Citation

Sacco FC, Twernlow SW, Fonagy P. Smith Coll. Stud. Soc. Work 2007; 77(4): 31-51.

Copyright

(Copyright © 2007, Informa - Taylor and Francis Group)

DOI

10.1300/J497v77n04_03

PMID

unavailable

Abstract

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models, it stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative "mentalising social system" approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.