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Unconditional Care Book

Unconditional Care: Relationship-Based, Behavioral Intervention with Vulnerable Children and Families

In their book, Unconditional Care: Relationship-Based, Behavioral Intervention with Vulnerable Children and Families, John Sprinson and Ken Berrick present the Seneca treatment model for working with clients with intensive needs.  Central to the model are the following three “streams” of assessment and intervention: relational, behavioral, and ecological. 

This treatment approach forms the foundation of all of Seneca’s programs along the wide continuum of care represented in the agency.  What follows here is a brief description of some key elements of the model and how they apply to our work. 

Unconditional Care

Seneca’s stance of “unconditional care” can be characterized both as a core value or principle as well as an actual method of intervention.  In the former sense, it refers to our conviction and policy that we will not discharge clients from our programs for the behaviors that brought them to us in the first place.  In the latter, unconditional care can be seen as an implicit treatment intervention that informs and infuses all interactions between staff members and clients. 

"Brilliant... Clinicians and treatment programs will find Unconditional Care indispensable in understanding traumatized children and help them change and grow."

-- Douglas Davies, MSW, PhD, Lecturer, Schools of Social Work, University of Michigan

The Internal Working Model 

John Bowlby, a British psychoanalyst and leading contributor to the development of attachment theory, used the term “internal working model” to describe the framework through which children learn to see themselves and the world around them.  This model is developed through the actual interactions that children have in their early relationships with caregivers and other important adults.  These experiences shape their ideas about their own self-worth and capacities as well as their expectations of how they will be treated by others.  Once these beliefs are developed, they then direct the way that the children behave, which, in turn, impacts how others experience and react to them. The reactions induced in others often serve to confirm the children’s internal working models.    

“In the final analysis, this is a book about two profoundly simple and yet endlessly complex ideas: love and learning. In order to make such abstract concepts accessible we rely on terms such as attachment theory and behavioral theory. But make no mistake, the core concepts are simply love and learning.”

                                                  --Ken Berrick, author

Relational Assessment and Intervention

Relational assessment and intervention focus largely on gathering information to describe a client’s internal working model and developing interventions that serve to “disconfirm” the implicit beliefs within it.  The description is achieved by considering the following two domains of information: the client’s history of relationships with caregivers and the client’s current behavior in her environment and relationships with staff members, family, or others in her natural ecology. 

Relational intervention follows from assessment and begins with a clear articulation of the client’s internal working model, as well as the “invitations” that may be expressed by the client’s behavior and to which the staff may be at risk of responding.  The team then develops a list of “therapeutic disconfirming stances,” which are aimed at providing a new and different experience and helping to shift the client’s worldview and behavior. 

“This book is one of the most interesting and useful integrations of clinical science and successful intervention strategies that I have ever encountered. Highly recommended!”
-- Phillip R. Shaver, PhD, Distinguished Professor of Psychology, University of California, Davis, and coeditor of Handbook of Attachment: Theory, Research, and Clinical Interventions.

Behavioral Assessment and Intervention

Behavioral assessment and intervention are based on the principles of learning theory, which include the following ideas:

  • Observable behavior is the focus
  • Behavior is assumed to stem from gaining rewards or avoiding consequences
  • Antecedents, settings, consequences, and contingencies associated with the behaviors are examined
  • Clients are encouraged to collaborate in developing their own behavioral goals
  • Treatment settings should be as rewarding as possible
  • There is a focus on helping parents and caregivers to see their ability to impact their children’s behavior through their interest and attention

Behavioral assessment focuses on building an accurate description of the behavior, including the extent to which it is occurring, and on attempting to understand the function that the behavior is serving.  A central focus of the Functional Behavioral Assessment is to identify replacement behaviors.  These are behaviors that are designed to meet the needs that the target behavior is fulfilling, but in a more adaptive, healthy, and pro-social manner.

Ecological Assessment and Intervention 

The “ecological stream” of the Seneca model focuses on the broader context within which the youth and families are living.  For them, as for all of us, a wide range of competing risk and protective factors exerts a powerful influence over daily experience and, as a result, requires our attention. 

Risk factors often relate to an overall experience of poverty, at times spanning multiple generations, and may include the following problems: limited access to financial or material resources; high levels of neighborhood violence or gang involvement; problems related to substance abuse; limited or inadequate housing, education, or employment opportunities; and, more broadly, problems related to securing basic safety. 

Another central consideration in the ecological stream relates to the youth or family’s network of support.  Frequently in this work, social isolation emerges as a key area of concern.  For youth in foster care, this may be an absence of enduring relationships, disconnection from family, and frequent change of “placements,” all reflecting a lack of permanency.  For youth referred through probation or mental health, while they may be living with parents or relative guardians, the youth or family as a whole may be experiencing a lack of connection with a network of social support.

Our goals in addressing the ecological stream will be mitigating the effect of risk factors and strengthening the depth and breadth of the child’s connectedness.