parent. The researchers also found that exposure to conflict was significantly decreased after treatment and therefore the COAs emotional wellbeing also improved (Rounsaville et al., 2014). These findings point to the possibility of reducing conflict within the marriage if Jeff is willing to enter into a treatment protocol for his drinking problem. Rounsaville et al. (2014) also state that discussions regarding conflict and its adverse results should occur in the presence of the children.
Education on the positive side of conflict has the potential to move the family towards a better way of handling conflicting situations. Some benefits of resolving conflict properly include developing new methods for dealing with conflict and emergence of a stronger relationship (Davis Jr., 2002). Therefore, treatment goals include understanding each family member’s style of conflict management, bringing awareness of conflicts so they are properly addressed, and learning to communicate effectively (Davis Jr., 2002).
Empowerment
The counselor can work collaboratively with the family to identify their strengths and needs, while intentionally prioritizing their abilities to make decisions for their family, with the intention of maintaining an ecological model as a guiding principle (Bruns et al., 2010). By adopting the wraparound process, the counselor chooses to coordinate a plan of care collaboratively, empowering the family by supporting them and addressing barriers to success in treatment (Bruns et al. 2010). Additionally, empowering the father to take a more active role in the family can also promote higher levels of functioning in a family with a child diagnosed with ASD (Rankin et al., 2019).
Cultural Awareness
Part of embracing cross-cultural competency in services includes bringing awareness to the parental involvement in the everyday life of the family, so as to address the gender-norms typically present in society (Lee, 2015; Rankin et al., 2019). With the William’s family in particular, it could be beneficial to point out the differences in how each of the parents handle the difficulties and then to explore how they can learn from each other. Although fathers’ involvement has been shown to be diminished in children with ASD compared with children with other kinds of disabilities, research has also pointed to increased benefits to those families in which the father has taken an active role in the children’s intervention (Rankin et al., 2019). Therefore, after empowering Jeff to step up to a more involved family role, he can also be encouraged to step out of traditional gender roles in which the mother is considered the first most caregiver and become more involved in child rearing (Rankin et al. 2019).
Trauma-Informed Approach
The Substance Abuse and Mental Health Services Administration (SAMHSA) prepared a report on guidance for a trauma-informed approach (SAMHSA, 2014). According to SAMHSA (2014), trauma results from exposure to a traumatic event, how the individual experiences the event, and the effects it has on the individual’s well-being. To guide the trauma-informed approach, four assumptions and six principles were developed. This trauma-informed approach includes interventions, such as assessment and treatment, yet also focuses on the main assumptions and principles (SAMHSA, 2014). The four assumptions are comprised of realizing the impact of trauma and paths for recovery, recognizing signs and symptoms of trauma, responding by integrating trauma information into practice, and resisting re-traumatization by being aware of the environment (SAMHSA, 2014).
To embrace a trauma-informed approach, the six principles of (a) safety; (b) trustworthiness and transparency; (c) peer support; (d) collaboration and mutuality; (e) empowerment, voice, and choice; and (f) cultural, historical, and gender issues can be addressed with the family in counseling (SAMHSA, 2014). In essence, awareness and adherence to these principles and assumptions need to be modeled by the counselor so that the family can begin to develop their own awareness of trauma as well as apply the principles in their own lives and with those they come into contact with in the community.
Services Provided in Collaboration with Other Organizations
Local Church
In collaboration with Jeff, the counselor can explore his willingness to enter into the Twelve Steps with Godly Principles program (Hampton, 2002). Each step focuses on the spiritual disciplines of confession, self-examination, conversion, obedience, repentance, honesty, forgiveness, rededication, sanctification, and witnessing (Hampton, 2002). Hampton (2002) states that in understanding these principles, the addict can be truly delivered and free. In collaboration with a local church of their choice, these principles can be further elaborated on and understood. In church community, Jeff and the rest of the family can find the support they have been lacking. With regards to church recommendations, the counselor can present many alternatives since there is an active church community in Miami, FL. Further information is needed to determine which would be a best fit for the family.
Alcoholics Anonymous
Due to COVID-19, Alcoholics Anonymous (AA) groups have been meeting online through the Zoom platform (Alcoholics Anonymous, n.d.). Due to this new format, Jeff could participate without the added difficulty of being in a meeting physically. This could be a positive aspect, since it might encourage higher participation rates. After discussing his drinking and how it is affecting the family, adding this free and available resource in the community has the potential to cause needed changes.
Financial Management
Financial hardships being experienced by the family due to extenuating circumstances of the economy is compounding the stress they are already undergoing. It would be beneficial to acquire some personal finance education that can set the family in a better course. Consumer Credit Counseling Services (CCCS) is a nonprofit organization that provides such education for free (Consumer Credit, n.d.). Courses, which are available online, include (a) understanding your credit report; (b) creating a budget 101; (c) roadmap to financial freedom; (d) wise use of credit; (e) power of paycheck planning; (f) budget 911; (g) identity theft prevention; and (h) preventing foreclosure (Consumer Credit, n.d.). Taking advantage of this resource can provide the needed skills in managing spending behaviors and financial responsibility.
School System
Sandy and Jeff report being frustrated with the school system and feel the system is not doing enough to help either of the children. Education regarding the options available in the local public school has the potential to empower the parents in advocating for their children. Specifically, with Jacob being diagnosed with Asperger’s, Jeff and Sandy can learn about Section 504 of the Rehabilitation Act of 1973 and the protections it offers (Miami-Dade County Public Schools, n.d.). After evaluations, a Section 504 Plan is completed which requires the district to comply with its requirements (Miami-Dade County Public Schools, n.d.). The 504 Coordinator is identified in the school and a 504 Team is assigned to the student. This coordinator is often times the Assistant Principal (Miami-Dade County Public Schools, n.d.). In addition to Section 504, parents should also ask about the Individuals with Disabilities Education Act (I.D.E.A.), since this could also help them understand the rights they have as a parent of a child with special needs (Miami-Dade County Public Schools, n.d.). Parents should become familiar with the Individualized Education Program (IEP) and monitor their child’s education to ensure adherence to the IEP (Florida Health, 2020). Any time a parent feels that the child is not making progress, a meeting can be arranged to review and revise the IEP (Florida Health, 2020). It is in this moment that the counselor can join the clients in support of advocacy for the children and their wellbeing by speaking to teachers, administration, or counselors in the school.
Another option with regards to schooling is placing Jacob in charter or private schools tailored for his special needs. South Florida Autism Charter School is located in 18305 NW 75 Place, Hialeah, Florida 33015 (South Florida Autism Charter Schools, 2017). They can be contacted at (305) 823-2700. Parents with a child enrolled in this school must participate in four Parent Training Sessions, one per semester; and complete a minimum of thirty volunteer hours per school year. This school is free and has open enrollment, since it is a charter school. Eligibility is met when the student has been diagnosed with an Autism Spectrum Disorder (ASD), has an IEP which reflects eligibility for ASD services, be on a modified curriculum, and have either behavioral difficulties, a communication deficit, or require training in self-care skills. Applications can be downloaded from their website (South Florida Autism Charter Schools, 2017).
A private school option is The Victory Center, located in 18900 NE 25th Avenue, North Miami Beach, Florida, 33180 (The Victory Center, n.d.). They can be contacted at (305) 466-1142 or office@thevictoryschool.org. This school is dedicated for students who have been diagnosed with autism and specializes in providing a very low student-teacher ratio of Applied Behavioral Analysis interventions in all classrooms (The Victory Center, n.d.). The admissions process includes completing a student application form, scheduling a tour and evaluation, and if determined eligible, beginning the enrollment process. Jacob’s age would place him in the Vocational Program which focuses on teaching students ages 14-22 essential skills in the transition to adulthood and independence. It also provides community-based instruction, job training and placement. Financial assistance is available through the Mckay Opportunity Scholarship, the Gardiner Scholarship Program, and the Victory Center Scholarship Program (The Victory Center, n.d.).
Support for Students Growth Center provides services for social skills, counseling and behavior, executive functioning, in-home services, and readiness programs (Support for Students, 2021). It is located in Boca Raton, Florida, which is a short distance drive of about forty-five minutes to an hour away, however, they provide online tutoring, coaching, therapy, and counseling. A program that would be beneficial for Jacob is the Online Therapeutic Social Skills Group which meets between 12-14 times and each meeting costs $80, with an additional fee for new clients (Support for Students, 2021).
Based on the trauma Leo is undergoing due to his brother’s diagnosis and the current family dynamics, Jeff and Sandy can also choose to seek help from the school by means of the school counselor and meetings with teachers. Once they have gathered awareness of their issues, they can better assist and advocate for their children in school. It is important for them to pay close attention to Leo’s issues, since he likely feels a heavy burden which he seems to be internalizing. The level of conflict in the home is likely handled very differently by each family member, and therefore more exploration of Leo’s experience is needed so that his outward manifestations can be better understood and helped (Davis Jr., 2002).
Asperger’s connect group
Support groups can provide the much-needed social experiences the whole family needs. The closest support group in the area is called Parent to Parent of Miami and is located at Sunrise Community, 9040 Sunset Dr., Suite G, Miami, Florida 33173. Phone numbers are (305) 271-9797 and 800-527-9552 (Parent to Parent, n.d.). Other ways Parent to Parent of Miami can be of assistance is by providing education about the disability, awareness of services in the community, networking with other parents, I.D.E.A information, education on the kind of environment needed at home, and information on policy and legislative issues relevant to families with children with disabilities (Parent to Parent, n.d.).
Trauma-Informed Approach
At the community level, implementing a trauma-informed approach includes the domains of (a) governance and leadership; (b) policy; (c) physical environment; (d) engagement and involvement; (e) cross sector collaboration; (f) screening, assessment, treatment services; (g) training and workforce development; (h) progress monitoring and quality assurance; (i) financing; and (j) evaluation (SAMHSA, 2014). Paying close attention to the key principles and domains in developing a trauma-informed approach for the Williams family provides the ability to understand and process their current issues. Therefore, attending both to the individual trauma and the trauma that results from the community lacking the proper avenues through which to assess and aid those who may be enduring multiple difficult situations provides the opportunity for a treatment plan that is based on an ecological perspective.
Conclusion
Although the family has had to endure difficult moments, the community has many resources to come along side it and provide needed support. Maintaining an ecological perspective in treating this family leads to the consideration and usage of multiple venues of help. It also allows room for choice and therefore increased collaboration between the counselor and family.
Ideas for Future Research
Further research is recommended for the understanding of Asperger’s syndrome and its placement in the ASD continuum. Additionally, more information on Applied Behavioral Analysis could be beneficial for the overall health of the family as they learn to properly handle outbursts and reduce conflict.
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Discerning Trauma 