Rebecca Mirick, PhD, LICSW Adjunct FacultySimmons School of Social [email protected]
Reactance and the Child Welfare ClientA Framework for Engaging Resistant Parents
September 18, 2012
[email protected] FamiliesInSociety.org alliance1.org
A Framework for Engaging Resistant Parents
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GoalsDevelop an understanding of psychological reactance
and how to use it as a framework to understand resistance in child welfare services
Identify client responses to feelings of reactance
Utilize the reactance theory framework to assess for reactance and identify interventions with “resistant” child welfare clients
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Children in Child WelfareWho is impacted by child welfare services?
675,000 children became involved with child welfare services in 2010
Approximately 400,000 children were in foster care in 201155% of children in foster care have been there for more
than 1 year31% of children in foster care have been there for more
than 2 years
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U.S. Department of Health and Human Services, 2010; www.acf.hhs.gov
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Characteristics of Child Welfare ServicesWhat is expected of parents in child welfare work?
Participation
Compliance
Demonstration of “deference to the authority of the worker”
Task completion
Parents are often resistant to child welfare servicesAlpert & Brittner, 2009; Altman, 2005; Altman, 2008; Reich, 2005; Smith, 2008
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Resistance in Child WelfareAngerDefensivenessAggressionArguingInterrupting or ignoring the workerChallenging the workerBlaming others for problemsMaking excuses for behaviorsMinimizing/denying the problemBeing unwilling to make changes or engage in the workArriving late to services or not attending at allPassive resistance
Rooney, 1992/2009
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Impact of Resistance and NoncomplianceParental lack of participation (noncompliance) and resistance impacts decision making.
Noncompliance is associated with:Longer stays in foster careHigher rates of child removalHigher rates of future maltreatment reportsGreater chance of termination of parental rights
Atkinson & Butler, 1996; DePanfilis & Zuravin, 2002; Jivanjee, 1999; Karski, 1999; Rittner & Dozier, 2000; Reich, 2005
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Examples of Resistant Clients
Suzy (23) is a Caucasian mom of two small children involved with child welfare services for the first time; the
baby (5 weeks old) broke her leg while her dad was watching her. She is very angry and frustrated that the
children are in foster care—she yelled at the worker in a planning meeting. She does not like two of the goals
(admitting that the boyfriend intentionally hurt the baby & getting a restraining order ) and believes the baby’s
injury was an accident. She has been told not to contact her boyfriend; while her children are living in foster
care, she secretly sees him. As a result, overnight visits with her children were postponed for 6 months. She is
now pregnant.
Jenna (28) is an African American mom living in an urban public housing development. She is polite and
respectful to the worker, but is often not at home, even when visits were scheduled ahead of time. She has a
history of substance abuse issues. She has missed multiple sessions of substance abuse treatment. She is
always regretful about missing services and has a reason why she missed (e.g., car wouldn’t start, boss
wouldn’t let her off of work, etc.) and promises not to miss any more…and yet always does. The worker told
her that she has to attend all treatment services and meetings for the next month or the worker will
recommend that she not regain custody of her little boy.
Maria (35) is a Latina mom with a history of substance abuse; her children’s school filed a 51-A for neglect.
She is angry that CPS is back in her life, and that she has mandated drug testing and substance abuse
treatment. Although she was attending AA regularly a few months ago, she has now stopped. She blames the
school for CPS involvement—they just don’t like her. Maria’s children remain with her at present, but the CPS
worker has said that the children may need to live with a family member if she cannot cooperate with services.
Maria’s been asked to do anger management treatment, a substance abuse program, attend AA regularly, do
drug testing, and attend a parenting class.
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Why Don’t Parents Participate?Conventional Explanations
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Explanation #1: Family Characteristics
There are family characteristics or problems that negatively impact participation.
Substance abuse/major mental illnessShameDomestic violencePovertyCultural issues/disconnectLack of access to transportation or ability to get
time off of workLack of access to health insurance
Resistance: These issues interfere with parents’ engagement in services or access to services.
Ayon & Aisenberg, 2010; Reich, 2005; Staudt, 2007
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Explanation #2: Lack of Motivation
Lack of motivation to change or motivation to parent can impact participation.
They do not care enough about their child to make changes or participate in treatment services
They are in denialTherefore, lack of participation is a predictor of whether the
parent can parent the child safely
Resistance: The parent is not motivated enough by the love of the child or desire to parent, the parent is in denial.
Altman, 2008; Reich, 2005; Smith, 2008
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Explanation #3: Mistrust
A lack of trust that the worker or agency is there to help can impact participation in services.
Mistrust is common particularly in poor, urban neighborhoods of color
Child welfare agencies often have negative reputations (“baby snatchers”)
Resistance: The parent does not trust the worker or the agency.
Anderson, 2000; Reich, 2005
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Explanation #4: Readiness to Change
There are mutually exclusive stages of change that clients cycle
through in a non-linear manner.
Precontemplation
Contemplation
Preparation
Action
Maintenance
Resistance: Clients are pushed to change in the
precontemplation or contemplation stage.
Girvin, 2004; Littell & Girvin, 2004; Prochaska & DiClemente, 1984
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Explanation #5: Worker/Client Relationship
A motivational interviewing approach suggests that worker’s behavior in the relationship can impact resistance.
Resistance: Occurs when there is dissonance in the relationship between worker and client. The worker should address this by changing her/his approach.
Hohman, 1998; Miller & Rollnick, 2002; Mullins et al., 2004
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Psychological ReactanceAn Alternative Explanation
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What is Reactance?
Take a minute and think about a situation where you were forced to do something you really did not want to do.
What did you think?
How did you feel?
What did you do?
Rooney, 1992
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Psychological ReactanceA normal, expected motivational drive to regain a lost or threatened freedom a person had assumed would be available to him/her.
The magnitude of the reactance depends on:
1. The importance of the lost/threatened freedom to the person
2. The presence of an implied threat to other freedoms
3. The strength of the person’s assumption that this freedom would be available to him/her
4. The proportion of freedoms threatened/lost versus those available to the person
Brehm, 1966; Brehm & Brehm, 1981; Rooney, 1992/2009
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Threatened or Lost FreedomsThreatened/lost freedoms in child welfare include:
Decisions about who to date/ live withLiving arrangementsDecision to leave a partner or to obtain a restraining
order against a partnerCustody of a child Parenting decisionsAlcohol or drug useAA/NA attendance/ treatment attendance
Altman, 2008; Reich, 2005; Smith, 2008
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How Is Reactance Expressed?Responses to reactance can be viewed as attempts to decrease intolerable affect (reactance) and regain feelings of power and control.
How do clients express reactance?
1. Attempt to regain the lost/threatened freedom
2. Search for loopholes to restore the lost/ threatened freedom
3. Express hostility or aggression towards the person who restricted/threatened the freedom
4. Value the lost/ threatened freedom more than before it was lost/ threatened Brehm, 1966; Brehm & Brehm, 1981; Rooney, 1992/2009
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1. Attempts to Regain the FreedomPeople often respond to reactance by trying to regain the lost freedom directly.
Examples:Arguing with the child welfare workerDenying the abuse occurred Demanding the return of the child/ childrenDefending parent’s behavior
Rooney, 1992/2009
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2. Search for Loopholes
Parents respond to the feeling of reactance by trying to regain the freedom—not outright, but indirectly through a loophole in the limit.
Examples:If children are placed with family members, the
parent may try to visit there, instead of at the supervised, scheduled visits
A mother who has lost custody of a child may get pregnant again
Rooney, 1992/2009
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3. Anger
Parents express reactance as anger, hostility, or aggression toward the limit-setter. This occurs even when the expression of anger will not restore the lost or threatened freedom.
Examples:Parent gets angry and frustrated in a team meeting Parent spends half of a treatment session
expressing anger and frustration about CPS involvement
Rooney 1992/2009
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4. Restricted Behaviors Become More AppealingSometimes reactance is not expressed either directly or indirectly and must be tolerated instead. The prohibited behavior can become more desirable.
Examples:The unsafe partner becomes more desirableAlthough a parent with substance abuse issues had
been contemplating about change—the mandate to attend treatment services and label of “substance abuser” decreases her desire to enter treatment services
Rooney, 1992/2009
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Example #1Suzy (23) is a Caucasian mom of two small children involved
with child welfare services for the first time; the baby (5 weeks old) broke her leg while her dad was watching her.
She is very angry and frustrated that the children are in foster care—she yelled at the worker in a planning meeting. She does not like two of the goals (admitting that the boyfriend intentionally hurt the baby and getting a restraining order ) and believes the baby’s injury was an accident.
She has been told not to contact her boyfriend; while her children are living in foster care, she secretly sees him. As a result, overnight visits with her children were postponed for 6 months. She is now pregnant.
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Example #2Jenna (28) is an African American mom living in an urban public
housing development. She is polite and respectful to the worker, but is often not at home, even when visits were scheduled ahead of time.
She has a history of substance abuse issues. She has missed multiple sessions of substance abuse treatment. She is always regretful about missing services and has a reason why she missed (e.g., car wouldn’t start, boss wouldn’t let her off of work, etc.) and promises not to miss any more…and yet always does.
The worker told her that she has to attend all treatment services and meetings for the next month or the worker will recommend that she not regain custody of her little boy.
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Example #3Maria (35) is a Latina mom with a history of substance abuse;
her children’s school filed a 51-A for neglect. She is angry that CPS is back in her life, and that she has mandated drug testing and substance abuse treatment. Although she was attending AA regularly a few months ago, she has now stopped. She blames the school for CPS involvement—they just don’t like her.
Maria’s children remain with her at present, but the CPS worker has said that the children may need to live with a family member if she cannot cooperate with services. Maria’s been asked to do anger management treatment, a substance abuse program, attend AA regularly, do drug testing, and attend a parenting class.
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How Can Reactance Theory Be Used in Child Welfare Work?
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Benefits of Reactance
Can be predictedClient-centered approachSome approaches are supported by
preliminary researchIs congruent with social work valuesSeparates client behavior from client
motivation/ desire to parentNot client blaming
Rooney, 1992/2009
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Assess for Reactance
Signs of reactance: Anger, refusal to participate in services, denial, interrupting, getting off task easily, making negative comments, questioning the worker or treatment provider’s expertise, missing appointments or visits.
Formal measures of reactance:Hong Psychological Reactance ScaleTherapeutic Reactance Scale (Dowd)
Beutler et al., 2011; Dowd, Milne & Wise, 1991; Hone & Page, 1989
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Approaches With Reactant Parents1. Use the lens of reactance theory to interpret the
parent’s behavior
2. Use interventions likely to reduce the reactance versus increase it
Interventions to Reduce Reactance1. De-emphasize the power differential
2. Use nondirective approaches
3. Limit restrictions
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Intervention #1: Limit Use of Power
Parents in child welfare services are sensitive to the power issues inherent in the work.
Examples: ○ Mandates○ Threats○ Unscheduled home visits○ Asking parents to “jump through hoops” to
demonstrate motivation ○ Persuasion○ Coercion
Altman, 2008; Berg & Kelly, 2000; Diorio, 1992; Dumbrill, 2006; Smith, 2008
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What Does It Look Like to De-Emphasize Power?
Avoid threats, coercion, or persuasionAvoid unnecessary requirements or mandatesBe respectful of client’s space particularly when in
their home (e.g., ask permission to look in the kitchen or talk to the child—if the response is no, then have a conversation about what that might mean)
Focus on a collaborative, empathetic approach versus one that highlights power differential
Berg & Kelly, 2000; Dumbrill, 2006; Rooney 1992/2009
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The Cycle of Reactance andUse of Power
Reactance behaviors expressed
Social worker responds with use of power &
authority
Increased reactance
Increased use of power & authority
Increased reactance
G. D. Rooney, 2009
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Example #1Suzy (23) is a Caucasian mom of two small children involved
with child welfare services for the first time; the baby (5 weeks old) broke her leg while her dad was watching her.
She is very angry and frustrated that the children are in foster care—she yelled at the worker in a planning meeting. She does not like two of the goals (admitting that the boyfriend intentionally hurt the baby & getting a restraining order ) and believes the baby’s injury was an accident.
She has been told not to contact her boyfriend; while her children are living in foster care, she secretly sees him. As a result, overnight visits with her children were postponed for 6 months. She is now pregnant.
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Intervention #2: Non-Directive Approaches
Directiveness is how much the practitioner is in control of the work
This intervention for high-reactant clients has the most empirical support
Practitioner directiveness is negatively correlated with outcomes for high reactant clients
Beutler & Clarkin, 1990; Beutler & Harwood, 2000; Beutler et al., 2011; Karno & Longabaugh, 2005
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What Are Non-Directive Approaches?Directive approaches Non-directive approaches
Cognitive behavioral therapy Supportive therapy
Traditional, disease model-based substance abuse treatment
Motivational interviewing
Practitioner as expert Client as expert in his/her own life
Giving advice, confrontation, interpretation, providing information, initiating topics
Active listening, collaborative goal setting
Limiting choices, using persuasion or coercion, taking the lead
Offering choices, letting the client take the lead, avoiding persuasion or coercion
Avoid practitioner-directed interventions
Use client-directed interventions (like bibliotherapy)
Beutler & Clarkin, 1990; Karno et al., 2009; Karno & Longabaugh, 2005
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Example #2Jenna (28) is an African American mom living in an urban public
housing development. She is polite and respectful to the worker, but is often not at home, even when visits were scheduled ahead of time. She has a history of substance abuse issues. She has missed multiple sessions of substance abuse treatment.
She is always regretful about missing services and has a reason why she missed (e.g., car wouldn’t start, boss wouldn’t let her off of work, etc.) and promises not to miss any more…and yet always does.
The worker told her that she has to attend all treatment services and meetings for the next month or the worker will recommend that she not regain custody of her little boy.
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Intervention #3: Limit RestrictionsTheoretically, decreasing the number of restrictions on personal freedoms should decrease the reactance response.
Examples:Keep goals as specific as possibleEmphasize the freedoms which remain available to
the clientClarify “silent mandates”
G.D. Rooney, 2009; R.H. Rooney, 1992/2009
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What Does It Look Like to Limit Restrictions? If the parent is mandated to attend substance abuse treatment
services, offer the parent a choice of programs; thus, the main limit still remains, but the freedom to choose which one remains
Emphasis specific, not global, goals; and clarify that the parent needs to stay away from a violent partner, not stop dating; the issue is the violence, not the dating
Help a parent manage losses associated with the required loss of an unsafe partner—find new childcare, if he cannot watch the children, or apply for financial assistance since he is no longer helping to pay the bills
Avoid restrictions or requirements that are only present to determine how motivated the parent is
Smith, 2008
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Example #3Maria (35) is a Latina mom with a history of substance abuse;
her children’s school filed a 51-A for neglect. She is angry that CPS is back in her life, and that she has mandated drug testing and substance abuse treatment. Although she was attending AA regularly a few months ago, she has now stopped. She blames the school for CPS involvement—they just don’t like her.
Maria’s children remain with her at present, but the CPS worker has said that the children may need to live with a family member if she cannot cooperate with services. Maria’s been asked to do anger management treatment, a substance abuse program, attend AA regularly, do drug testing, and attend a parenting class.
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Future ResearchWhat Is Needed?
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Future ResearchDoes the use of reactance theory have the potential to improve child welfare
outcomes?
How open are child welfare agencies to the use of reactance theory? Workers themselves versus administration? If barriers to the adoption of this approach are present, what are they?
What is the impact of the context of child welfare work (e.g., federal legislation, timelines, safety concerns for both child and self, lack of treatment services)?
How can child welfare workers effectively assess for reactance?
How many parents are experiencing reactance? How many are resistant for other reasons? What are these reasons?
Does the use of reactance-based interpretations of parent-behavior improve parent attendance and increase engagement in services? Is this associated with more positive outcomes?
September 18, 2012 ● Alliance for Children and Families
[email protected] FamiliesInSociety.org alliance1.org/intellectual-capital-division
Dr. Rebecca G. [email protected]
Additional Alliance ResourcesPRACTICE• Practice & Policy Focus:
http://alliance1.org/ppf • Alliance for Children and Families Annual Conference (Innovation Track):
http://www.alliance1.org/nc/workshops-innovation-implementation• START and Family Outcomes: Collaborative Strategies That Work (Webinar):
http://alliance1.org/webinar/start-and-family-outcomes-collaborative-strategies-work
POLICY• Washington Insider: http://www.alliance1.org/policy/insider
• Reactance and the Child Welfare Client: Interpreting Parents’ Resistance to Services Through the Lens of Reactance Theory (2012) Families in Society, (93)3, doi:10.1606/1044-3894.4224
• Presentation references available in handout file.
Presentation Resources
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ReferencesAdministration for Children & Families. Retrieved from www.acf.hhs.gov/programs/cb/stats_research/afcarsAlpert, L.T. & Britner, P.A. (2009). Measuring parent engagement in foster care. Social Work Research, 33, 135-145. doi:
10.1093/swr/33..3.135.Altman, J.C. (2005). Engagement in children, youth & family services. In G.P. Mallon & P.M. Hess (Eds), Child welfare for the 21st
century: A handbook of practice, policies and programs (pp. 72-86). New York: Columbia University Press. Altman, J.C. (2008). Engaging families in child welfare services: Worker versus client perspectives. Child Welfare, 87, 31-63. doi:
0009-4021/2008/030841-61Altman, J.C. & Gohagan, D. (2009). Work with involuntary clients in child welfare settings. In R.H. Rooney (Eds.), Strategies for
work with involuntary clients (224-247). New York: Columbia University Press.Anderson, D.G. (2000). Coping strategies and burnout among veteran child protection workers. Child Abuse & Neglect, 24, 839-
848.Atkinson, L. & Butler, S. (1996). Court-ordered assessment: Impact of maternal noncompliance in child maltreatment cases. Child
Abuse & Neglect, 20, 185-190. doi: 10.1016/S0145-2131(95)00146-8 Ayon, C. & Aisenberg, E. (2010). Negotiating cultural values and expectations within the public child welfare system: A look at
familismo and personalismo. Child and Family Social Work, 15, 335-344. doi: 10.1111/j.1365-2206.2010.00682xBarth, R.P. (2008). The move to Evidence-Based Practice: How well does it fit child welfare services. Journal of Public Child
Welfare, 2, 145-173. doi: 10.1080/15548730802312537Berg, I.K. & Kelly, S. (2000). Building solutions in child protective services. New York: Norton.Beutler, L.E. & Clarkin, J. (1990). Systematic treatment selection: Toward targeted therapeutic interventions. New York:
Brunner/Mazel.Beutler, L.E. & Harwood, T.M. (2000). Prescriptive therapy: A practical guide to systematic treatment selection. New York: Oxford
University Press. Beutler, L. E., Harwood, T. M., Michelson, A., Song, X., & Holman, J. (2011). Resistance Level. In Norcross, J. C. (Ed),
Relationships that work: Therapist Contributions and Responsiveness to Patient Needs (2nd ed.). New York: Oxford University Press.
Brehm, J. (1966). A Theory of Psychological Reactance. New York: Academic Press.
Brehm, S. & Brehm, J. (1981). Psychological reactance: A theory of freedom & control. New York: Academic Press.
Bundy-Fazioli, K., Briar-Lawson, K. & Hardiman, E.R. (2009). A qualitative examination of power between child welfare workers
and parents. British Journal of Social Work, 39, 1447-1464. doi: 10.1093/bjsw/bcn038
DePanfilis, D., & Zuravin, S. J. (2002). The effect of services on the recurrence of child maltreatment. Child Abuse & Neglect,
26(2), 187–205. September 18, 2012 ● Alliance for Children and Families
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References (continued)Dowd, E., Milne, C., Wise, S. (1991). The Therapeutic Reactance Scale: A Measure of Psychological Reactance. Journal of Counseling &
Development, 69, 541-545.
Drake, B., Jolley, J.M., Lanier, P., Fluke, J., Barth, R.P. & Jonson-Reid, M. (2011). Racial bias in child protection? A comparison of competing
explanations using national data. American Journal of Pediatrics, 127, 471-478. doi: 10.1542/pes.2010-1710
Diorio, W. D. (1992). Parental perceptions of the authority of public child welfare workers. Families in Society, 73(4), 222-235.
Dumbrill, G. (2006). Parental experience of child protection intervention: A qualitative study. Child Abuse and Neglect, 30, 27-37. doi:
10.1016/j.chaibu.2005.08.012
Gelles, R.J. (1996). The book of David: How preserving families can cost children’s lives. New York: Basic Books.
Girvin, H. (2004). Beyond 'stages of change': using readiness for change and caregiver-reported problems to identify meaningful subgroups in a child
welfare sample, Children & Youth Services Review, 26, 897-917. doi: 10.1016/j.childyouth.2004.04.001
Hohman, M.M. (1998). Motivational Interviewing: An intervention tool for child welfare case workers working with substance abusing parents. Child
Welfare, 77, 275-291.
Hong, S. & Page, S. (1989). A psychological reactance scale: Development, factor structure and reliability. Psychological Reports, 64, 1323-1326.
Jivanjee, P. (1999). Professional and provider perspectives on the family involvement in therapeutic foster care. Journal of Child and Family Studies,
8(3), 329-341.
Karno, P.M., Beutler, L.E. & Harwood, M. (2002). Interactions between psychotherapy process and patient attributes that predict alcohol treatment
and effectiveness: A preliminary report. Journal of Alcohol Studies, 27, 779-797.
Karno, P.M. & Longabaugh, R. (2005). Less directiveness by therapists improves drinking outcomes of reactant clients. Journal of Consulting &
Clinical Psychology, 73, 262-267.
Karski, R.L. (1999). Key decisions in child protective services: Report investigation and court referral. Children and Youth Services Review, 21(8),
643-656.
Karno, P.M., Longabaugh, R. & Herbeck, D. (2009). Patient reactance as a moderator of the effect of therapist structure on post treatment alcohol
use. Journal of Studies on Alcohol & Drugs, 70, 929-936.Keller, J. and McCade, K. (2000). Attitudes of low-income parents toward seeking help with parenting: Implications for practice. Child Welfare, 79,
285–312.Littell, J.H. & Girvin, H. (2004). Ready or not: Uses of the stages of change model in child welfare. Child Welfare, 83 (4), 341-366. doi: 0009-
4021/2004/040341-26Miller, R.M. & Rollnick, S.P. (2002). Motivational Interviewing: Preparing people for change. New York: Guildford Press.Mullins, S.M., Suarez, M, Ondersma, S.J. & Page, M.C. (2004). The impact of motivational interviewing on substance abuse treatment retention: A
randomized control trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27, 51-58. doi: 10.1016/j.jsat.2004.03.010
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References (continued)Prochaska & DiClemente (1984). The transtheoretical approach: Crossing the traditional boundaries of change. Homewood, IL:
Dow Jones/Irwin.Reich, J.A. (2005). Fixing families: Parents, power and the child welfare system. New York: Rutledge.Rittner, B., & Dozier, C. D. (2000). Effects of court-mandated substance abuse treatment in child protective services cases. Social
Work, 45(2), 131-140. Rooney, R.H. (1992). Strategies for work with involuntary clients, 1st edition. New York: Columbia University Press. Rooney, R. H. (2009). Strategies for work with involuntary clients, 2nd edition. New York: Columbia University Press. Rooney, G.D. (2009). Oppression and involuntary status. In R.H. Rooney (Eds.), Strategies for work with involuntary clients (349-
387). New York: Columbia University Press.Smith, B.D. (2008). Child welfare service plan compliance: Perceptions of parents and caseworkers. Families and Society, 89,
521-533. doi: 10.1606/1044-3894.3818Staudt, M. (2007). Treatment engagement with caregivers of at-risk children: Gaps in research and conceptualization. Journal of
Child and Family Studies, 16, 183-196. doi: 10.1007/s10826-006-9077-2US GAO. (July 2007). African American children in foster care. GAO-07-816. Retrieved March 23, 2012 from
www.gao.gov/cgi-bin/getrpt?GAO-07-816.U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2010
(Washington, DC: U.S. Government Printing Office, 2010).
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