CAPÍTULO I: MARCO TEÓRICO 1.1 Antecedentes de la investigación
Dimensión 1: Foros de debate
1.2.2 Bases teóricas de la variable rendimiento académico El rendimiento académico
In1998,anestimated38percentofthe
Nation’shomelesswerefamilies,withapproxi- mately100,000childrensleepingeachnightin shelters,abandonedbuildings,oronthestreet (VanderbiltUniversityInstituteforPublic PolicyStudies1999).Homelessnesscantakea varietyofforms,fromspendingnightsin sheltersanddaysonthestreet,tosettingup “housekeeping”inabandonedbuildings,to movingaroundamongfriends,acquaintances, andrelatives.Douyonetal.(1998)define homelessnessas“theinabilitytosecureregular housingwhensuchhousingisdesired”(p.210). Studieshavefoundthatmorethanamillion teenagersliveinemergencysheltersoronthe streetsonanygivennight.Manyhavefamilies thatwouldtakethemback,butsomehavebeen kickedoutoftheirhomes,andothersare runningfromsexualorphysicalabuseor similarlyintolerablecircumstances.Onestudy foundthatcomparedtoadultcounterparts, homelessteensweremorelikelytobefemale, andtheirbehaviorsweremorelikelytoinclude sexualpromiscuity,prostitution,unplanned pregnancy,andsuicideattempts(Cocoand Courtney1998).
Mosthomelesspeoplehaveahistoryofsome sortofabuse.Inalookatpreviouslyhomeless peopleinshelter-basedtherapeuticcommuni- ties,Jainchilletal.(2000)determinedthat84 percentofwomenand68percentofmenhad eitherbeenphysicallyorsexuallyabused. Theirstudyfoundthathomelessnesswasmore likelytobeepisodicthanconstantina
person’slife.
Whileithaslongbeenpresumedthatthe prevalenceofsubstanceusebyhomelesspeople ishigh,nodefinitivedataareavailableonthis subject.Someearlystudieshavebeencalled intoquestionbecausetheyusedlifetimerather thancurrentmeasuresofsubstanceabuse.The NationalCoalitionfortheHomeless(NCH) concludedthat“thereisnogenerallyaccepted ‘magicnumber’withrespecttotheprevalence ofsubstanceusedisordersamonghomeless adults”(NCH1999,n.p.).Somestudieshave foundasmanyastwothirdsofhomelesspeople abusealcohol,andhalfuseillicitdrugs.
Surveys in shelters found 90 percent of residents with alcohol problems and more than 60 percent withillicitdrugproblems.Co-occurringpsychi- atricdisordersarealsocommoninhomeless people,asarelackofeducationandjobskills (Jainchilletal.2000).(Formoreinformation onhomelessnessseetheforthcomingTIP
SubstanceAbuseTreatmentforPersons WithCo-OccurringDisorders[CSATin developmentk].)
Application to family therapy
Thehomelessarepeoplewithmultipleand complexneeds.Firstconsiderationmustbe giventotheirbasichumanconcerns,suchas health,shelter,andsafety.Manyhomeless womenandchildrenhavefledsituationsof domesticviolence.Socialserviceandhealth needsarebestaddressedbynetworkingwith therangeofagenciesthatprovideservicesto meettheirneeds.Connectingclientswith fundingagencieswillalsoaddressconcernsof payingfortreatment.
Atherapistmustaddresshomelessnessearlyon tofindthehomelessfamilyaplacetoliveand
helpapplyforservicesforwhichitiseligible. Followingtheseinitialsteps,therapistscan thenassesssubstanceabuseandtheparticular factorsthathaveledtothehomelessness. Homelessnessdoesnothaveasinglecause.The counselorshouldlookforstrengthsbyusing suchtoolsasperseverance,creativity,and humor.
Manyhomelesspeopledonothaveafamily grouptobringintotherapy,evenbythemost inclusiveinterpretationsoffamily.Itmaybe impossibletoreconnectfamiliesoforiginwith some clients who have been cut off due to substance abuse, mental illness, and related problems. Still, family dynamics remain integral tothefunctioningofeventhemostisolated individuals,andone-personfamilytherapy maybeaneffectiveapproachinsubstance abusetreatmentiffamilymembersarenot reachableoramenabletobeingintreatment.It mightseematfirstglancethatafamily
genogramwouldyieldlittleusefulinformation, butconstructingonecanbehelpfulanditmay allowforsurprisinginsights.Itshouldlookat notonlyanindividual’sfamilyoforigin,but alsothefamilyofchoice,ifsuchastructure exists.
Itisimportantforthetherapisttoconsider howrealityisdefined.Forexample,ahomeless personmaytalkofhowshewasthrownoutby herfamily,whileherfamilyspeaksofherleav- ingvoluntarily.Thetherapistneedstohelpsort throughthesealternaterealities,although absolutetruthmaybeelusive.Evenwhatseems anobviousfact(e.g.,aperson’slifewouldbe betterifhestoppedabusingsubstances)maybe hardforanindividualtorecognizeandaccept.
Veterans
The statistics relating to veterans and substance abusedolittlemorethanprovidesnapshots thathintattheextentoftheproblemandthe effortsbeingmadetotreatit.Forexample,in fiscalyear2000,theDepartmentofVeterans Affairs(VA),whichprovideshealthservicesfor theNation’sveterans,counted366,429clients diagnosedwithasubstanceusedisorder.In
2000,morethan55,000veteranswereadmitted topubliclyfundedsubstanceabusetreatment facilities(OAS2003b).AccordingtotheVA studies,76percentofhomelessveteranshave experiencedalcohol,drug,ormentaldisorders inthepastmonthand93percentatsometime intheirlife.Mosthomelessveterans(98percent) aremale(NationalCoalitionforHomeless Veterans2002).
In2000,alcoholwastheprimarysubstanceof abuse(68percent).Cocainewasthenextmost commonlyreportedsubstanceused(15
percent),followedbyheroin/opioids(8percent) (OAS2003b).
PTSDresultsfromexperiencingorwitnessing traumaticlife-threateningeventssuchascombat, terroristacts,naturaldisasters,orpersonal violenceandischaracterizedbyasetofcognitive- behavioralsymptoms(i.e.,hypervigilence, emotionalavoidanceandnumbing,andintrusive memories).Researchershaverecognizedthe highriskforPTSDamongveteranpopulations sincestudiesofVietnamWarveteransbeganto emerge.StudiescomparingVietnamveteransto WorldWarIIandKoreanWarveteransfound thatVietnamveteransweremorelikelyto experiencedistressrelatedtolossoffriends andmemoriesofbrutality,whiletheolder veterans’symptomsweremoreoftenrelatedto physicalinjuriesorcapture(Johnston2000). PTSDisassociatedwithanincreasedrateof substanceabuse.Onestudyfoundthat34.5 percentofmenand26.9percentofwomenwith alifetimehistoryofPTSDreporteddrugor alcoholabuseordependenceatsomepointin theirlives.Thisratecomparestosubstance abuse incidence of 15.1 percent and 7.6 percent inmenandwomen,respectively,whodidnot have PTSD. Stress of any sort is a potent trigger forsubstanceabuseandrelapse,notonly becauseofthepsychologicaleffectsofstress, butbecauseitisnowunderstoodtoinitiatea biologicalprocess,therebyincreasingcertain brainchemicals(NIDA2002).Veteranswho experienceddomesticviolenceaschildrenand thenthetraumaofwarhaveadoubleburden tobear.
Application to family therapy
Littlespecificfamilytherapyresearchabout veteranpopulationsexists.Themostcommon pathtosubstanceabusetreatmentforveterans isthecriminaljusticesystem(includingdriving whileintoxicatedreferrals),especiallyfor veteransundertheageof25(OAS2001b).A techniquethatmightbehelpfulintrackingand changingfamilybehaviorisfamilybehavior loopmapping.Liepmanetal.(1989)describe thistoolasamethodofdiagrammingthe repetitivebehaviorcyclesspecifictowet anddryphasesinsubstanceabuseaffected families.
Thetherapistcanhelptheveteranlocate services,includingbenefitstowhichtheyare entitled.Therapistsneedtoknowwherelocal veterancentersare.Iftreatmentisdifficultto access,itmaybehardtogetfamiliesinvolved. Apsychologicalissuethatmanyveteransmust addressissurvivorguilt—havinglivedwhile theircomradesperished.Theissueofabandoned childrenmayalsobedifficultforveterans.A numberofveteransfatheredchildrenwhilein theservice.Forexample,Americanmilitary meninVietnamfatheredmanyoffspring.These lostfamiliesoftenneedtobeaddressedinfami- lytherapy.Therapysessionswith
veteranscanbecomegraphicandhorrifying. Thetherapistmustbeabletoworkwithhigh levelsofintensity.
Veterans’wives,particularly,mayneed support,andsupportgroupscanbehelpful. Childrenmayfaceanumberofissuesrelated toaparent’sveteranstatus.Therapistshave observed,forexample,thatasthechildrenof Vietnamveteransapproachtheagetheir fathers were when they went to Vietnam (usually lateteens),thefathersbeginpressuringthemto learntobetough.
Chapter 5 Summary Points From a
Family Counselor Point of View
•Childrenandadolescentscanrepresentanumberofchallengingconcernsand mightrequirereferral,especiallyforconcernsaboutinhalantabuseorabuse andneglect.
•Olderadultsmayrequirereferraltodistinguishorganicmentaldisordersthat aresubstance-relatedfromotherorganicbraindisorders.
•Thecomplexrolesanddemandsthatcanbeplacedonwomenwithinsome familiesrequiresspecialattention,includingenhancedassessmentprocesses andpossibleancillaryservices.
•Diversity,disability,andco-occurringdisordersoftenrequireadministrative, clinical,andsupervisorysensitivity.