AUTHOR:Tracy Anne Stinchfield
TITLE:Clinical Competencies Specific to Family-Based Therapy
SOURCE:Counselor Education and Supervision 43 no4 286-300 Je 2004
COPYRIGHT:The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibited.

Research has indicated that traditional office-based family therapy services are not always effective with at-risk families and that there is an increasing trend toward home-based delivered services (W. Snyder & E. McCollum, 1999). In this qualitative study, the author explored experienced home-based family therapists' perceptions of the competencies most salient to the provision of family-based therapy. Several themes emerged from this study. The author presents 2 central themes: joining--including joining with the family, the family's community, and school personnel--and bridging the gap between academia and current community-based programs.
Counselor educators' primary responsibility is preparing students to be future counselors. Part of a counseling student's developmental process is gaining the skills and knowledge necessary to provide ethically sound counseling to future clients. One of counselor educators' roles is clinical supervisor to counselor trainees. In providing supervision, the ethical guidelines established by the Association for Counselor Education and Supervision state that the "knowledge and skills conveyed should reflect current practice, research findings, and available resources" (as cited in Bernard & Goodyear, 1998, p. 308). In this qualitative study, I explored the knowledge and skills conveyed to counseling students in relation to an at-risk population being served by family-based therapists.
Children and adolescents with serious emotional, behavioral, and mental health disorders have encountered a service system that has struggled to identify their needs and implement services to meet these needs. "Traditionally, this population of children, if they received services at all, received outpatient therapy in clinic and office settings or received treatment via inpatient hospitals or residential treatment centers" (Stroul & Goldman, 1996, p. 453). Office-based service delivery has, in fact, not been effective with some families in the improvement of their presenting concerns (Snyder & McCollum, 1999). Friedman (as cited in Meyers, Kaufman, & Goldman, 1998) reported the ineffectiveness of academic training programs in stating,

While the public service delivery system has concentrated on developing a range of services to enable it to better serve those youngsters for whom traditional mental health settings and services are ineffective and/or inappropriate, academic training programs have not only continued but perhaps even increased their focus on traditional forms of therapy in traditional mental health settings, (p. 7)

In addition, Snyder and McCollum believed that "the home is likely to find increased use as the setting in which family therapy is delivered" (p. 229). In the past two decades, federal and state governments have made numerous attempts to construct and implement treatment for this population.
Existing research is evaluative of which "factors relate to successful program outcome, usually defined as maintaining the identified adolescent with the nuclear or extended family" (Werrbach, 1992, p. 506). Knowledge and skills should reflect current research; however, research has not been grounded in understanding the competencies specific to family-based services.

Counselor's Role
A brief description of the counselor's role in family-based therapy might shed light on a field with which counselor educators and future family-based therapists may be unfamiliar. The role of a family-based therapist is that of clinician. Services are family focused, and only families determined to be at-risk are considered appropriate clients. For the purposes of this study, at-risk was defined as children and adolescents with severe emotional and behavioral problems who have not been successful with less intensive mental health services, such as outpatient therapy, and are likely to be placed in more intensive, out-of-home services. The persons who determine whether a family is considered at-risk include, but are not limited to, psychologists, psychiatrists, and the managed care providers authorizing services. In addition to providing family therapy in the home, the clinician's role also includes being available 24 hours a day, 7 days a week, for on-call crisis intervention and collaboration with schools, physicians, social workers, inpatient staff, residential staff, case workers, and courts, as well as being familiar with available city resources.

Status of Services
Twenty-four years have passed since the passage of the Adoption Assistance and Child Welfare Act of 1980, and in 1984, the Child and Adolescent Service System Program's Initial Cohort Study pilot tested community-based services in 10 states (Schlenger, Etheridge, Hansen, Fairbank, & Onken, 1992). It is perplexing that although an identified, at-risk clinical population requires nontraditional services, services that commenced 20 years ago, studies have concluded that the clinical staff who work with this specific population have not received applicable training and that academia has failed to respond to this identified need. At this time, the role of counselor educators and the training needs of family-based therapists have not been identified.
Because of the limited amount of research to date, it is imperative that the clinical competencies specific to family-based therapy be identified to inform counselor education programs. As previously stated, numerous research findings have clearly indicated that current mental health professionals are not trained to work outside of a clinic-based setting (Christensen, 1995; Meyers et al., 1998; Schlenger et al., 1992). Christensen recommended specialized training for persons working as home-based therapists. Thus, there seems to be a gap between meeting the needs of a clinical population and of counselors who are trained to render more intensive mental health services and the research knowledge base of the competencies specific to family-based therapy.

Purpose of Stud
The purpose of this qualitative study was to understand the perceptions of current family-based mental health professionals and the competencies they believed to be specific to in-home family therapy. The significance of this study is understanding the uniqueness of providing in-home family therapy and the competencies specific to such a service, as well as bridging the gap that exists between the knowledge base and skills that are presented in university curricula and the current practice needs of the communities in which counselors work.


Heuristic Inquiry
The nature of the relationship between the participants and me--and the information sought--dictated the use of heuristic inquiry. Heuristic inquiry draws on the experiences of the researcher as well as the experiences of the participants (Patton, 1990). Patton identified two essential aspects unique to heuristic inquiry: "[T]he researcher must have personal experience with and intense interest in the phenomenon under study," and second, "others ... who are part of the study must share an intensity of experience with the phenomenon" (p. 71). The researcher and research participants must work collaboratively to elucidate the meaning of an experience. I had worked as an in-home therapist for 1 1/2 years and was a family-based supervisor for an additional 1 1/2 years.

Data Collection
Two forms of data collection (10 individual interviews and one focus group) were used in this study. The use of individual interviews in a qualitative study seeks to elicit participants' "everyday lived world" and to search for "meaningful themes" (Shank, 2002, p. 44) in participants' everyday experiences. In an effort to collect additional data, I also conducted a separate focus group with a different group of individuals. Conducting a focus group in addition to individual interviews serves as one form of methodological triangulation that increases the trustworthiness, or credibility (Maxwell, 1996), of the findings in a qualitative study.

Sampling Process
The participants were selected by purposeful, homogeneous sampling (Patton, 1990). The requirement for participation as an individual interviewee was current employment as a family-based therapist. Focus group members were selected on the basis of their professional involvement with family-based therapy and family-based therapists. All family-based therapists who were working in the largest, family-based, nonprofit agency located in a northeastern urban area were invited to participate. The primary mission of this agency was to provide mental health services to children and their families. The agency where the participants for the individual interviews were employed was selected specifically because I had worked at this agency and therefore had a deeper understanding of the particular program model. Having worked at this agency, I knew that the family-based therapists there had greater job stability and less staff turnover. Less staff turnover allowed the interviewees to comment on their experiences over time rather than after 2 months of work and ensured their availability throughout this study.

Key informant individual interviews. I interviewed key informants, 10 family-based mental health therapists (FBMHTs), using a 60-minute semistructured interview format to determine their perceptions of the competencies specific to family-based therapy. Regarding the demographic information of the individual participants, 9 of the 10 self-identified as Caucasian and 1 as African American, length of time in current position as a family-based therapist ranged from 6 months to 2 1/2 years, all participants were female, and age ranged from 26 to 57 years (mean age, 31.9 years). Participants' professional degrees included master's degrees in special education, pastoral counseling, social ministry, counselor education, and three social work degrees (with 1 of the participants being licensed) and two bachelor's degrees in psychology, one in counseling psychology, and one in child development. One participant held two master's degrees and had completed postgraduate work in the area of marriage and family therapy.
The main research question was, "What are the competencies specific to family-based therapy?" This particular question was asked to determine the clinical competencies that are specific to family-based therapy. Each interview started by asking the participant to "Tell me what your experiences have been like as an in-home therapist." Additional questions included "What skills do you believe are specific to in-home therapy?" and "What are the unique aspects of family-based therapy?" From the participants' responses, I used additional probes to encourage the participant to expand on a statement, thought, or experience. I concluded the interviews by asking the participant what she believed counselor educators and persons who were thinking about working as family-based therapists needed to know about family-based therapy.
Focus group interviewing. In an effort to gain access to rich and detailed information on the competencies specific to family-based therapy, I conducted a 2-hour focus group interview. "The object is to get high-quality data in a social context where people can consider their own views in the context of the views of others" (Patton, 1990, p. 335). Shank (2002) encouraged qualitative researchers to think in terms of representativeness: "Have you sampled a broad enough spectrum of informants? Have you gone to a variety of settings?" (p. 134). Individual interviews with what became the focus group members were not feasible because of the unavailability of the participants during the time parameters of this study. Wanting to cover a "broad enough spectrum of informants" (Shank, 2002, p. 134) and to gather data from multiple sources, I decided to conduct a focus group.
The focus group followed a guided discussion format (Berg, 2001), which meant that I facilitated the discussion around the participants' perceptions of the competencies that are specific to family-based therapy. Questions were less structured than in the individual interviews, and again, they focused on the participants' perceptions of the competencies specific to family-based therapy as well as the question, "How do you see higher education preparing people to do in-home work?"
The focus group participants were more diverse than the participants whom I interviewed individually. The focus group included 4 men and 3 women, 6 participants who self-identified as Caucasian and 1 as African American, and an age range of 30-55 years (mean age, 39.8 years). Three of the participants were family-based program directors, 2 were program supervisors, 1 was a family-based care manager, and 1 was a director of family-based training for the county. Time in current position ranged from 7 months to 3 1/2 years. The participants held master's degrees in fields such as clinical psychology, counseling, social work, addictions counseling, and nursing.
In addition to triangulation, a second method I used to establish credibility was again speaking with participants after the interviews had been conducted. They were invested in the process, and the findings and were available after the interview, which allowed me to further verify meaning attributed to findings. These conversations, unlike all the interviews, were not recorded. Only two focus group members were available to further clarify findings and responses given during the focus group interview.

Researcher Bias
A note of caution concerning heuristic study is that, unless measures are taken to ensure the credibility of the reported findings, research bias may lead to the researcher finding what he or she wants to find. As previously mentioned, one measure taken to ensure a more credible study was to collect data from two separate groups of informants, using two methods of data collection. Because I had worked as an in-home family therapist and supervised family-based therapists, I had a strong connection to the material and potential for bias. I anticipated that the experiences of the participants might be similar to my experiences. The chance of researcher bias having an impact on the interviews was so significant that I used multiple forms of data collection to ensure creditability of findings. In addition, an external research consultant also served as an unbiased reviewer of the interview questions and transcripts and provided feedback on emerging categories.

Data Analysis
All interviews were recorded and transcribed for data analysis. The units of analysis occurred at several levels including, but not limited to, phrases, sentences, and paragraphs (Berg, 2001). Berg referred to what Abrahamson (1983) termed an inductive approach in which the researcher becomes immersed in the data collected to identify themes and make meaning from the interviews. This approach was one method used to identify the competencies specific to family-based mental health service delivery. Relevant units of analysis were stated in the exact wording used by the participants as much as possible to maintain the purity of the individuals' perceptions and thoughts. Data were continually collected until the data were saturated and no new data emerged from the interviews. The collected data were then categorized according to either being "knowledge-based" or a "skill set." For example, all the responses that referred to joining were categorized by the type of joining that took place (e.g., joining with the family, community and neighborhood, school personnel).
A cross-case analysis was the final method of analysis between the individual interviews and the focus group interview. In a cross-case analysis, Patton (1990) noted that the researcher begins to analyze the data by grouping the common responses with regard to central questions or issues. In reviewing the patterns and themes identified in both sets of interviews, I looked for overlapping or repeating responses. The results indicate what themes emerged during the cross analysis of the data in the study. All the themes that emerged were categorized accordingly.

Responses were considered significant when mentioned in multiple interviews. Numerous themes emerged as the focus group and individual interviews were cross analyzed. Analysis revealed two themes that are relevant to training counseling students in terms of the skill of joining and the ability to apply this skill in the home. I also discuss the implications for counselors and counselor education programs.

Family counseling theories refer to the joining process that takes place between the therapist, individual family members, and the family as a whole. "Joining ... lets the family know that the therapist ... understands and is working for them" (Goldenberg & Goldenberg, 2000, p. 207). Participants believed that many counseling programs focus on counseling individuals and focus little, if any, on counseling children and families. Joining with individuals is different than joining with a family, and many therapists stressed the need to join with the family as a whole, in addition to joining with each individual member of the family, as well as with the community, neighborhood, and schools.
The family. One focus group member reflected on his supervision with family-based therapists and recalled, "I see people going into these homes and they are joining with these families. Certain people can do it and do it well, and others, it just can't happen." Several members used the words being real to describe therapists who are able to join with families. Part of being real is being able to "meet the family" where they are, being respectful of the family and their home. Living conditions have ranged from a $300,000 home in the suburbs to an inner-city home that Children and Youth Services has deemed filthy and unlivable, is roach infested, does not have walls to separate living spaces, and has furniture that has been urinated on by pets. A core counseling principle is being nonjudgmental. This core way of being with people is significantly tested on entering a family's home. "It is very difficult. You have to do a lot of supervision around getting these people [family-based therapists] to understand and be able to work in these homes."
One therapist commented on the first skill a family-based therapist needs is to be able to join with the family. She stated, "I think that [joining] is even more important than any other setting that you do therapy in, when you are in their home, it is so personal... it really is an invasion." In her experience, "[I]t is really important to have those joining skills to create a good rapport with a family or else you are not going to get anywhere."
Another therapist compared outpatient therapy with family-based therapy and acknowledged, "When you are working in someone's home, I think it takes building a deeper relationship and I think that you have to work more to build someone's trust to allow them to come into your home." The element of being in the home adds another layer to joining with a family. In an initial session, one therapist stated that she used the environment to begin building a deeper relationship with families by asking who the people are in the pictures or about the family's pet. Several statements reflected the need to empathize with the family and to express how intrusive family-based services are as other ways to develop trust with the family.
One focus group member accentuated the emphasis that family-based therapy places on relationships. They are "intense relationships." Such intensity can be better understood in the words of one therapist:

I think about the families that I have and actually went into the home, and they begged me not to close.... Not because they didn't succeed, but because I was a big part of that family.... The one particular family we just closed, I almost cried because the family was crying.

However, establishing rapport with families is so important that when it is not occurring, or when it is extremely challenging, "that makes you cry when you go home. You are like, 'I don't want to face the day.'"
Community and neighborhood. Joining includes many layers, including the client/family community. One therapist hypothesized about this expanded joining process: "Once you have rapport ... with the family ... you also have rapport with their community. That goes hand in hand." If one does not show respect for the community that the family lives in, then "you will not get respect from that family because they will be scared and you probably won't be invited to come back." The community, specifically in a housing project, "is guarded" and "they protect their own." In contrast to traditional, office-based counseling, joining with a client/family goes beyond the persons present for a session, all contained by four walls. "Joining is different in an office than it is in a family home. Part of that is that you join in terms of a neighborhood." "The joining is also very stifled in an office because it sets up a hierarchy, that is, I think, experienced by people very differently when they go to the office as opposed to inviting someone into your home."
In working to build therapeutic relationships, one therapist commented,

You cannot go into a community, [in] which you do not belong, clearly for whatever reason, color or whatever, you cannot go in there thinking that you deserve that respect because you are coming in and you don't live there.... You have to be wary of your surrounding, of what is going on. I guarantee you, if you go into the projects, as a family-based worker, with a chip on your shoulder, with the attitude that I am better than this, I will not [break confidentiality] ... you probably will end up being harassed when you leave, or somebody being around your car. You probably would be in a bad situation. The family would also lose respect in the community as well.

The therapist may be apprehensive about entering a housing community that is considered dangerous. This apprehension can be sensed by the family and community and will affect the joining process.
Several participants spoke of the reverse hierarchy that takes place when entering into the home. In the office-based setting, the client or family is on the therapist's turf, and there can be a perception by the client/family that the therapist is "in-charge." As stated in an interview, "In the office, I am always in charge. In the home, I am not always in charge. So, how do I not be in charge of their home, but be in charge of the therapy?" For example, she recalled a situation in which the teenager got up and left the room. As the therapist, she would not allow the teenager to leave the session. "So how do I balance that, by saying to the parent, '[I]s that permissible?'" She reframed this incident to give power to the parent by saying, "You have given permission for the children to be in and out of the family constellation.... Is that something that happens with you as parents too? That you are in and out too?" In the office, she can get up and ask the child or adolescent to come back for a set time. In the home, "I ask the parents to do that in hopes of empowering them and also making it known whose position of control it is."
One therapist provided an example of how this reverse hierarchy was used to facilitate the joining process:

There was this one guy that was a crackhead and he would always approach us, every time we would come out of the house. I was afraid of him because he would just stagger around, say crazy things to us, and I just didn't know what to expect. I was a little bit nervous about him, but my client would come out and she would say, "Oh don't worry about him. He is harmless."

In this example, the client is communicating to the therapist that the situation is safe and that the therapist can trust the client. This trust contributes to the development of the therapeutic relationship. In addition to being another resource for understanding the client/family, the community serves as an additional system to be familiar with and at the same time to join. Therapists need to have a knowledge base about the atmosphere in which the client/ family lives. Dangerous situations can occur when an individual is not aware of surroundings and does not know how to act in such situations or environments.
There is also another layer to joining with the community--joining with other professionals involved in the family's life. One focus group member emphasized the significance of working respectfully and collaboratively with professionals (e.g., managed care representatives, resource coordinators, school personnel, social workers, psychologists).

[T]his is probably the hardest type of therapy to do because you have to be able to do it all.... I really think that the strength of FB [family-based] is that people also have to diversify more than in any other type of treatment, in any other type of training.

Joining with school personnel. Family-based therapists commonly work with the family in any setting in which the family or family member is struggling. Children who are receiving family-based services typically struggle behaviorally, emotionally, or academically in the school setting. Consequently, the family-based therapist must also have the skills to join with the teachers, school counselor, special education teacher, and principal.
One therapist, who was working at that time on her master's degree in special education, recalled, "some schools are not accepting of having people come in." She continued to say,

I don't think a lot of them are trained to deal with any kind of kid who has any disability, physical, mental health. They are uncomfortable with having someone looking at them, and thinking they are going to be judging them.

The participant went on to discuss the joining that takes place between the therapist, the family, the school, and any other providers who are involved with the family. The same therapist added, "and at the same time, you are not trying to piss anybody off so that they completely shut you down so that you can't help the kid at all. It is very easy to do that." There needs to be an understanding and respect for the role of each professional.
The role of the FBMHTs is to provide support and to be an advocate for the child within the school setting, although they must balance this role with the expectations the school and teachers have for the student. For example, a significant number of the children who are being served by family-based services follow an Individualized Educational Plan (IEP). Therapists attend IEP meetings, advocating for their client from a mental health perspective on the basis of psychological assessment and ability. Family-based therapists must work collaboratively with the school, specifically the teachers, to ensure that the school is making accommodations and providing support that their client needs to succeed in an academic environment, taking into consideration the family system and its impact on the child's functioning in the school.
One FBMHT recalled her experience working with the school setting and the integration of multiple systems that is needed:

I could see teachers would only see, this is how the kid is at school. How could anyone have any problems at home? Or, they always blame what is going on at home. I think by doing in-home you are seeing the entire picture of someone's life. Then, you are able to get a better feel for how to help them.

Family-based therapists are exposed to family system information and are challenged to integrate their knowledge of the effects of family dynamics on the child with how the child is at school.

Counselor Education
All participants were asked what information about family-based therapy they wanted counselor educators to hear. One participant, an experienced therapist, family-based trainer, and educator, strongly vocalized a dilemma she had encountered: "I think the subtle encouragement [is] that you [the professor] need to get this information out so that people just have the information and don't worry about the applicability. They will get that once they leave [school]." As a result, students gain knowledge, but the application of that knowledge to at-risk families is not necessarily the focus or emphasis of training programs. She proposed that what is needed is a balance between the knowledge and its application. Another focus group member added the qualification that the skills and knowledge are parts that can be increased with exposure and clinical practice, but the concern is that there has not been a previous opportunity to apply any knowledge gained in school beyond traditional settings. This same focus group member continued, "you can have all the education in the world and not be able to apply it." Focus group members agreed that it is assumed by academia that application to at-risk families will be learned on the job, but they warned that this is too late and that something needs to occur during the educational experience. This idea can be heard through the words of one focus group member:

There is an underlying assumption that advisers and the school really know what FB [family-based] really is. I would bet money ... if you did a survey in most higher education master's programs and asked them what FB services were about, they would give you a generic, "therapist goes into the home and talks with the family." If that. If that.

The bottom line is awareness. There needs to be an awareness that family-based is a different and unique clinical service providing therapy to at-risk families. Consider a universal ethical issue for all counselors: accepting a gift or food from a client/family. Therapists working in home received conflicting messages from academia and clinical trainers. One therapist shared an ethical dilemma she often encounters:

It is funny because in school, when I was in school a couple of years ago, it was like, "Absolutely not. You don't take anything. You don't take drinks. You don't take cupcakes. You don't take any gifts." And then, about 2 weeks ago at a conference with [name of Western Psychiatric Institute and Clinic clinical trainer], she said, "Absolutely. They offer you a drink of water, you take it!"

Another therapist commented on this double message she received, and she believed that if one is struggling to build a relationship that

[I]t might be more beneficial with a family that is more insistent on you eating or drinking because it might be something that is part of their culture ... as to not insult the family, but to focus on the relationship and building the relationship.

Ethical issues arise when establishing therapeutic relationships with family members, because there are cultural implications that must be taken into consideration as well as taking into consideration the environment and the uniqueness of family-based services.
The focus group participants stressed the significance of a "connection between the educational system and the applied system." One member concluded,

Going into homes is an additional pressure. Some people can handle sitting in an office and having people come to them. I think it takes a very special person to be able to go out into the community and meet people where they are.


Implications for Counselors
Applying the skills and knowledge base learned in counseling programs, as they currently exist, does not address or acknowledge family-based therapy or prepare counselors to work in the home as therapists. There are unique aspects of the joining process that are sorely overlooked, or not recognized, by educators. Information that counseling students receive about confidentiality, joining, accepting food and gifts from clients, to name a few issues, all take on a different meaning when working in the home.
The role of the counselor must include collaboration with other helping professionals to provide the most ethical treatment to future clients/families. Family-based therapists, realizing the emphasis placed on collaboration, consistently mention the importance of joining with other professionals who are working with families. Working in isolation leads to counselor burnout and is detrimental to the client/family in the long run.

Implications for Counselor Education
The participants' perceptions of the competencies specific to family-based therapy generated a wealth of information based on their personal and professional experiences. The themes, or categories, presented here are intended to serve as a vehicle for awareness, understanding, and integration into counseling with at-risk families. All the participants expressed that they had either no or insufficient exposure to at-risk families in clinical training programs. These findings indicate a professional responsibility, as educators, to promote current clinical practice as reflected by the clinical needs of at-risk families in our communities. These issues can be incorporated in courses such as, but not limited to, ethics, theories of counseling, and theories of family counseling.
In addition, participants in this study clearly supported counselor education that emphasized the application of theory. As has been illustrated in this article, there are a myriad of considerations in the "real world" practice of family-based mental health therapy, the most salient of which may be unique joining concerns and the preparation of counselors to meet the needs of the clinical population. Encouraging counseling students to go beyond their knowledge of the counseling field and to venture into an awareness of current clinical needs for children and families is another recommendation.
A final implication for counselor educators is to support the integration of the helping disciplines that are involved with at-risk families. At-risk families are involved with multiple service providers who have little understanding of the professional roles that each service provider plays in relation to the family. An emphasis on collaboration with other professionals needs to take place prior to graduation from a counseling program. As counselor educators, supporting and modeling an interdisciplinary approach is a first step. One recommendation is to invite faculty and professionals from other disciplines into the classroom to engage in dialogue about professional roles. Bringing guest speakers, such as persons from children and youth, criminal justice, social work, and psychology programs, into practicum and internship to discuss how we, as professionals, can work together for the benefit of our shared future clients is a start.
Given that there is a clear trend toward family-based therapy, it is incumbent on counselor educators, and their respective programs, to provide training that will adequately prepare students for this as well as other settings. The results of this study offer a starting point for such an integrative program.

Because members checks (Maxell, 1996) increase credibility, not being able to verify my understanding of the meaning that they attributed to the data with all of focus group members was one limitation to this study. A limitation of interviewing people is that the data collected are a limited source of information that is a part of their perceptions. Data should not be generalized, and additional studies similar to this one should be conducted to confirm the findings of this study.

Recommendations for Future Research
Including counselor educators as participants in the focus group is the first recommendation. Focus group participants believed that progress was being made toward bridging the gap between academia and community programs; however, there was a sense of longing and urgency for more direct dialogue to take place. Having counselor educators participate in a focus group would help further bridge the gap and would help form collaborative relationships to better serve the needs of the client/family and to further counselor education.
Involving counselor educators in a separate focus group, which would meet after the integrated focus group of community key informants and counselor educators, could serve as a place to discuss the integration of family-based competencies into academic curriculum.
Tracy Anne Stinchfield, Counseling Department, Idaho State University. Correspondence concerning this article should be addressed to Tracy Anne Stinchfield, Campus Box 8120, Idaho State University, Pocatello, ID 83209 (e-mail

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