Unconditional Care: Relationship-Based, Behavioral Intervention with Vulnerable Children and Families Book

Introduction xv

1 Relationship and Engagement as Treatment 1

Opportunities for Engagement 4

2 Strengths and Risk Factors of Children with Intensive Needs 9

Risk Factors and Vulnerabilities 9

Strengths, Protective Factors, and Exceptions 25

A Final Note on Assessment, Treatment Planning, and Intervention 27

3 Attachment 28

Some Examples of Relationship in Practice 28

Commonalities of the Case Examples 30

Attachment Principles of Assessment and Intervention 31

Relationship, Attachment, and the Development of Psychopathology 47

From Attachment Theory to "Relationship-Based Intervention" 56

4 Assessment, Diagnosis, and Case Formulation 63

History of the Child and the Parents' Attachments 68

Current Relationships as They Emerge in Program 68

Traumatic Events 70

Strengths of the Child and the Family 70

Adaptive Capacities 71

Other Observational Categories 73

5 Relational Assessment and Intervention 77

Underlying Assumptions in Two Diagnostic Models 78

Assessment and Description of the Internal Working Model 81

The Child's Experience with Caretakers 85

The Child's Current Interpersonal Behavior 97

Relational Intervention: Using the Description of the Child's Internal Working Model to Drive Treatment 107

6 Positive Behavioral Intervention 113

Behavioral Intervention and Relationship-Based Work 114

Why Do Behavioral Intervention? 116

Methods of Behavioral Intervention 119

The Behavior Itself 120

Useful Dimensions for Describing Behavior 122

Criteria for Evaluating Descriptions 124

Behavioral Assessment I: How Much of the Behavior Is Happening? Does It Meet a Defined Standard? 126

Behavioral Assessment II: Attempting to Discern the Function of Behavior 128

The Questions that Drive a Functional Analysis 130

Key Ingredients in Implementing Positive Behavioral Change 136

General Considerations on the Use of Negative Consequences 151

7 Phases of Treatment and Key Activities 153

Preintake and Initial Screening 154

Assessment 155

Behavioral Intervention 163

Relational Assessment and Treatment 169

The Treatment Process Flowchart 173

8 Case Illustrations of the Model 176

The Case of David S. 176

The Case of Sarah P. 202

Afterword

A Note Regarding Values 229

Love and Compassion 230

Respect 231

Curiosity 231

Hope and Courage 232

Joy 232

Appendices 235

Appendix A Relational Assessment Worksheet 235

Appendix B Relational Treatment Plan 239

Appendix C Target Behavior Definition Form 240

Appendix D Behavioral Assessment Planning Worksheet 243

Appendix E Observation Form-Frequency 247

Appendix F Observation Form-Intensity 248

Appendix G Observation Form-Frequency/Duration 248

Appendix H Observation Form-Duration 249

Appendix I Functional Assessment Worksheet 250

Appendix J Client Variables Form 255

Appendix K Functional Behavior Assessment Form 257

Appendix L ABC Observation Form 257

Appendix M Behavior Log 258

Appendix N Replacement Behavior Worksheet 259

Appendix O Behavioral Treatment Plan Worksheet 261

Notes 265

References 267

Index 275