The Ecological Perspective and Need for Multisystem Interventions
The PPC approach is rooted in an ecological perspective which asserts that to understand an individual it is necessary to understand the environmental and systemic contexts that influence their behaviors and social-emotional functioning. The foundation for this viewpoint can be found in Bronfenbrenner’s (1977, 1979) ecological theory. Its practical implications are delineated in this chapter.
Bronfenbrenner’s Social Ecology Model for Human Development
Bronfenbrenner’s (1977, 1979) theory of social ecology posits that child development must be understood by understanding the interactions and influences between the child and the various proximate and more distant systems that affect development. As Figure 3.1 suggests, he viewed the various social systems as nested within each other, recognizing that not only the immediate environment influences child development, but that the larger cultural and societal formal institutions and informal cultural beliefs influence development. The most immediate system, the microsystem, involves the influences of the immediate setting of the child’s life, most prominently the family, peers, and school. The mesosystem encompasses the interactions among these systems (e.g., the interactions between family and school, family and peers, family and church, and other proximate microsystems). The next level, the exosystem, acknowledges the influence on the child and on the interactions among core daily contexts of larger systems from the local neighborhood to government and other informal social networks. The exosystem level underscores that the child might be significantly impacted by environments that he or she does not have immediate contact with (e.g., a child affected by a parent being required to work longer hours on a special project).
The macrosystem incorporates the larger influences of culture, ethnicity, and socioeconomic status on attitudes and values. For instance, culture impacts broad beliefs regarding gender roles, which in turn influence individual behaviors and aspirations.
These systems form a backdrop for daily codes and patterns of behavior. Bronfenbrenner dramatically expanded our understanding of the multiple contexts that may simultaneously influence child development and thus the character of behavior patterns, social skills, and coping strategies. This viewpoint does not negate the importance of understanding the immediate antecedents and consequences to behavior, but it underscores the importance of understanding that all behaviors are influenced not only by immediate but by overarching social systems.
FIGURE 3.1 Bronfenbrenner’s ecological systems theory
Source for content: Bronfenbrenner, U. (1977). Towards an experimental ecology of human development. American Psychologist, 32(7), 513—531.
Also, changes in one context can reverberate across other systems, altering the nature of their impact on development. Immigration is a clear example of an event, or more truly a process, that creates radical changes in various social systems. This significant change can alter individual functioning and change or disrupt the character of cultural and other contexts. Educators often see firsthand in their classrooms the tensions that immigrant children experience between competing cultural expectations.
Presenting a comprehensive and integrative approach to understanding human development, Bronfenbrenner (1979) also recognized the critical role of biology and its contribution to individual differences. Additionally, he described the reciprocal influence between individuals and their contexts. Faced with similar contextual demands, two individuals may respond somewhat differently and in turn influence the system that affects their choices and actions. His theory of social ecology articulates the multi-determined nature of human behavior. It recognizes the complexity of human development.
This recognition of the complexity and the reciprocal influences of multiple proximate and distant systems challenges our understanding of psychological intervention. While it does not negate the benefits of more discrete and circumscribed therapeutic approaches, it challenges mental health practitioners to understand the influences on behavior development and maintenance in an exponentially broader context. Psychodynamic approaches focus on biological drives and the influence of personal history, and operant and respondent behavioral approaches focus on observable behaviors and immediate environmental influences. These models provide important but limited perspectives for understanding the development of maladaptive behavior. Linear analysis of behavioral sequences does not sufficiently take into account the complex influence of the larger micro and macro contexts that impact behavior. Social learning theory’s delineation of the reciprocal influence between individual and environment is consistent with Bronfenbrenner’s perspective while less expansive in defining social contexts. Applying a systemic perspective, early family therapy recognized the importance of the family context, including extended family, but it paid less attention to larger social structures. Growing beyond its family therapy foundations, various multisystem therapies began to identify the resources and barriers for behavior change in a much more comprehensive fashion. These approaches designed interventions that incorporated actions within multiple social contexts, thus beginning to recognize the complexity of reciprocal influences in a manner closer to Bronfenbrenner’s theory of social ecology.
Family Therapies: Systemic and Relational Approaches
The ecological theories of Bronfenbrenner influenced the emergence of family therapy approaches to clinical intervention. These approaches examined the relational components of psychological problems (e.g., communication patterns, family structures and routines, supervision and support dynamics, etc.). Early family therapists viewed problems as embedded in the family system, and not merely in the individual who was symptomatic. In their view, the child with social-emotional issues was merely the identified patient. Assessment of problem origination and maintenance would be found within the dynamics of the family system, and altering the structures and interpersonal patterns within the family was the target for change that would in turn alleviate the child’s symptoms. Therapists emphasized that everyone in the family was affected by the child’s symptoms and could also be resources for positive change. The treatment focus was the family and their interaction patterns expanding beyond individual sessions with the child or adolescent. In its early development, family therapy paid minimal attention to systems beyond the family. It is easy to see at this stage in its development that family therapy would be viewed as an intervention to take place outside of the school system.
Eventually, the family system perspective grew to consider multisystem approaches (Boyd-Franklin, 1989, 2003; Boyd-Franklin & Bry, 2000; Henggeler et al., 2009; Liddle, 2003, 2010). It is noteworthy that many of these multisystem innovators developed their approaches and conducted their research with multi-problemed youth, many of whom lived in low SES environments. Boyd-Franklin’s (1989) text on Black families in therapy proposed a multisystems schema that parallels Bronfenbrenner’s social ecology theory. Her schema placed the individual within multiple influential systems: family, extended family, friends, church and community resources, social service agencies, and other outside systems (see Figure 3.2). Henggeler et al. (2009) and Liddle (2003, 2010) worked primarily with multi-problemed adolescents who exhibited problems at home, school, and in the community. Prone to delinquency and substance abuse, these teens frequently interacted with legal and social service agencies. Expanding beyond the family focus, Henggeler placed particular emphasis on the role of antisocial peer groups and designed interventions to address participation within this social subsystem as well.
Boyd-Franklin and Bry (2000) called for family therapists to reach out beyond their clinic offices to meet and work with troubled youth and families within home-based, school, and community interventions. Henggeler et al. (2009) met with probation officers, school officials, and community social service resources as necessary to coordinate services and guide the various influential systems impacting the adolescent’s life toward planful support for positive change. His group’s text (Swenson et al., 2009) on multisystemic neighborhood partnerships promotes cross-system interventions to reduce adolescent violence and substance abuse and mobilizes resources similar to school-initiated wraparound services (Eber et al., 2008). Simon (2016) delineated an approach to school-centered interventions that incorporated multisystemic interventions into practice directly in the schools while continuing to collaborate with community resources. This multisystemic perspective sets the stage for the close collaboration between families
28 The Ecological Perspective
FIGURE 3.2 The multisystems levels
Source for content Boyd-Franklin, N. (2003). Blackfamilies in therapy: Understanding the African American experience (2nd ed.). New York, NY: Guilford Press. Copyright Guilford Press. Reprinted with permission.
and schools that is the foundation of the PPC approach and provides the foundation for the necessity of conducting family work in schools.
Diversity, Culture, and Socioeconomics
The social ecological perspective requires incorporation of culture, race, gender, and socioeconomic factors into understanding child development, and thus psychological assessment and intervention. All of these multisystemic therapeutic approaches referenced above recognize these important systemic influences and consider their impact in intervention planning. Importantly, research on their effectiveness included many minority subjects with diverse backgrounds and settings struggling with poverty and social injustice.
Emanating from a family systems perspective, McGoldrick’s classic works described the importance of cultural considerations in understanding and assisting families (McGoldrick, Giordano, & Garcia-Petro, 2005; McGoldrick & Hardy, 2008). She and her associates outlined the impact of culture, race, and gender on child development and family functioning, and they recognized the barriers to healthy development and recovery from psychological problems inherent in poverty' and oppressive racial discrimination. They presented strategies for culturally competent practice that included culturally sensitive perceptions of family health and pathology and incorporation of cultural strengths and resources within individual families.
Falicov’s (2013) text on Latinos in family therapy described a multidimensional, ecosystemic, comparative approach to family therapy. She articulated the complex pressures of migration and acculturation. Her perspective on the impact of different stages of the process of acculturation underscored the direct impact on daily functioning of cultural factors of social ecology. This is particularly evident when different generations within a family are at different points in the process of acculturation or have different levels of participation in shared activities within the dominant culture. Falicov urged therapists to approach cross-cultural work with cultural humility, providing clients an opportunity to articulate the meanings and strengths within their cultural perspectives and practices. Recognizing diversity' within subcultures is important not only to avoid stereotyping, but to understand individual uniqueness. The family systems literature has played a lead role in describing culturally competent practices within the psychological intervention literature.