Presentation given by Sharon Law, M.A., M.F.T.
5th World Congress for Psychotherapy - Beijing, China
October 14, 2008
Presentation Text
_______________________________________________________________________
Applying the Systemic
Approach in Treating Children
& Adolescents At Risk in the
United States
以系统理论介入美国处於危机
状况的儿童及青少年
第五届世界心理治疗大会 中国北京 二零零八年十月十四日
5th World Congress of Psychotherapy, Beijing, October 14, 2008
1
_______________________________________________________________________
Presenter:
Sharon Law, M.A.
Marriage & Family Therapist
Los Angeles California, USA
罗秀嫦
美国加州婚姻及家庭治疗师
美国加州洛杉矶
www.SharonLawMFT.com
2
_______________________________________________________________________
Children’s System of Care Service:
A model for systemic intervention
美国加州儿童系统性关顾服务:
系统理论介入的范例
• Targeted for seriously emotionally disturbed
children/youths who are at risk of being
removed from their home once again due to
abuse/neglect, criminal offense, repeated
hospitalization, runaway, etc.
为患有重性情绪问题并处於危机状况儿童及青少
年提供服务，因应问题情况而可能再次被迁离家
庭, 例如: 身体/心理受虐、离家出走、重覆住院及
干犯法律
3
_______________________________________________________________________
Children’s System of Care Service:
A Brief History
美国加州儿童系统性关顾服务: 历史
• The Children’s System of Care model was
developed and piloted in 1984
儿童系统性关顾模式於一九八四年开始建立及
运作
• California’s funding in 2003-2004 for the
Children’s System of Care program was $20
million USD
於二零零叁年至四年期间，此计划於美国加州获
得政府二千万美元资助
4
_______________________________________________________________________
What makes this service so special?
此计划的独创性
Traditional Medical Model
传统医疗模式
Government money is primarily
allocated for Institutional Care
政府资金主要流向住院性服务
Individualistic Intervention
-- Focus is on identified patient
个人化辅导介入模式
Clinic-based / Office-based Intervention
以服务提供地点为本作出介入
Therapist is in charge of making
treatment decisions
治疗师主责治疗方向及相关决定
Children System Care Service Model
儿童系统性关顾模式
Government money is primarily focused
on Community Care
政府资金主要流向地区为本服务
Systemic Intervention -- Collaboration
with families and across departments
系统性介入模式--家庭与不同系统及服务
部門合作
Community-based Intervention
社区为本介入 – 为接受服务者所在区域
作出介入
Clients, families and the therapist are all
in charge of treatment decisions
当事人, 家庭及治疗师共同负责治疗方向
及相关决定
5
_______________________________________________________________________
Teamwork: Collaboration
between multiple teams
团队合作
• Child and Family Team (Family System)
儿童及家庭团队 (家庭系统)
• Inter-department Team (Community System)
跨部門团队 (社区系统)
• Treatment Team (Therapy System)
治疗团队 (治疗系统)
6
_______________________________________________________________________
A Wrap Around Treatment Team:
24-7 availability
全天候治疗团队: 24小时服务
• Team Leader (My role) 团队主任 (本人)
• Therapists 治疗师
• Case Managers 个案经理
• Parent Advocate 家长倡导
• Psychiatrist 精神科医生
• Department Liaisons (Probation Dept., Child
Protective Service, Dept. of Mental Health)
部門联繫 (例: 感化部門、儿童保护科、精神健
康部門)
7
_______________________________________________________________________
Case Study 个案研讨
• Steve, Male age16 Chinese-Korean American
史提夫、男性、16岁、美籍中国及韩国混血儿
• Severe anger outbursts at home and at
school (choking mother, threats, vandalism)
在家庭及学校表现出严重发怒的行为(例如: 用手
揑著母亲的颈项并要胁杀人及毁坏公物))
• Repeated police arrests; locked up in juvenile
hall; now on probation
被警方重覆递捕: 曾经被监禁在儿童监狱，现正
守感化令
8
_______________________________________________________________________
Case Study: Steve
个案研讨: 史提夫
• Major generational conflicts with
immigrant parents
与移民父母出现两代代沟及衝突
• At risk of being sent back to juvenile hall
again if his behavior does not improve
若史提夫行为持续倒退，他将会被再次关
进儿童监狱
9
_______________________________________________________________________
Case conceptualization:
Three guiding principles - 个案分析: 叁个重要原则
• Systemic thinking: How do different systems
cooperate to respond to Steve’s situations?
系统概念思考模式: 系统间怎样相互合作处理史
提夫的状况?
• Developmental Theory: What are the child
and family reaching for in their life stages?
生命週期理论:孩子与家庭正处於甚麽生命阶
段?
• Contextualism: Impact of immigration and
ethnic minority experience?
处境化: 是否受著移民及弱势种族经验影响?
10
_______________________________________________________________________
Facilitating the Optimal Fit Between
Child & His Family
促进史提夫与父母间的最大合作
• Understand Steve’s perspective: “My Parents
are stupid & crazy”
掌握及明暸史提夫的立场: 「我的父母实在愚蠢及
癫狂!」
• Understand parents’ perspective: “Steve is
impulsive, irresponsible and shameful”
掌握及明暸家长立场: 「史提夫实在是衝动及不
负责任，而他的行为实在可耻!」
11
_______________________________________________________________________
Facilitating the Optimal Fit Between
Child & His Family
促进史提夫与父母间的最大合作
• Intensive Family Therapy: Helped Steve and
his parents recognize each other’s needs and
respect each other’s boundaries
针对性及深入式家庭治疗: 协助史提夫及其父母
瞭解及肯定彼此的需要及学习尊重彼此的界限
(例: 定时回家、私隐、文明沟通、不可动武)
12
_______________________________________________________________________
Facilitating the Optimal Fit Between
Family & School
促进家庭与学校间的最大合作
• Understand School’s perspective: “Steve is a
trouble maker with a criminal history”
掌握及明瞭学校立场:「史提夫是个问题儿童，并
且犯案累累!」
• Understand Family’s perspective: “School
only identified problems but did not help.
Steve was failing school”
掌握及明瞭家庭立场: 「学校只管投诉，却没有作
出任何协助，这才致令史提夫一败塗地」
13
_______________________________________________________________________
Facilitating the Optimal Fit Between
Family & School
促进家庭与学校间的最大合作
• Mediation work: Mediated between Steve, his
parents, school system and School District
Board
调解工作: 协助史提夫，家长 ，学校及校区委员
会进行调解
• Advocacy work: Changed Steve to a different
school that provides special accommodation
倡导工作: 协助史提夫转学至另一所学校，而新
校能为史提夫提供更佳环境以协助他适应
14
_______________________________________________________________________
Facilitating the Optimal Fit
Between Family & Juvenile System
促进家庭与感化部門间最大合作
• Understand Probation Officer’s perspective:
“We will lock him up if Steve gets out of
control”
掌握及明瞭感化官立场: 「若史提夫再次失控，我
们必会关禁他!」
• Understand family’s perspective: “We do not
want Steve to go to jail again”
掌握及明瞭家庭立场: 「我们不想史提夫再被关进
牢房!」
15
_______________________________________________________________________
Facilitating the Optimal Fit
Between Family & Juvenile System
促进家庭与感化部門间最大合作
• Intensive behavioral management: Help
family to apply proper rewards and
discipline to motivate behavioral changes
in Steve.
针对性行为治疗管理: 协助家庭实践适当奖励及
执行纪侓，促使史提夫作出行为改变及遵守感
化令
16
_______________________________________________________________________
Benefits of Facilitating an Optimal Fit
促进系统间最大合作的果效
• Significant improvement in children’s and
parents’ ability to negotiate conflicts
父母与子女建立处理衝突的能力
• Improvement of school attendance and
performance
改善在学出席率及表现
17
_______________________________________________________________________
Benefits of Facilitating an Optimal Fit
促进系统间最大合作的果效
• Avoidance of institutional care
避免住院性照顾(例如: 儿童监狱、精神病院、儿
童院等)
• Substantial cost savings to government
国家支出明显地减少
18
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• 23 “severe” cases were referred to the
Children’s System of Care program
二十叁个重性个案被转介至儿童系统性关顾服务
计划
19
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• Before any intervention, all of these cases
were children or youths who have been
removed from their homes multiple times to
jail, hospital, child protective service, etc
在介入前，所有儿童及青少年个案皆曾经从家庭
处被迁离，他们来自监狱、医院及儿童保护服务
20
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• After 6 - 12 months of intensive systemic
intervention, only 3 child/adolescent clients were
removed again from their home, a total of 20
children/adolescent clients were able to function
well within their families and the community. They
met their treatment goals and were discharged.
透过为期六至十二个月的针对性系统介入，只有叁
个儿童/青少年个案需要重新被迁离家庭，共有二
十个儿童/青少年能够在家庭及社区内正常生活。
其後他们皆因为治疗目标已达而悉数被终结。
21
_______________________________________________________________________
Major reform of the mental health
system in California
美国加州精神健康政策改革
• California’s Mental Health Service Act law
passed in 2005 provides significant funding for
community-based systemic programs for
severely mental ill of all ages. Approximately
3.6 Billion USD in funding have accrued as of
May, 2008
精神健康法例於二零零五年通过议案大幅支援以
社区为本的系统模式介入服务，统计於由二零
零五年至零八年五月合共拨款叁十六亿美元以
协助患有重性精神健康疾病的任何年龄人士
22
_______________________________________________________________________
Conclusion: Systemic focus maximizes
benefits for both individual and environment!
结论: 系统介入为个人及环境提供
最大效益!
Individualistic perspective
从个人辅导角度出发
Problems are situated within the
individual. The focus is on improving
individual ability to cope with outside
environment.
问题焦点在於个人 ，辅导工作以协
助个人建立适应生活环境的能力为目标
Systemic perspective
从系统介入角度出发
Problems are situated between
different systems. The focus is on
promoting the best fit between the
individual and the environment.
问题焦点在於系统间怎样相互合作，
辅导工作以协助个人及环境间达到
最大助益及互利互惠为目标
23
_______________________________________________________________________
Thank You Very Much!
谢谢大家!
_______________________________________________________________________
End
_______________________________________________________________________
Applying the Systemic
Approach in Treating Children
& Adolescents At Risk in the
United States
以系统理论介入美国处於危机
状况的儿童及青少年
第五届世界心理治疗大会 中国北京 二零零八年十月十四日
5th World Congress of Psychotherapy, Beijing, October 14, 2008
1
_______________________________________________________________________
Presenter:
Sharon Law, M.A.
Marriage & Family Therapist
Los Angeles California, USA
罗秀嫦
美国加州婚姻及家庭治疗师
美国加州洛杉矶
www.SharonLawMFT.com
2
_______________________________________________________________________
Children’s System of Care Service:
A model for systemic intervention
美国加州儿童系统性关顾服务:
系统理论介入的范例
• Targeted for seriously emotionally disturbed
children/youths who are at risk of being
removed from their home once again due to
abuse/neglect, criminal offense, repeated
hospitalization, runaway, etc.
为患有重性情绪问题并处於危机状况儿童及青少
年提供服务，因应问题情况而可能再次被迁离家
庭, 例如: 身体/心理受虐、离家出走、重覆住院及
干犯法律
3
_______________________________________________________________________
Children’s System of Care Service:
A Brief History
美国加州儿童系统性关顾服务: 历史
• The Children’s System of Care model was
developed and piloted in 1984
儿童系统性关顾模式於一九八四年开始建立及
运作
• California’s funding in 2003-2004 for the
Children’s System of Care program was $20
million USD
於二零零叁年至四年期间，此计划於美国加州获
得政府二千万美元资助
4
_______________________________________________________________________
What makes this service so special?
此计划的独创性
Traditional Medical Model
传统医疗模式
Government money is primarily
allocated for Institutional Care
政府资金主要流向住院性服务
Individualistic Intervention
-- Focus is on identified patient
个人化辅导介入模式
Clinic-based / Office-based Intervention
以服务提供地点为本作出介入
Therapist is in charge of making
treatment decisions
治疗师主责治疗方向及相关决定
Children System Care Service Model
儿童系统性关顾模式
Government money is primarily focused
on Community Care
政府资金主要流向地区为本服务
Systemic Intervention -- Collaboration
with families and across departments
系统性介入模式--家庭与不同系统及服务
部門合作
Community-based Intervention
社区为本介入 – 为接受服务者所在区域
作出介入
Clients, families and the therapist are all
in charge of treatment decisions
当事人, 家庭及治疗师共同负责治疗方向
及相关决定
5
_______________________________________________________________________
Teamwork: Collaboration
between multiple teams
团队合作
• Child and Family Team (Family System)
儿童及家庭团队 (家庭系统)
• Inter-department Team (Community System)
跨部門团队 (社区系统)
• Treatment Team (Therapy System)
治疗团队 (治疗系统)
6
_______________________________________________________________________
A Wrap Around Treatment Team:
24-7 availability
全天候治疗团队: 24小时服务
• Team Leader (My role) 团队主任 (本人)
• Therapists 治疗师
• Case Managers 个案经理
• Parent Advocate 家长倡导
• Psychiatrist 精神科医生
• Department Liaisons (Probation Dept., Child
Protective Service, Dept. of Mental Health)
部門联繫 (例: 感化部門、儿童保护科、精神健
康部門)
7
_______________________________________________________________________
Case Study 个案研讨
• Steve, Male age16 Chinese-Korean American
史提夫、男性、16岁、美籍中国及韩国混血儿
• Severe anger outbursts at home and at
school (choking mother, threats, vandalism)
在家庭及学校表现出严重发怒的行为(例如: 用手
揑著母亲的颈项并要胁杀人及毁坏公物))
• Repeated police arrests; locked up in juvenile
hall; now on probation
被警方重覆递捕: 曾经被监禁在儿童监狱，现正
守感化令
8
_______________________________________________________________________
Case Study: Steve
个案研讨: 史提夫
• Major generational conflicts with
immigrant parents
与移民父母出现两代代沟及衝突
• At risk of being sent back to juvenile hall
again if his behavior does not improve
若史提夫行为持续倒退，他将会被再次关
进儿童监狱
9
_______________________________________________________________________
Case conceptualization:
Three guiding principles - 个案分析: 叁个重要原则
• Systemic thinking: How do different systems
cooperate to respond to Steve’s situations?
系统概念思考模式: 系统间怎样相互合作处理史
提夫的状况?
• Developmental Theory: What are the child
and family reaching for in their life stages?
生命週期理论:孩子与家庭正处於甚麽生命阶
段?
• Contextualism: Impact of immigration and
ethnic minority experience?
处境化: 是否受著移民及弱势种族经验影响?
10
_______________________________________________________________________
Facilitating the Optimal Fit Between
Child & His Family
促进史提夫与父母间的最大合作
• Understand Steve’s perspective: “My Parents
are stupid & crazy”
掌握及明暸史提夫的立场: 「我的父母实在愚蠢及
癫狂!」
• Understand parents’ perspective: “Steve is
impulsive, irresponsible and shameful”
掌握及明暸家长立场: 「史提夫实在是衝动及不
负责任，而他的行为实在可耻!」
11
_______________________________________________________________________
Facilitating the Optimal Fit Between
Child & His Family
促进史提夫与父母间的最大合作
• Intensive Family Therapy: Helped Steve and
his parents recognize each other’s needs and
respect each other’s boundaries
针对性及深入式家庭治疗: 协助史提夫及其父母
瞭解及肯定彼此的需要及学习尊重彼此的界限
(例: 定时回家、私隐、文明沟通、不可动武)
12
_______________________________________________________________________
Facilitating the Optimal Fit Between
Family & School
促进家庭与学校间的最大合作
• Understand School’s perspective: “Steve is a
trouble maker with a criminal history”
掌握及明瞭学校立场:「史提夫是个问题儿童，并
且犯案累累!」
• Understand Family’s perspective: “School
only identified problems but did not help.
Steve was failing school”
掌握及明瞭家庭立场: 「学校只管投诉，却没有作
出任何协助，这才致令史提夫一败塗地」
13
_______________________________________________________________________
Facilitating the Optimal Fit Between
Family & School
促进家庭与学校间的最大合作
• Mediation work: Mediated between Steve, his
parents, school system and School District
Board
调解工作: 协助史提夫，家长 ，学校及校区委员
会进行调解
• Advocacy work: Changed Steve to a different
school that provides special accommodation
倡导工作: 协助史提夫转学至另一所学校，而新
校能为史提夫提供更佳环境以协助他适应
14
_______________________________________________________________________
Facilitating the Optimal Fit
Between Family & Juvenile System
促进家庭与感化部門间最大合作
• Understand Probation Officer’s perspective:
“We will lock him up if Steve gets out of
control”
掌握及明瞭感化官立场: 「若史提夫再次失控，我
们必会关禁他!」
• Understand family’s perspective: “We do not
want Steve to go to jail again”
掌握及明瞭家庭立场: 「我们不想史提夫再被关进
牢房!」
15
_______________________________________________________________________
Facilitating the Optimal Fit
Between Family & Juvenile System
促进家庭与感化部門间最大合作
• Intensive behavioral management: Help
family to apply proper rewards and
discipline to motivate behavioral changes
in Steve.
针对性行为治疗管理: 协助家庭实践适当奖励及
执行纪侓，促使史提夫作出行为改变及遵守感
化令
16
_______________________________________________________________________
Benefits of Facilitating an Optimal Fit
促进系统间最大合作的果效
• Significant improvement in children’s and
parents’ ability to negotiate conflicts
父母与子女建立处理衝突的能力
• Improvement of school attendance and
performance
改善在学出席率及表现
17
_______________________________________________________________________
Benefits of Facilitating an Optimal Fit
促进系统间最大合作的果效
• Avoidance of institutional care
避免住院性照顾(例如: 儿童监狱、精神病院、儿
童院等)
• Substantial cost savings to government
国家支出明显地减少
18
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• 23 “severe” cases were referred to the
Children’s System of Care program
二十叁个重性个案被转介至儿童系统性关顾服务
计划
19
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• Before any intervention, all of these cases
were children or youths who have been
removed from their homes multiple times to
jail, hospital, child protective service, etc
在介入前，所有儿童及青少年个案皆曾经从家庭
处被迁离，他们来自监狱、医院及儿童保护服务
20
_______________________________________________________________________
Statistics: July ’05 - October ‘06
统计: 二零零五年七月份至二零零
六年十月份
• After 6 - 12 months of intensive systemic
intervention, only 3 child/adolescent clients were
removed again from their home, a total of 20
children/adolescent clients were able to function
well within their families and the community. They
met their treatment goals and were discharged.
透过为期六至十二个月的针对性系统介入，只有叁
个儿童/青少年个案需要重新被迁离家庭，共有二
十个儿童/青少年能够在家庭及社区内正常生活。
其後他们皆因为治疗目标已达而悉数被终结。
21
_______________________________________________________________________
Major reform of the mental health
system in California
美国加州精神健康政策改革
• California’s Mental Health Service Act law
passed in 2005 provides significant funding for
community-based systemic programs for
severely mental ill of all ages. Approximately
3.6 Billion USD in funding have accrued as of
May, 2008
精神健康法例於二零零五年通过议案大幅支援以
社区为本的系统模式介入服务，统计於由二零
零五年至零八年五月合共拨款叁十六亿美元以
协助患有重性精神健康疾病的任何年龄人士
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Conclusion: Systemic focus maximizes
benefits for both individual and environment!
结论: 系统介入为个人及环境提供
最大效益!
Individualistic perspective
从个人辅导角度出发
Problems are situated within the
individual. The focus is on improving
individual ability to cope with outside
environment.
问题焦点在於个人 ，辅导工作以协
助个人建立适应生活环境的能力为目标
Systemic perspective
从系统介入角度出发
Problems are situated between
different systems. The focus is on
promoting the best fit between the
individual and the environment.
问题焦点在於系统间怎样相互合作，
辅导工作以协助个人及环境间达到
最大助益及互利互惠为目标
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Thank You Very Much!
谢谢大家!
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End