IN DESIGNATED SOCIAL TREATMENT PATTERNS ATER LANSING SERVICE AGENCIES IN GRE Vivian S. Babcock by: Shirley A. Bursey Sheila R. Housler Avonne C. Maran MSU LIBRARIES m RETURNING MATERIALS: Place in book droEEto remove this checkout from your record. [INES will be charged if book is returned after the date stamped below. We? 1 f l i I .\ O ‘! TREATMENT PATTERNS IN DESIGNATED SOCIAL SERVICE AGENCIES IN GREATER LANSING By Vivian S. Babcock Shirley A. Bursey Sheila R. Housler Avonne C. Maran AN ABSTRACT OF A RESEARCH PROJECT Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK School of Social Work 1967 THESIS ABSTRACT TREATMENT PATTERNS IN DESIGNATED SOCIAL SERVICE AGENCIES IN GREATER LANSING by Vivian S. Babcock Shirley A. Bursey Sheila R. Housler Avonne C. Maran This was a study to determine the extent of treatment to alcoholics given by social service agencies in the com— munity of Lansing, Michigan. The sample included all of the professional workers from five community agencies. A three part testing instrument was constructed to gather information on priority ranking patterns of treatment cate- gories in own agency and the other agencies in the sample, percentage of treatment categories in the actual caseloads, and estimate of treatability of each category on a five point scale. On the basis of a two-thirds return, conclu— sions from the data indicated that alcoholism was given the lowest priority ranking, made up less than one per cent of total average caseload and was rated least treatable. There was some evidence that certain agencies in the com- munity were seen as specializing-in child, family, or individual treatment. TREATMENT PATTERNS IN DESIGNATED SOCIAL SERVICE AGENCIES IN GREATER LANSING By Vivian S. Babcock Shirley A. Bursey Sheila R. Housler Avonne C. Maran A RESEARCH PROJECT Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK School of Social Work 1967 TABLE OF CONTENTS Page LIST OF TABLES . . . . . . . . . . . . . iii REVIEW OF THE LITERATURE . . . . . . . . . 1 METHOD 6 View of Selves . . . . . . . . . . . 9 View of Others . . . . 1n SUMMARY . . . . . . . . . . l7 FOOTNOTES . . . J . . . . . . . . . . l9 BIBLIOGRAPHY . . . . . . . . . . . . . 22 ii LIST OF TABLES Average rank on priority of problems served for own and other agencies compared to percentage in case loads Priority ranking of problems as seen within own agencies and total community average rank Average estimate of percentage of caseload in own agency compared to total community . Average treatability ratings of problems as perceived by agency staffs . . Average priority ranking of problems treated in each agency as seen by other agency workers iii Page 10 ll 13 IA LIST OF FIGURES Figure Page 1. Average estimate.of per cent of caseload for total community . . . . . . . . 12 iv REVIEW OF THE LITERATURE Alcoholism today ranks as the fourth largest public health problem, exceed only by heart disease, cancer and venereal disease. It is estimated that there are five million alcoholics in the United States today.1 The range of definitions of alcoholism extends to the number of sources available. For our purposes alco- holism will be defined as the excessive use of alcohol which interferes with the emotional, social, family and economic life of the individual. From ancient times the excessive use of alcohol has been identified with sin, debauchery and weakness. Public indignation was aroused at what was considered a blatant search for escape and pleasure. This pervasive current of moralism has tended to retard public recognition of the tragedy presented by the problem of the individual alco- holic and his family. During prohibition it was hoped that the problem could be legislated out of existence. Societal prejudice still weighs heavily about his neck, even though today it is easier for the alcoholic to obtain help for himself. He may be incarcerated, institu- tionalized or socially ostracized. Some feel that he must suffer hardship and be desperate before being helped. Others suggest that conversion, the submission of the uncon— scious, is necessary. Alcoholics Anonymous, which is believed to have the greatest successful treatment rate stresses the expiation of guilt and the conversion factor involving religious commitment. Not until 1956 did the American Medical Association officially recognize alcoholism as an illness.2 The studies of Dr. E. J. Jellinek, between 1910 and 19A5, accounted in large measure for the increased scientific and medical attention to the problem.3 The disease concept of alcoholism still lacks total cultural acceptance, partially because of lingering moral— istic attitudes, but also because there appears little objective evidence for such a theory.“ While few would argue the physiological effects of chronic alcoholism such as cirrhosis of the liver and brain damage, there seems to be no single physical causative factor. The disease concept of alcoholism while implying medical or physical causative factors has been associated with the theory that alcoholism is the symptom of an under- lying personality disturbance. Zwerling5 suggests that a basic character disorder is at the root of the illness although he admits that the symptomological picture may vary considerably. Otto Fenichel6 characterizes alcoholics by their "oral and narcissistic premorbid personalities" with strong unconscious homosexual impulses. Others have pointed out that alcoholics may be found among any of the neurotic or psychotic disorders. There appears to be no definitive personality study which has achieved general recognition and acceptance. Attempts to define and explain alcoholism have crossed every field from religion to medicine, psychiatry to sociol- ogy. Possibly the most positive result of this explosion of theories has been the growing public recognition of alcoholism as a critical social, psychological and medical problem. Many diverse Opinions continue to exist and treatment continues to be sporadic, eclectic, and confused. Social work has not escaped this confusion and the resulting diverse treatment approaches to the problem of alcoholism. Actually little can be stated with reliability concerning the successful treatment of the alcoholic person.7 Currently, much of the available treatment is focused upon the chronic alcoholic. It has been suggested, however, by Wellman, Maxwell, and O'Hallaren that the great majority of male alcoholics in the United States never seek treatment and are hidden from recognition because they do not conform to the old stereotype of what the alcoholic is like. They are hidden by their-ability to present a fairly normal appearance to personal and social integration.8 Hunter points out that the alcoholic is resistant to help.9 Fox states that the alcoholic fails to seek treatment because of low ego strength. She stresses the relationship between one's ego strengths and ability to accept and cope with reality.lO Menninger feels that a progressive-reintegra- tion with the environment is necessary for successful treatment.-ll The social work agencies, as such, have not been conspicuously successful with the alcoholic clients and, as a result do not welcome them for service. According to Krimmel and Falkey,12 prominent among reasons for this is the strongly entrenched notion that, without exception, alcoholic clients require long months and years of treat- ment. Nearly as strong is the feeling that the alcoholic will remain indefinitely, clutter up the caseload and exclude from service other clients whose prognosis is more favorable. Reluctance by professionals to treat them is directly related to the alcoholic being viewed as a low prestige client, according to Morris.1 Some social workers,1u as-well as members of the medical profession,15 feel that complete abstinence is necessary before treatment can be initiated. Corkl6 feels it is necessary for the social work profession to recognize the social problems incurred as a result of over indulgence. When these needs have been met, it is then possible to deal with the deeper psychological problems. Bailey and Fuchs feel that social workers traditionally have been reluctant to involve themselves in treatment relationships with the alcoholic, who they have regarded as unreliable and unrewarding clients. Most social workers learn little about alcoholism and their attitudes have been generally pessimistic. Their study, in which A29 NASW members participated, indicated that Alcoholics Anonymous is considered to be the most favorable treatment source. No more than 30 per cent of the respondents considered the alcoholics prognosis good with any method of treatment. Social casework was rated as a good treatment method by 22.1 per cent of the social workers. Bailey and Fuchs concluded that there is a relationship between pessimism and frustration of these social workers and their tendency to View alcoholism as a symptom rather than as a disease. They also concluded that those helping persons whose goals are oriented toward the resolution of underlying problems only may thus be failing to observe the principle of meeting the client where he is, and resolving environmental dif- ficulties.17 Karen-Horney's holistic theory states that the indi— vidual and his envornoment are mutually influenced and influencing. Nathan Ackerman emphasizes a holistic approach to treatment of the total family unit.18 Ruth Fox,19 Landy,2O and Thelma Whalen21 have pointed up the importance of dealing with family interaction as an essential in treatment of individuals with alcoholism. Bailey22 stresses the need for workers to deal directly with reality problems rather than minimizing them in favor of the underlying psychological conflicts. METHOD Our review of the literature revealed considerable variance of opinions concerning approaches to treatment of alcoholism. It also revealed that social work has not been notably successful in treating alcoholics. This survey was designed to determine the extent of service to alcoholics in the social work agencies in Lansing, Michigan, a medium size city representative of other Midwestern cities of similar size. It was decided to analyse the treatment patterns of agencies offering primarily social work service to see if there were any significant differ- ences between the pattern of treatment for the alcoholic and other identified problem treatment categories. In our study, we included five agencies designated as primarily offering social work service, such as individ- ual, conjoint, family and group therapy. We excluded those agencies whose caseloads are defined by law or whose policy excludes the alcoholic. The agencies involved were Family Service, Catholic Social Service, Ingham County Comprehen- sive Mental Health Clinic,* and the Lansing Mental Health Clinic, both Adult and Child Divisions.** *Ingham County Comprehensive Mental Health Clinic ‘will be referred to as the All Purpose Clinic. **The Adult Division of the Lansing Mental Health Clinic will be referred to as the Adult Mental Health Clinic; the Child Division as the Child Guidance Clinic. 6 Treatment pattern, as it is used in our study, includes per cent of identified problem in worker's case- load, priority ranking of problem treated at agency and worker's perception of treatability. Significant differ- ences in treatment will be in terms of relative per cent treated, position in priority ranking, and how treatable the alcoholic is perceived to be in relation to other identified problems. Treatable is not to include ease or length of treatment. The other identified problems in our study are parent- child conflict, personal adjustment, school problems, unwed mothers, foster homes, and acting~out adolescents. We constructed an instrument asking each worker to give priority ranking, from one to eight (one being the highest rank) to each of the identified problems that were treated at his agency and to estimate the per cent of each category in his caseload. Then he was asked to rate the identified problem on a five point scale according to treat- ability. The scale ranged from one, most treatable, to five, untreatable. Workers were also asked to rank problems as they believed other agencies in the study gave them priority. We hypothesized that the alcoholic client would rank Slow on the priority ranking, make up a low per cent of the <3aseloads, and be rated low on the treatability scale. We aalso thought agencies would be identified as serving spe- cxific treatment categories and that the alcoholic would not 'bee included. We were aware that the categories were overlapping and would not allow for individualization of the client. To give more flexibility to the instrument, we left one category open and invited comments. We felt that the information requested in the first two questions concerning priority ranking and per cent of the problem treated in the caseload would be governed by the agency intake policy. This would determine what problems are treated and to what degree. Our intent in the third ques- tion was aimed toward the workers' own bias and attitudes. Thus, we asked them to disregard length and ease of treat— ment in their evaluation of the categories (see instrument in the appendix). The research team distributed thirty-six instruments to the social workers from the designated agencies, and twenty-five were returned. All of the agencies were well represented in the reSponses, with the exception of the Adult Mental Health Clinic which returned only one of four instruments. The reader should consider this fact when reviewing the results of the study. All of the questions were not answered by all of the workers. Priority ranking in "own agency" and per cent of each problem category in each caseload was answered in twenty-two cases. The question of treatability was answered 13y fifteen respondents and priority ranking of the other aagencies' treatment patterns received only eight responses. 'Total community averages were based on computation of total qudividual responses rather than agency averages. On occasion, when any single rank was not given we arbitrarily used the lowest rank of'eight. The averages were then translated into ranks on the basis of numerical size. View of Selves According to these responses, as shown in Table 1, when all workers ranked problems treated in their own agency, alcohol was ranked lowest and it received less than one per cent in the total average of the caseloads in the community. When we changed the total average percentage to a rank order, marital received rank one and personal adjust- ment, rank two. However, there was little actual difference in per cent given. TABLE l.-—Average rank on priority of problems served for own and other agencies compared to percentage in case loads. Priority Ranks Own Agency Other Actual Actual Problem Rank Agency Rank % Rank % N=20 N=8 N=22 N=22 Marital l 3 2 22.23 Personal Adjustment 2 l l 23.23 Parent-Child 3 2 3 17.09 SChool II 14.5 14 10.27 Acting Out Adolescent 5 A.5 5 8.23 Foster Homes 6 8 7 3.514 thawed Mothers 7 6 6 5.82 Alcoholics 8 7 8 .77 10 This data shows that alcoholics were given the lowest priority rank in treatment and made up the smallest percent- age in the caseloads. There were, of course, some differences among individ- ual ranks and among agencies. Tables are included showing the differences (see Tables 2, 3, A, and 5). Table 2 shows average priority rankings of each agency and total average rank for all agencies. Alcoholism was viewed lowest by all agencies except the Adult Mental Health Clinic which ranked alcoholism fifth. TABLE 2.--Priority ranking of problems as seen within own agencies and total community average rank. Average Rank by Agency Problems *FSA CGC AMH APC 053 Total N=5 N=7 N=l N=1 N=6 N=2O Marital l A 2 l l 1 Personal Adjustment 3.5 3 l 2 2 2 Parent-Child 3.5 l 6 A 3 3 School 7 2 A 3 5.5 A Acting Out Adolescents 5 5 3 5 5.5 5 Foster Homes 6 7 7 8 7 6 'Unwed Mothers 2 6 8 8 A 7 .Alcoholics ' 8 8 5 8 8 8 *FSA=Family Service Agency; CGC=Child Guidance Clinic; IXMH=Adult Mental Health; APC=A11 Purpose Clinic; CSS=Catholic Social Service . 11 Table 3 gives average per cent of problem categories treated in each agency and total community averages. In the total community averages, alcoholism represented less than one per cent of the caseloads. No agency average allocated more than two per cent of its caseload to alco- holism. Figure 1 gives a graphic illustration of the total average per cent of caseloads allocated to the treatment categories. TABLE 3.——Average estimate of percentage of caseload in own agency compared to total community. Average Per Cent by Agency APC FSA CSS AMH CGC Total Problems Comm.Av.% N=3 N=A N=8 N=1 N=6 N=22 Parent Child 21.66 11.5 11.37 .02 28.66 17.09 Personal Adjustment 30.66 26.25 9.12 .80 26.83 23.23 School 9.33- 1.75 A.OO .0A 25.83 10.27 Marital 18.66 53.75 20.62 .05 8.00 22.23 Unwed Mothers 3.33 2.5 13.37 .01 — 5.82 Foster Homes .66 - 8.25 - — 3.5A Acting Out Adolescents 3.66 6.25 6.00 .05 10.33 8.23 Alcoholics 2.00 1.5 .37 .02 - .77 12 .muficsesoo Hmp0p pom omoaommC mo pcmo poo mo mumsflpmm ommnm>