reconceptualizing the domain and boundaries of family life ... · questions by sharing the...

JUDITH A. MYERS-WALLS Purdue University

SHARON M. BALLARD East Carolina University*

CAROL ANDERSON DARLING Florida State University**

KAREN S. MYERS-BOWMAN Kansas State University***

Reconceptualizing the Domain and Boundaries

of Family Life Education

Many scholars have defined family life education(FLE), and some have differentiated it from otherfamily-related fields. For example, Doherty(1995) provided a definition of the boundariesbetween FLE and family therapy; however, webelieve those criteria can be improved. Weexplore the professions of family life education,family therapy, and family case managementusing the questions why, what, when, for whom,and how? After examining these questionsfor each role, we introduce the domains offamily practice to differentiate among them.The approach defines FLE and encouragesappropriate collaboration among the fields.Suggestions are made for using this model for

Department of Child Development and Family Studies,Fowler House, 1200 W. State St., Purdue University, WestLafayette, IN 47907-2055 ([email protected]).

*Department of Child Development and Family Relations,108 Rivers Building, East Carolina University, Greenville,NC 27858.

**Department of Family and Child Sciences, 120 Con-vocation Way, Florida State University, Tallahassee, FL32306-1491.

***School of Family Studies and Human Services, 303Justin Hall, Kansas State University, Manhattan KS, 66506.

Key Words: domains of family practice, family case man-agement, family life education, family therapy, professionaldevelopment.

career exploration, reviewing job requirementsto assess role consistency and clarity, and fordetermining the need for and appropriateness ofreferral and collaboration.

What is Family Life Education (FLE) andhow is it similar to and different from otherfamily-related fields? We begin to answer thesequestions by sharing the following commentsthat were among those posted on the CertifiedFamily Life Educator (CFLE) listserv in 2010.They are included to illustrate the struggleexperienced by many professionals in the field:

‘‘I am bothered by the correlation of FLE withtherapy. . . . Certainly the two have similarities,but they are not the same.’’ Esther Schiedel,MS, CFLE

‘‘For years, we have struggled with developinga clear definition for ‘Family Life Education.’’’Amelia Rose, CFLE

‘‘While there is a difference and there is aboundary that goes up at some point betweenCFLEs and doing clinical work, I do see roomfor both to work together. I think it depends onthe service itself that is being delivered.’’ TammyWhitten, LMFT, CFLE

‘‘While there are some similar topics dealtwith in FLE as in clinical work, they are different,should be different and need to be different. . . .What might it look like if CFLEs were part of ateam approach to addressing family needs? How

Family Relations 60 (October 2011): 357 – 372 357DOI:10.1111/j.1741-3729.2011.00659.x

358 Family Relations

would this be done? How would we work toclarify roles and responsibilities [and] respect eachprofession’s contribution to family health? . . . Ihope that in 10, 25, and 40 years we see both morerecognition of our field and a better collaborativeapproach to family health.’’ Jennifer Best, CFLE

These quotes reflect the frustrations of manyof us in a developing field and provide thecontext for this paper. The field of FamilyStudies emerged out of a concern in themid 19th century regarding the abilities offamilies to address the social problems oftheir times (Doherty, Boss, LaRossa, Schumm,& Steinmetz, 1993). Family Life Educationprovided the means by which professionalsworked with families to help them learn to solvethese problems (Kerckhoff, 1964; Mace, 1971).This work continues. But, what is FLE? For morethan 50 years family scholars have composedstipulative definitions of FLE, descriptionsthat define the concept according to theparticular author for his or her current purposesregardless of other definitions (Thomas & Arcus,1992). Authors have provided definitions thatfocus on individuals, couples, and families;relationship development and maintenance;sexuality; personal development; and so forth.Many continued with the focus on problems andproblem solving; however, over the decades,descriptions of FLE have shifted to includeand even emphasize prevention of problemswithin families. More recently, FLE has begunto focus on assisting families in identifyingand developing their strengths to meet theirpotentials (Arcus, Schvaneveldt, & Moss, 1993).

Currently, the definition of Family LifeEducation as accessed on the National Councilon Family Relations (NCFR) website forthe CFLE program presents the profession’sfunction as using information about healthyfamily development within a preventive, family-systems perspective in order to teach knowledgeand build skills so that individuals and familiesmay function at their optimal levels (NationalCouncil on Family Relations, n.d.). It includesrecognition of the reality that all families faceproblems they must solve, as well as the idea thatall families possess strengths they can employto face these challenges.

Although the NCFR’s definition begins todescribe the scope of FLE, it includes suchbreadth that it leaves unanswered questionsabout the boundaries of the field. One importantcomponent of this discussion is what FLE

does include. A related question remains: Whatis beyond the boundaries of FLE or whatdoes it not include? How should professionalsconceptualize their work with families, and towhich family professionals should individualsand families turn for assistance in various timesof need? Cassidy (2009) concluded that FLE hasmade some progress in this area by defining itselfthrough the creation of curriculum guidelinesand standards for certification. But, as shealso noted, ‘‘employers and the public are stillunclear on what family life education is and howfamily life educators differ from social workers,therapists, counselors, etc.’’ (p. 13).

As suggested by Cassidy (2009), one ofthe areas of professional conflict or tension isdifferentiating between FLE and family ther-apy (FT). In 1995, Doherty addressed thisissue in an article in Family Relations. Hecreated a model of family involvement thatincluded five levels: (a) minimal emphasis onfamilies, (b) information and advice, (c) feelingsand support, (d) brief-focused intervention, and(e) family therapy. A primary stated goal of thismodel was to help family life educators avoid‘‘crossing the boundary into family therapy’’(p. 353). This model has been cited exten-sively and has helped numerous students andprofessionals situate themselves professionally;however, in our opinion as family life educators,it does not provide an accurate description ofFLE, nor does it identify the boundaries and dif-ferentiation we seek. Because it addressed onlythe domains of FLE and FT, it is also incomplete.In this paper we will reexamine the assumptionsof Doherty’s model and broaden its scope inorder to develop a new, alternative presentationof FLE and further advance the development ofthe profession. We expand the model to includefamily case management (FCM)—an aspect ofsocial work and other human-service profes-sions. Although we recognize that social workalso operates in other areas, such as medical andjuvenile justice fields, and that FCM may occurin non-social-work fields, we chose to focus onthe designation of FCM as a segment of socialwork that clearly involves work with familiesand that can represent an area of confusion whendifferentiating from FLE.

We acknowledge that all of the authors ofthis paper are family life educators. Therefore,we are viewing this definitional process as FLEinsiders and as outsiders in relation to FT andFCM. Using that perspective and building on

Reconceptualizing Family Life Education 359

our interactions with and feedback from severalfamily therapists and family case managers,we outline our concerns about the Levels ofFamily Involvement (LFI) model and proposean alternative and innovative structure. Our goalis to position FLE, FT, and FCM as related butunique professions, rather than suggesting oneas more advanced than the others, and to provideassistance for family professionals as they defineand identify the parameters of their work.

CONCERNS WITH DOHERTY’S LFI MODEL

Our concerns about Doherty’s (1995) LFI modelcenter around three areas: (a) it conceptualizesFLE and FT in a hierarchical relationship,(b) it presents a description of FLE that isinconsistent with the established definition, and(c) it distinguishes between FLE and FT usingsuperficial and sometimes inaccurate criteria.

FLE and Family Therapy in a HierarchicalRelationship

The LFI model is comprised of five levels.Doherty (1995) very clearly stated that onlythe first three levels are appropriate for FLE.(Actually, just Levels 2 and 3 are appropriate,because Level 1 is conceptualized as not focusedon families.) According to the LFI model, a fewadvanced FLE professionals may occasionallymove into Level 4: Brief Focused Intervention.All nontherapists, however, are specificallyinstructed to avoid intervening at Level 5.Doherty explained that family therapists canhelp FLE professionals learn to use Level 4effectively, because Level 4 includes overlapbetween the professions, but beyond Level 4family life educators must step aside to let familytherapists work with families at the highest level.

Although it is not stated directly, it is impliedwithin the LFI model and its vertical, addi-tive structure that family therapists are ableto do everything at the lower levels in themodel plus what is above those levels. Level5 addresses tasks that require different train-ing and experience when compared to the tasksat the lower levels, but the model implies thatthe tasks at lower levels are subsumed in thefinal level. Doherty (1995) stated, ‘‘When fam-ily members see a therapist, they know theyare in mental health treatment and not in aneducational program, although education is alsolikely to occur’’ (p. 356). This presumes that

therapists are qualified to provide the educationalexperiences and that they will have learned tointervene educationally. We question that pre-sumption. Although some marriage and familytherapists have had this training, many have not.We contend that FLE training is specific andunique and will not automatically be includedin therapy training. (Later sections of this paperoutline these and other unique characteristics.)Therefore, we assert that this is an inappropriatedistinction to make between FLE and FT.

The LFI hierarchy also states that dealing withfeelings and support is a higher order profes-sional skill (higher on the model’s ladder) thandealing with information and skills. We questionthat assumption. Additionally, putting those twocategories in separate levels suggests that knowl-edge and skills can be taught without referringto feelings and support and vice versa. As thetitle of an article by Mace (1981) indicated, it is‘‘a long, long road from information-giving tobehavioral change,’’ and there has been muchcontroversy about the steps and their sequencealong that road. If behavior change and positiveend results are the ultimate goals of educationalinterventions, these interventions, although theymay occur in a different order, are likely torequire attitude changes, knowledge gain, skilldevelopment, increased perceptions of support,and self-reflection regarding feelings and moti-vations. Campbell and Palm (2004) highlightedthe importance of needs assessment as a step inprogram planning and development, and elicit-ing and assessing participants’ feelings, values,and attitudes are presented as critical parts ofthat process. Separating information and advicefrom feelings and support is neither possiblenor desirable. It takes considerable skill to edu-cate families in all of these areas—information,skills, feelings, and support—but we assert thatit is most effective when all are addressed. Froman educational point of view, the LFI levels leaveus looking for a clearer description of profes-sional involvement with families that recognizesboth the overlap and the uniqueness of FLE andFT without placing them in a hierarchy.

Inconsistent Definition of FLE

FLE has been defined most clearly in applica-tion to the certification program for family lifeeducators (CFLE) by the National Council onFamily Relations, in which the NCFR considersFLE to involve ‘‘prevention and education


for individuals and families relevant to the10 FLE content areas’’ (National Council onFamily Relations, n.d., ¶ 2). The 10 FLE con-tent areas include (a) families and individu-als in societal contexts, (b) internal dynamicsof families, (c) human growth and develop-ment across the life span, (d) human sexual-ity, (e) interpersonal relationships, (f) parentingeducation and guidance, (g) family resourcemanagement, (h) family law and public pol-icy, (i) professional ethics and practice, and(j) family life education methodology (NationalCouncil on Family Relations, 1984, 2009).

In contrast to this broad definition, the LFImodel places some of the CFLE content areasin the FLE realm and others in the FT domain.Doherty (1995) stated that Level 4 of the model is‘‘confined to parenting related issues [whereas]Level Five may move beyond parenting intocouple relationship issues’’ (p. 356). He furtherstated, ‘‘Level Four deals only with issues ofparenting, not marital functioning, psychologi-cal disorders, or personality problems of adults’’(p. 355) and that ‘‘anger management with chil-dren is appropriate [at Level Four], but angermanagement with one’s mother-in-law or bossis not’’ (p. 355). In the LFI model, couple rela-tionships are excluded from the knowledge basea professional should hold until Levels 4 and 5,and family systems theory is not identified asan important theoretical background context forany levels below 4.

Although we agree that psychological disor-ders and personality problems are outside therealm of FLE, we contend that education aboutcouple and family relationships, in addition toeducation about parenting, is very appropriatewithin FLE. Indeed, Arcus (1995) contendedthat an ‘‘early specialization in family life edu-cation was that of marriage education’’ (p. 340).As stated in the definition of FLE on the NCFR’swebsite, FLE professionals should understandthe basics of the entire family system in all oftheir work. Clearly, all 10 CFLE content areashave been identified by the NCFR as relevantfor FLE. So the LFI framework is inconsistentwith the NCFR’s conceptualization and does notaccurately distinguish between FLE and FT.

Superficial and Inaccurate Criteria

As stated above, a differentiation between FLEand FT based on which of the 10 CFLE contentareas is included is not appropriate. There is

significant overlap in the content areas addressedin both fields. In a similar way, we believeit is not adequate to draw the boundaries byfocusing on the type of clientele served by FLEand FT professionals. Doherty (1995) wrote,‘‘some parents’ needs and problems are toointense to be worked with constructively inan education/supportive approach’’ (p. 355). Hewent on to say that Level 4 is for ‘‘familieswho are in high-risk situations . . . [such as] teenparents with family and peer problems, familiesinvolved in the mental health or child protectiveservices systems, and parents facing the stress ofa chronically ill or disabled child’’ (p. 355). Thisstatement suggests that audience type determinesappropriate levels of intervention. He assertedthat an active problem-solving approach goesbeyond Level 3, and, as he stated several timesin the article, therapists need to help educatorsprovide services above Level 3.

We fully agree that work with audiences inhigh-risk or high-need situations requires pro-fessionals to be highly skilled and experienced,but we also believe that those audiences mayneed various types of services, including thosewithin the scope of FLE practice. For example,assessment of family situations, problem solv-ing, goal setting, and helping families develop aplan of action are activities that Doherty (1995)identified as occurring in Level 4 work. Theseactivities are not only appropriate for both thecontent and the methods of FLE, but include theskills that many FLEs possess. Darling, Fleming,and Cassidy (2009) examined the importance ofthese activities within a FLE practice-analysissurvey conducted with CFLEs and a compara-ble group of noncertified family practitioners.Among the tasks that were rated high in impor-tance in that study were ‘‘assess family dynamicsfrom a systems perspective,’’ ‘‘evaluate familydynamics in response to crisis,’’ and ‘‘assist indi-viduals and families in effective developmentaltransitions’’ (Darling et al., 2009, p. 336). Thesetasks fit within the Level 4 activities in the LFImodel described by Doherty (1995), where heindicated they belong in the domain of ther-apy. We question this assertion and declare thatthese tasks may be completed appropriately indifferent ways by therapists and educators.

Consequently, FLEs can be very effec-tive with high-need populations, such as teenparents or incarcerated fathers, by provid-ing research-based information or materials,support-group opportunities with open sharing


and peer support, or skill-building sessions thatteach problem solving and goal setting. Thoseaudiences also could be served by a therapistthrough therapeutic interventions designed toaddress psychological issues or dysfunctions.We conclude that defining FLE by target audi-ence is another LFI model approach that doesnot satisfy our quest to identify the boundariesdefining FLE and other family professions.

In summary, FT and FLE are differentcareers with different certification or licensurerequirements. It is important for professionals tounderstand the boundaries, but Doherty’s (1995)LFI model does not adequately address theseboundaries for our purposes. So how can thetwo fields and other family-related professionsbe differentiated?

DIFFERENTIAL PATHS TOWARD HEALTHYAND EFFECTIVE FAMILIES

Professional identity confusion is not limitedto FLE versus FT, but also includes familycase management and other family professions(Cassidy, 2009). Consequently, our analysisexamines three common and overlapping profes-sional roles that all focus on family well-being:family life education, family therapy, and familycase management. We focus on the professionsand roles themselves rather than on the indi-viduals performing those roles, because manyprofessionals fill multiple roles over time. There-fore, we focus on what those roles involve, theapproaches taken by each, and when each may beappropriate. To take a fresh approach in differen-tiating these three roles, we use the journalisticquestions: Why? What? When? For whom? andHow?

Why?

FLE, FT, and FCM each defines its purpose:why that discipline works with families. Allthree roles identify a similar long-term goal:healthy, competent, and happy family membersand relationships. The specific purpose of eachoccupation is, however, different, leading tovarious identifiable outcomes to meet thatultimate goal.

Why Family Life Education? According to theNCFR website in the section entitled ‘‘What IsFamily Life Education,’’ the purpose of FLE isto teach and foster knowledge and skills related

to communication, typical human development,good decision making, positive self-esteem,and healthy interpersonal relationships (NationalCouncil on Family Relations, n.d.). By doingthis, FLE’s goal is to increase healthy familyfunctioning and help family members use theirstrengths to prepare for and deal effectively withrisks and dangers.

Why Family Therapy? A statement of thepurpose of Marriage and Family Therapy canbe found in a section entitled ‘‘What Is Marriageand Family Therapy?’’ on the AmericanAssociation of Marriage and Family Therapywebsite (American Association of Marriage andFamily Therapy, n.d.). The statement explainsthat FT is ‘‘an intervention aimed at amelioratingnot only relationship problems, but also mentaland emotional disorders within the context offamily and larger social systems’’ (¶ 3). Thelong-term goal, as stated on that site, is stable,long-term, emotionally enriching relationshipsas a way to improve the state of society.

Why Family Case Management? The U.S.Department of Health and Human Services’Administration for Children and Families web-site includes information about family-centeredpractice (U.S. Department of Health and HumanServices’ Administration for Children and Fam-ilies, n.d.b) with a section called ‘‘Overview.’’It explains that the purpose of family-centeredpractice is to work with families ‘‘across ser-vice systems to enhance their capacity to carefor and protect their children’’ (¶ 1). The pri-mary focus is on the children’s needs, usingstrengths-based programming to advocate forimproved conditions for families. It supportsand stabilizes families by reunifying them orbuilding new families and connecting them toresources. In family-centered case management(U.S. Department of Health and Human Ser-vices’ Administration for Children and Families,n.d.b), the goals are to encourage families touse their skills to access resources, participatefully in services, and evaluate progress in reach-ing desired goals. In both of these sources, thefocus is on crisis intervention and resource man-agement to increase the stability, safety, andwell-being of children and families.

Comparison of purposes. All three professions—FLE, FT, and FCM—share a vision ofhealthy and strong families, but the intermediate


FIGURE 1. WHY?

purposes vary across the roles. Those differencesare illustrated in Figure 1. FLE concentrates onincreasing knowledge and skills by providinginformation, tools, and strategies. The goal is tomotivate and equip families to improve theirlives and their functioning. FT, in contrast,attempts to ameliorate problems, which maybe individual or relationship based, but thepurpose of therapy is to correct a conditionthat is keeping families and individuals fromfunctioning optimally. FCM also works withfamilies who are facing problems, but its goalis helping families to negotiate and comply withsystems and supports. Professionals using FCMfocus on fixing situations more than people,but they do assume that there is a problem tobe addressed. These intermediate goals havedirect linkages to differences in methods andapproaches used by the three professions. Thosedifferences will be explored further in several ofthe following sections.

What?

What is the content or research base thatprofessionals use as their foundation for workingwith families? Answers to this question acrossthe three roles show significant overlap. FLE,FT, and FCM use similar literature and researchto inform their work, because they all focus onfamilies. There are, however, some areas uniqueto each role as well.

What is Family Life Education content?Although literature related to FLE has been

in existence for over a century, the specificcontent of FLE was first published in 1984when a task force of national experts from theNCFR introduced the University and CollegeCurriculum Guidelines for FLE curricula andthe Standards and Criteria for Certificationof Family Life Educators (National Councilon Family Relations, 1984). These guidelinesrepresented the required knowledge base forthe professional practice of FLE and have beencommonly referred to as the FLE ‘‘10 contentareas.’’ An understanding of each of these areaswas deemed essential to effectively practiceFLE, and a recent survey of FLEs has confirmedthat the areas are still relevant (Darling et al.,2009). (These 10 content areas were presentedearlier in the paper.)

What is Family Therapy content? In a processsimilar to that followed by the NCFR, theAmerican Association for Marriage and FamilyTherapy, along with interested stakeholders,defined the domains of knowledge and requisiteskills that provide the basis of the practice ofFT. The ultimate goal of establishing thesecompetencies was to improve the quality ofservices delivered by marriage and familytherapists. The six core competency categories,which contain 128 specific competencies,are (a) admission to treatment; (b) clinicalassessment and diagnosis; (c) treatment andcase management; (d) therapeutic interventions;(e) legal issues, ethics, and standards; and (f)research and program evaluation. These domainsfocus on types of conceptual, perceptual,


executive, evaluative, and professional skillsor knowledge that are central for familytherapy.

What is Family Case Management content?FCM is only one type of case management withinsocial services. It is not as clearly identified asa separate profession as the other two groupspresented in this paper, so we were not able tolocate one overarching list of competencies andareas of knowledge for family case managers.There are certification programs overseen byorganizations like the American Academy ofCase Managers within the American Instituteof Health Care Professionals (2006) andCenter for Case Management (2002), butthose organizations only partially encompasswork with families. We found two nationaldocuments that provided insight into familycase management. For example, a trainingmanual for FCMs that was created by theOffice of Child Abuse and Neglect within theDepartment of Health and Human Services(DePanfilis, 2003) included eight components:(a) theories and philosophies of casework, (b)the helping relationship, (c) legal requirements,(d) intake, (e) assessment and investigation,(f) case planning, (g) service provision, and(h) case closure. Not surprisingly, consideringthe source of this list, a major focus inthese guidelines is on child abuse and neglect,foster parenting and adoption, and removal ofchildren from homes or reunification. Second,in a presentation developed for the NationalCenter on Elder Abuse by the National AdultProtective Services Association (2005), 22modules are listed to cover core competenciesof that profession. These include values andethics; agency standards and procedures; theaging process; mental illness, substance abuse,physical abuse, and so forth; specific casemanagement steps; collaboration/resources; andlegal issues and law enforcement. In both lists ofFCM competencies, the content centers on bestpractices to ensure the safety, permanence, andwell-being of families along with a knowledge ofcommunity resources necessary to link clients tothe supportive services they need. Within theselists there is minimal focus on family roles andrelationships.

Comparison of the content. This exploration ofthe content that forms the foundations for FLE,FT, and FCM highlights several similarities

among the three roles, such as understandingsystems theory and concepts; using relevantresearch to inform practice; attention to diver-sity (gender, age, socioeconomic status, culture,race, ethnicity, sexual orientation) and largersocial systems; and incorporating professionalethics and standards of practice including adefined scope of practice and competence. Eachprofessional domain also includes unique areasof content. Of the 10 FLE content areas, oneof them, Family Life Education Methodology,appears to be exclusive to FLE and essentialfor its practice. In the same way, each of theother roles includes its own content base relatedto methodology. FLE also includes a strongeremphasis than the other areas on healthy familyfunctioning and, with its 10 content areas, isbased on a broader and more inclusive knowl-edge foundation. On the other hand, the focuson service delivery is much greater in the otherroles. In comparison to FLE, the competenciesof FT and FCM focus in greater depth on specificknowledge, behaviors, and skills related to thepractice of FT and FCM, including assessmentand diagnosis; understanding the effect of med-ications; treatment goals and modalities; state,federal, and provincial laws that apply to FT andFCM; maintaining client records; and closingcases. In addition, FT guidelines include refer-ences to licensing, billing, and psychotherapy,and FCM competences include a focus on under-standing specific problems families may facethat would account for them being referred forcase management. Additional content categoriesthat are shared by pairings of the professionaldomains are indicated in Figure 2.

When?

The next question we address is When?This question considers two issues: When dopractitioners in each role deliver services tofamilies and what is the time orientation of thoseservices?

When are services offered? This questionaddresses when the services are delivered inrespect to the occurrence of the families’problems or concerns. A traditional argumenthas concluded that FLE addresses preventionwhereas FT and FCM focus on intervention.This implies that FLE is offered only beforeproblems occur and FT and FCM after crisesor problems are encountered. The definitions of


FIGURE 2. WHAT?

prevention and intervention, however, often arenot clearly distinct and may even overlap. Forexample, Webster’s Dictionary defines inter-vene (n.d.) as ‘‘to interfere with the outcomeor course, especially of a condition or process(as to prevent harm or improve functioning),’’thereby using both ‘‘intervention’’ and ‘‘pre-vention’’ in the definition. Consistent with thisdefinition, Guerney and Guerney (1981) assertedthat intervention can take place anytime—beforea problem needs to be faced, while someone isstruggling with the problem, or after an individ-ual has struggled with the problem and has beenunsuccessful. Most often, many health, socialservice, and education professionals label thesecategories as primary, secondary, and tertiaryprevention rather than intervention. Primary pre-vention has as its goal to protect healthy peopleor relationships from experiencing harm beforeit occurs. Secondary prevention occurs afterproblems, conflicts, or serious risk factors havealready been identified. The goal is to halt or slow

the progress of the problem in its earliest stages,and in the case of harm, secondary-preventiongoals include limiting negative long-term effectsand preventing further harm. Tertiary preventionfocuses on helping people manage complicated,chronic, and/or long-term problems and repairdamage. The goals include preventing furtherharm and restoring or maximizing the quality oflife.

Although one scheme uses the term ‘‘inter-vention’’ and the other ‘‘prevention,’’ they aredescribing similar strategies of working withfamilies. As outlined above in the Why? section,FLE, FT, and FCM are all interested in helpingfamilies make changes to increase their healthand well-being; however, where each domain fitsin the prevention and intervention frameworkshelps us identify some of the answers to thequestion When? Guerney and Guerney (1981)suggested that FLE deals with the first two levelsof intervention, because it includes skill building(which is essential in FLE) to influence behav-ior. We also would assert that FLE fits within thefirst two forms of prevention within that frame-work. Within both frameworks, FLE focuses onproviding services for families before problemsarise or early in the process. FT, however, fitsbest within the second and third categories ofboth schemes, and FCM fits most clearly in thethird category. The second and third categoriesfocus on solving problems during or after anissue has surfaced. To depict some of these rela-tionships, as well as the unique focus of eachfield, we present the continuum in Figure 3 toillustrate the first component of the time aspectof working with families.

What is the time orientation of services? Inaddition to the concept of when services areoffered to families, we would like to proposethat the issue of ‘‘when’’ also extends to the timeorientation approach that is taken with families(see Figure 4). FLE often deals with issues andchallenges in the present and the ‘‘here andnow’’ while intended outcomes are projectedinto the future. FLE often is conducted at timesof transitions or is linked to developmentalprocesses (both normative and nonnormative)occurring within families. Although someprograms may encourage participants to reflecton their past experiences, such reflection is notessential, as programming is designed to equipfamilies for current challenges and those yet tocome.


FIGURE 3. WHEN? TIMING OF SERVICES.

FIGURE 4. WHEN? TIME ORIENTATION OF SERVICES.

Many FT approaches, in contrast, addresspast family experiences and issues in order tohelp members understand and make changesin the present and future, adhering to thebelief that a family’s history influences itscurrent patterns of interaction. For example,a basic premise of Bowen’s (1976) conceptof multigenerational transmission suggests thatprevious generations influence present behaviorand that examination of these past influencescan help to prevent further repetition of thesenegative patterns in the present and future(Hanna, 2007). Therapists address issues ofdetriangulation and use genograms to examinefamily-of-origin patterns. These techniques maybe beneficial in treating traumatic childhoodissues, such as abuse, or to inform the origin ofbeliefs that guide current interactions (Hanna,2007). (It should be noted, however, thatsome current FT models are present and futureoriented.)

Finally, FCM often is precipitated by a currentcrisis or need. Families targeted by these servicesare viewed as in jeopardy or violation of the

FCM goals of well-being, stability, and safety.Services are provided to protect families andfamily members and facilitate the provision ofthose basic needs as soon as possible. In thisway, the time perspective in FCM is focused onpresent needs and solutions. Rarely do familycase managers have the charge or opportunity todeal with either past or future time periods.

For Whom?

For whom are FLE, FT, and FCM intended?Overall, the two primary factors that determinethe recipients of services within these profes-sions are eligibility and motivation. Whereaseligibility is determined by the professionaldelivering the services and often is based onascribed needs, motivation represents the per-ception by the service recipients that the serviceis needed and appropriate on the basis of feltneeds (Powell & Cassidy, 2007).

A number of definitions of FLE state that allindividuals or families are potential participants.Professionals are encouraged to target their


programs to specific audiences as much aspossible, so that, although virtually everyoneis eligible for FLE programming, eligibility forspecific, individual programs is ideally muchnarrower. For example, FLE often is relatedto normative developments that may be agerelated or event related (e.g., becoming a parent,preparing for retirement) and may thereby definea particular potential group of participants.FLE also may be related to nonnormativedevelopments or transitions related to some butnot all individuals (e.g., loss of job, parentingspecial-needs child; Arcus & Thomas, 1993).FLEs consider the educational needs of atarget audience or population, use the needs todetermine eligibility for the program, and recruitparticipants. Theoretically, FLE programs couldbe designed for any individuals and families, aslong as participants are prepared to function in aneducational setting. FLE programs are designedfor a variety of populations and for individualsacross the life span (Arcus & Thomas, 1993).As such, FLE is very inclusive in its answer tothe For whom? question.

Although participation in some FLE program-ming may be mandated or based on the needs ofparticular individuals, most programs are pop-ulated with participants who are motivated toparticipate or have felt needs. If individuals rec-ognize a need for information and skills andsee that a program will fill these needs, theyare likely to attend. FLE participants generallyare individuals or families who are committedto learning skills and information that will helpthem strengthen their family well-being.

FT tends to focus on families who areexperiencing specific types of problems (Hanna,2007). Definitions of FT identify eligibleparticipants as individuals or families whohave been identified or diagnosed as havingfunctional difficulties or who are experiencingcrisis or trauma and are willing to participatein a therapeutic environment. The motivationto participate grows out of an awareness ofthose difficulties, whether the awareness comesbeforehand, leading families to engage therapyservices, or after formal diagnosis that couldeven lead to court-mandated therapy.

Families become eligible for FCM when theyenter the government child and family welfaresystem, most often because of reports of child oradult abuse and neglect, or have been found to bein violation of another public regulatory system.There are specific guidelines for eligibility that

are determined by local, state, and/or federalguidelines, laws, and regulations. Motivationof families to participate in the services ishelpful, but services are rarely a result of afamily’s initiative.

Figure 5 summarizes these conclusions.Because FLE services are most often voluntary,participation is based heavily on families’ feltneeds, although professionals may work withmandated audiences, or they could consult fam-ily literature to ascribe some likely or anticipatedneeds of a target audience. FT uses a balanceof felt and ascribed needs, relying on clinicalassessments to determine needs and encouragefamilies to identify and find motivation fromtheir own felt needs. FCM is based on ascribedneeds almost exclusively, using assessments,investigations, and reports to identify familiesnot meeting particular expectations.

How?

Answering the How? question is in manyways the culmination of efforts to defineand differentiate the fields of family practice,because it addresses the actual processes thatfamily professionals use when working withfamilies. While the answers to the Why?What? When? and For Whom? questions areinterrelated and in some ways interdependent, itis critical that professionals consult the answersto all of those questions when answering How.We include four steps in this category: theprocesses of determining specific participantneeds and setting program goals and objectives,the techniques used when services are delivered,the settings and modes of services, and howfamilies are involved in the services.

How are specific needs determined? The Why?question defines the overall purpose of theprogramming, and the For whom? question dealswith the felt or ascribed needs that bring afamily to the programming. The How? questionthen employs needs-assessment techniques toexamine the characteristics of the specifictarget participants. This is important for allfamily professionals when they are selectingappropriate content and methods.

In FLE, a basic operational principle isthat practices be based on the identified needsof the target population (Arcus et al., 1993).These need-based objectives often emerge fromresearch about families—the answer to the


FIGURE 5. FOR WHOM?

What? question—that creates a vision of healthy,well-functioning families and individuals. OtherFLE needs assessments are conducted bylooking at community statistics or surveys of thetarget audience. Although it is recommendedthat representatives of the target audience beincluded in the program development process,the assumption is that the program willreach multiple families, so the educator isexpected to examine the research literatureto identify needs of the target audience as awhole. It is clearly important for educatorsto adjust and adapt their specific objectivesand methods on the basis of the needs andcharacteristics of particular audiences, but theoverall targeted endpoints remain quite similaracross comparable audiences.

FT, on the other hand, uses a more individual-ized approach to determine goals and objectives.In the American Association for Marriage andFamily Therapy’s (2004) Marriage and Fam-ily Therapy Core Competencies, the first twocategories are Admission to Treatment andAssessment and Diagnosis. These assessmentsare performed with individuals or individualfamilies and seek to identify specific strengths,problems, and syndromes that then determinethe treatment plans.

FCM begins with steps similar to FT, specif-ically, intake, assessment and investigation, andcase planning (U.S. Department of Health andHuman Services’ Administration for Childrenand Families, n.d.a). Again, the identification ofneeds and functioning is done with individualfamilies. It measures the ways in which fam-ilies are and are not meeting the well-being,stability, and safety needs of their members.The result of the needs assessment is case plan-ning to determine the services that will help tobuild well-being, security, and reunification inthe assessed families.

How are services delivered? Beginning with theanswers to the Why? and When? questions andusing goals and objectives as a base, appropriatemethods for delivering services to families aredetermined by all groups of family professionals.Methods can be thought of as the process usedto meet the needs of the families within thepurpose of the profession and to reach the goalsand objectives of the program.

FLE tailors its methods to what is knownabout the population, concentrating on strengthsof the targeted families and attempting toempower them, enrich their knowledge and skilllevels, and build more positive attitudes and


aspirations. Additionally, when planning FLEprograms and the methods that will be used, FLEconsults learning styles along with principles ofpedagogy and andragogy (Knowles, 1984) tochoose FLE methods that will build on andenhance the experience of the learners.

Rather than using lesson plans or curricula,the methods of FT are outlined in a treatmentplan that is developed on the basis of theneeds of an individual family (Hanna, 2007). FTmethods are guided largely by a variety oftheoretical frameworks. Family therapists tendto work within one or more of these frameworks,which dictate the particular techniques that areused during therapy sessions (Asay & Lambert,1999). In a similar way, FCM bases caseplanning on the identification and coordinationof the services that are likely to fill gaps in afamily’s functioning.

Settings and modes. A third consideration inanswering the How? question is what settingand mode the work with families will entail.FLE occurs in many different settings (Arcuset al., 1993) as diverse as community centers,schools, or prisons and may occur in differentmodes. For example, FLE can occur in a massmode or distance-learning mode (e.g., newsletteror website), an individual mode (e.g., in thehome), or in a group mode (e.g., group parenteducation). All of the decisions about settingsand modes are linked, meaning that methods areoften chosen on the basis of objectives, whichdetermine the mode of learning and the specificsetting.

In contrast, FT is usually delivered as a seriesof private, face-to-face meetings, with a mean of12 sessions; approximately half of FT sessionsare conducted with individuals whereas the otherhalf are with couples or families (AmericanAssociation for Marriage and Family Therapy,n.d., FAQs ¶ 5). The settings are less variedthan for FLE, most often taking place in privatelocations with limited distractions to enhancethe comfort and protect the confidentiality of theclients.

Settings for FCM are usually in the fieldand can be in homes, residential institutions,child-care settings, or wherever the professionalcan find the families. Because the goals ofFCM include assessment and monitoring offamilies, professionals in this role may nothave much ability to control the setting. Whenpossible, FCM professionals are encouraged to

use guidelines similar to those of therapists,which include finding a private, comfortableenvironment (DePanfilis, 2003). The modes ofFCM most often involve one family workingwith one case manager at a time.

How are families involved in the services? Acornerstone of FLE has been the involvement ofthe learner as an active partner with the programleader and other participants in the FLE process.In a review of FLE literature, Arcus and Thomas(1993) determined that most FLE programsemphasize small-group interaction as well asother interactive strategies such as simulationsand role-plays. Duncan and Goddard (2011)discussed the need for instructional balance—abalance between leader talk and participant talk,which highlights the active role of the FLEparticipant.

Although FT also stresses the importanceof involving families in goal setting and inestablishing rapport and alliances with theprofessional, there is generally no interactionwith other families included in the serviceprovision, so the sharing of strategies andreactions with other families is not included.FT professionals work first on building trust andopenness between themselves and the families.Once a therapeutic alliance has been estblished,the professionals and families work together toidentify objectives that will help both sides reachtheir desired outcomes.

Finally, FCM strives to include the familyin case planning. Models of case managementoften assemble the immediate family, extendedfamily, and other members of the social supportsystem in order to make decisions about howsafety and well-being will be achieved andmaintained (DePanfilis, 2003). Guidelines stressthe central position of family strengths in thisplanning. All of the actions are aimed at reducingor eliminating maltreatment and focus on safety,permanence, and well-being of individuals andfamilies.

Reviewing the answers to the How? question,one sees clear contrasts among the three rolesthat are linked to all of the other questions.The FLE process of working with familiesnormally begins with the purpose of increasingknowledge and skills on the basis of the broadliterature about healthy family functioning in aprimary or secondary prevention context for anyfamilies who are motivated and able to functionin an educational setting. Programs establish


objectives that are applicable to a population,use settings and modes that are varied and broad,and attempt to involve family input at all levels.

The FT process begins with the purposeof ameliorating family problems using anunderstanding of family development andtherapeutic methods in a secondary or tertiaryprevention context for families who have beenreferred by self or others. The How? componentstarts with an individual assessment of personaland family functioning, is usually delivered toone client or family at a time, and involves familyinput as partners in the therapeutic process.

The FCM process is grounded in the purposeof helping families comply with regulatoryexpectations and use community resources onthe basis of the foundation of interventionresearch and in a tertiary prevention context forfamilies in need of services. The How? answersbegin with an individual family assessmentor investigation to assess compliance with orviolation of laws and guidelines; then servicesare offered to families wherever they are, andattempts are made to include families andtheir support systems to increase adherence totreatment plans and goals.

FAMILY LIFE EDUCATION IDENTITY

We have explored how FLE is distinct fromyet related to similar professions by outlininga number of overlaps and contrasts among thefields of FLE, FT, and FCM. In so doing, weattempted to compensate for our concerns withDoherty’s (1995) Levels of Family Involvementmodel by eliminating the hierarchical approach,increasing the consistency with publisheddescriptions of FLE, and using accurate anddeeper criteria. We also made the analysis morecomplete by including family case managementin the comparisons. The results of our analysisare summarized in Table 1: the Domains ofFamily Practice (DFP) Model.

We encourage all family professionals to usethe questions in the table to examine their work inmany settings. Even though professionals some-times may begin with an answer to a questionthat appears at the bottom of the table, all ofthe questions should be addressed. For example,some professionals are assigned a curriculumto use—answering the How? question. Thoseprofessionals should address the Why? What?When? and For whom? questions as well tomake sure there is consistency of purpose and

approach. The same is true for those who beginwith an assigned audience or with a particularlibrary of background literature.

DFP can be used in several ways. One wayis to review a job setting and ask each of thequestions to identify the column in which thatjob resides. Ideally, a job will fit in one col-umn consistently across the questions that areasked. This will help to place it clearly in one ofthe professional categories. In some situations,however, the job may fall in different columns.We encourage professionals and supervisors inthose settings to review performance expecta-tions and either attempt to build more internalconsistency or identify the occasions in whichthe job will focus on one role versus the others.

A second way to use the model wouldbe for an individual to look carefully at thequestions to identify which column or categoryfeels comfortable or best fits his or her skills.This process can not only help individuals withcareer planning and employment seeking, butalso help those counseling others in identifyingtheir career goals. In other cases, FLEs couldwork to alter the demands of a job already heldto more closely fit their training and skills.

Because there is often a high level ofconfusion and an unclear sense of identity in thefamily fields, we have another vision of how themodel can be used. We encourage professionalswho see themselves in the FLE field to usethe descriptions in the table as a guide to keepthem firmly grounded in the expectations andfoundations of FLE. When they feel they arebeing asked to use methods or deliver servicesin a way that does not fit their job descriptionsor their training, they can seek professionalswho do have those complementary skills andwork cooperatively to meet the needs of familiesmore fully. Likewise, they can offer to helpprofessionals in other fields by contributing FLEskills and knowledge.

Whereas some people may function in justone of these roles, others have the training,expertise, and need to perform multiple rolesand use varying strategies to meet the needsof the families with whom they work. Whenmoving across roles or combining them,however, it is important to confirm thatthey have the preparation and backgroundto make this transition. Part of the ethicalguidelines for all three fields should include anexpectation that each professional will refrainfrom operating outside his or her scope of


Table 1. Domains of Family Practice

QuestionFamily Life Education’s

ResponsesFamily Therapy’s

ResponsesFamily Case Management’s

Reponses

Why?Purpose and goals of

work with families

To increase knowledge anddevelop skills so familiesmay build on theirstrengths to function attheir optimal levels

To ameliorate relationshipproblems and mental oremotional disorders toachieve stable, long-term,emotionally enrichingfamily relationships

To help families negotiatesystems, understand andcomply with legal andregulatory requirements toincrease family safety,permanence and well-being

What?Content base and

foundation

Family and life-span theoryand research in the 10 FLEcontent areas; learning,pedagogical orandragogical andeducational philosophiesand methodologies

Family and relationshiptheory and research;therapy-focusedphilosophies andmethodologies

Case management theoriesand methodologies;research and informationabout social systems,resources, and policies;information about familydysfunction

When?The timing of work

with families

Deal with current familyneeds and challenges toprepare for and improvecurrent and future familyfunctioning

Cope with past and currentfamily problems focusingon past causes and patternsto improve current andfuture family functioning

Deal with current problemsand immediate crises

For whom?Target population for

services

Any individual or familywilling and able to functionin an educationalenvironment andcommitted to learning

Individuals, couples, andfamilies who have beendiagnosed with functionaldifficulties who are willingto participate in atherapeutic environment

Families identified as being atrisk or who demonstrate aneed for assistance inmeeting legal and societalregulations

How?Techniques andmethods used

Assess family-relatededucational needs; setgoals on the basis of familyneeds and strengths; canoccur in a variety ofsettings; teach aboutknowledge, attitudes, andskills; families—individu-ally or in groups—areactive in the learningprocess

Diagnose family problems;identify a treatment planguided by particulartheories or philosophies;occurs in private settings;establish a therapeuticalliance with one family ata time; families have inputbut little or no interactionwith other families

Assess family functioning;set goals to fill gaps infamily functioning; occursin the field; coordinatecommunity services whilemonitoring compliance,difficulties, and successes;families (may includeextended family)participate in services butrarely interact with otherfamilies

training and preparation, but also should includethe expectation that professionals connect withothers who do have that training when necessaryto meet the needs of families. For example, if FTsshift into FLE, they should obtain the appropriatetraining and skills in the 10 content areas of thefield, develop educational rather than therapeuticgoals, and use FLE methods. Or an FT couldestablish an alliance with a professional FLE.

Although this analysis could have beenapplied to other fields such as family policyor family nursing, this article has demonstrated

that FLE, FT, and FCM are related and importantbut distinct professions. All three recognizethe importance of the family context but havedifferent viewpoints, use different tools, andtake different paths as they work with families.The three fields are intimately interrelated andinterdependent. None is superior to the others;all are critical pieces of the puzzle in workwith families. The analysis here should helpprofessionals and those who use their servicesto identify more clearly each of the domains andthe boundaries around them.


NOTE

An earlier version of this article was presented at the2010 Annual Meeting of the National Council on FamilyRelations, Minneapolis, Minnesota. The authors expresstheir appreciation to the many colleagues who providedfeedback at that presentation and to Mark White and CiaVerschelden for their comments and suggestions for thisarticle from MFT and FCM perspectives, respectively.

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