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PubMed2004

Outcomes of the peer-taught 12-week family-to-family education program for severe mental illness.

OBJECTIVE: Family-to-Family Education Program (FFEP) is a 12-week course for family members of adults with serious mental illness (SMI). This study evaluates the effectiveness of FFEP for several family member outcomes. METHOD: The FFEP enrollees on a > or =3-month waiting list were eligible; 95 consenting family members agreed to four interviews (waitlist, pre-FFEP, post-FFEP, and 6 months post-FFEP) regarding subjective and objective burden, empowerment, and depression. Mixed effects ANOVA models tested hypotheses of decreased burden and increased empowerment after FFEP. RESULTS: The FFEP was associated with reduced subjective burden (P < 0.01) and increased empowerment (P < 0.01) without changes in objective burden. Knowledge about SMI, understanding the mental health system, and self-care also improved. There was no significant decay at 6-month followup. CONCLUSION: This study provides evidence that FFEP is helpful to relatives of persons with SMI by reducing subjective burden and worry, and increasing empowerment, knowledge about SMI, understanding the mental health system, and self-care.

Baltimore↗
PubMed1995

Family structure, family functioning and adolescent well-being: the transcendent influence of parental style.

This study assessed the association between parental style, family functioning and adolescent well being, contrasting intact families with those of changed configuration. Eight hundred and one grade 10 general level teenagers in 11 high schools of a single educational system were the subjects. Results indicated that the configuration of the family was not the key determinant of effectiveness of family functioning. Instead the style of parenting turned out to be the main determinant of both family functioning and well being of the adolescents. While both "parents" were judged to have contributed to these outcomes cross gender effects were found.

Adaptation, Psychological↗
PubMed1979

Circumplex model of marital and family system: I. Cohesion and adaptability dimensions, family types, and clinical applications.

The conceptual clustering of numerous concepts from family therapy and other social science fields reveals two significant dimensions of family behavior, cohesion and adaptability. These two dimensions are placed into a circumplex model that is used to identify 16 types of marital and family systems. The model proposes that a balanced level of both cohesion and adaptability is the most functional to marital and family development. It postulates the need for a balance on the cohesion dimension between too much closeness (which leads to enmeshed systems) and too little closeness (which leads to disengaged systems). There also needs to be a balance on the adaptability dimension between too much change (which leads to chaotic systems) and too little change (which leads to rigid systems). The model was developed as a tool for clinical diagnosis and for specifying treatment goals with couples and families.

Adaptation, Psychological↗
PubMed1991

Priority setting in family change and clinical practice: the Family FIRO Model.

We update a theoretical framework for understanding priority setting for the management of family change, with special emphasis on developmental change. We propose that three core dimensions of family interaction--inclusion, control, and intimacy--constitute an optimal priority sequence for managing major family change stemming from life-cycle transitions and other stressful experiences. In the next section of the article, we compare the Family FIRO Model and other models of family change. Finally, we suggest that therapists can benefit from an explicit, clinical decision-making model for setting priorities in treatment: issues of inclusion take precedence over issues of control, which in turn take precedence over issues of intimacy.

Clinical Protocols↗
PubMed1993

Beyond the "psychosomatic family": a biobehavioral family model of pediatric illness.

This article proposes a multilevel systems model of the interactive biological, psychological, and social processes in childhood illness. This heuristic model can organize the investigation of pathways and mechanisms by which these levels influence one another. A pivotal feature of this biobehavioral family model is the construct of responsivity, which is conceptualized at both family (interpersonal responsivity) and individual (biobehavioral reactivity) levels. Individual biobehavioral reactivity is proposed as a bidirectional pathway by which family patterns and disease processes influence one another. Illustrative clinical material and relevant research are presented with recommendations for future study. This model integrates individual and family-level theory and thus has the capacity to bridge the fields of psychosomatics, pediatrics, behavioral medicine, and family systems medicine.

Adult↗
PubMed1996

Toward a definition of family resilience: integrating life-span and family perspectives.

Family resilience is a relatively new construct that describes how families adapt to stress and bounce back from adversity. Literature pertaining to resilience as a family-level variable is reviewed. An overview of the developmental psychopathology literature dealing with individual resilience is also provided. Implications for extending the study of family resilience drawn from research on individual resilience are discussed and a definition of family resilience is proposed.

Adaptation, Psychological↗
PubMed2001

Comparing the second-order factor structure of the Family Environment Scale across husbands' and wives' perceptions of their family environment.

The Family Environment Scale (Moos & Moos, 1986) is one of the most widely used environmental measures in clinical and family research. Clinicians and researchers often use the FES for comparing spouses' perceptions of their family environment, under the assumption that the underlying structure of the FES is the same for husbands and wives. However, no studies have actually compared the structure of the FES across spouse responses to the FES. Additionally, a review of the literature generally suggests a lack of consensus regarding the factor structure of the FES. Using confirmatory factor analyses, we examined whether the second-order factor structures of the FES, as identified in the literature, were consistent across spouses' perceptions of their family environment. Husbands and wives in 130 nonclinical families responded to Form R of the FES. The findings supported the two-factor solution presented by Fowler (1981) and by Boake and Salmon (1983), and did not differ across responses by husbands and wives. In contrast, responses by husbands and wives to the FES could not be modeled using the three-factor solutions presented by Moos and Moos (1986) and by others. The importance of using a measure that is structurally the same across different groups of respondents is discussed.

Adult↗
PubMed1996

Moving from psychoeducation to family education for families of adults with serious mental illness.

The number of psychosocial interventions for relatives of adults with serious and persistent mental illness has increased significantly in recent years. Psychoeducational interventions combine educational and therapeutic objectives, offering didactic material about the ill relative's disorder and therapeutic strategies to enhance the family's communication and coping skills with the goal of reducing the patient's rate of relapse. The more recent development of family education differs from psychoeducation in that its primary goals are didactic and supportive rather than therapeutic. Interventions are focused on improving family members' quality of life by reducing stress and burden and only secondarily on benefiting the ill relative. The author reviews the conceptual and empirical basis of both psychoeducation and family education, discusses the distinctions between these two approaches in program structure and effectiveness, and suggests future policy, program, and research directions for family interventions.

Adult↗
PubMed1995

Special features of familial intracranial aneurysms: report of 215 familial aneurysms.

FAMILIAL INTRACRANIAL ANEURYSMS (FIAs) were compared with nonfamilial aneurysms (non-FIAs); the study group from east Finland included 167 family members from 85 families with FIAs. In every family, there has been two or more proven cases of subarachnoid hemorrhages among first-degree family members. Two-hundred and fifteen FIAs were found. The patients with FIAs were younger, and their aneurysms were smaller. Half of the FIAs were on the middle cerebral artery (n = 106 of 215), preferentially on the right side. Nearly one-third of the ruptured FIAs were smaller than 6 mm, and more than 80% of the aneurysms were under 14 mm in diameter. There were no significant differences between the frequency of aneurysms at mirror sites in FIA and non-FIA groups. Among siblings with FIAs, the frequency of pairs with age at onset within 10 years of each other was more than twice that expected from randomly selected pairs in the non-FIA group.

Adult↗
PubMed1980

Engaging "resistant" families in treatment. I. Getting the drug addict to recruit his family members.

For family therapy to have any effect on correcting drug problems, the family must obviously be involved. However, such families are often resistant to treatment. This paper describes techniques in working with the addicted member toward recruiting his family for therapy. A sequential approach to the initial interview is presented. Interview rationale, structure, and strategy are outlined, along with examples of common resistances and therapeutic counters. The model and techniques are potentially applicable to other types of symptomatic families as well.

Family Therapy↗
PubMed1999

The family educator: a professional resource for families.

The family educator works with the client's family members to help in their understanding of their ill relative and to assist with managing the stress of the caregiver role. Families come to understand that they can join forces with the clinical team in helping their relative engage in a trial of treatment. Each treatment recommendation is explained to the family and decisions are arrived at by consensus through partnership meetings. Role modeling effective interaction approaches and providing assistance in generating alternative solutions to problematic situations are important functions of the family educator.

Family↗
PubMed2001

[Family therapy appropriate even in somatic care. Study review of medically oriented family therapy].

By observing and analyzing the influence of the therapist on the family as well as interactions between family members, the encounter with a family in a medical setting can serve to improve the health of its members, by improving their ability to use their own resources. This method of focusing on the interaction between individuals in a family or other systems has been a valuable addition to medical treatment of chronic disease. Family therapy has been shown to effectively improve treatment of diabetes, asthma and obesity. A review of the literature is presented.

Adult↗
PubMed2001

How will family physicians care for the patient in the context of family and community?

Difficulties caring for patients in the context of family and community stem from problems of power and vulnerability. Patients are disempowered in relation to physicians and to the medical care system. Physicians are disempowered in their ability to provide comprehensive relationship-centered care to individuals and families because of economic constraints on medical care and limits on continuity of care. Individual patients are also vulnerable to abuses of power within their families because of physical and sexual abuse; the recognition of such abuses and appropriate interventions for them requires awareness of the gender ideology that underlies interpersonal abuses of power. Families and communities can be disempowered because of vulnerabilities related to race, ethnicity, poverty, and homelessness. The additive effects of these vulnerabilities have created health disparities that are a hallmark of inequities in our country's medical system. Opportunities to teach students to recognize and address these disparities abound within medical education. Participatory training and educational action projects can prepare learners to lead us toward a more just and egalitarian medical system with the potential to change the context of family and community in which we care for patients. However, systematic commitment from educational programs is necessary to produce activated clinicians, teachers, and researchers to achieve these changes.

Child↗
PubMed1975

Family portraits--a method of recording family history.

Family doctors are particularly concerned with family relationships. Family relationships are generally poorly recorded in general practice in the traditional records. Conversion to A4 folders in the practice provided an opportunity to develop a diagramatic representation of family structure and thus create for each patient a family ;portrait.'

Family↗
PubMed1995

[Family reunification and family formation migration strongly decreased].

"Statistics on international migration in the Netherlands do not make a distinction by reason of migration, e.g. family reunification and family formation. Because of the need for information on these types of migration, estimates were made based on demographic characteristics. The estimates show that the number of family reunionists was stable between 1987 and 1991....Recently, the Dutch policy on immigration has become more restrictive. Although information with respect to more recent years is largely lacking, tentative estimates suggest that the 1994 number of family reunionists and family forming immigrants combined has shown a strong decrease compared to 1991." (SUMMARY IN ENG)

Demography↗
PubMed1976

Family size in successive generations: the effects of birth order, intergenerational change in lifestyle, and familial satisfaction.

Studies of family size in successive generations have found a small but persistently positive effect of size of family of orientation. Recent work has suggested that this relationship may be influenced by birth order, intergenerational change in lifestyle, and familial satisfaction. Data from a 24-year longitudinal study of women in Pennsylvania indicate that number of siblings does influence size of family of procreation. More important, this relationship is stronger among women who were first-born that later-born, stronger for those not experiencing intergenerational change than for those who changed, and stronger among those who at age 16 were satisfied with their parental family than for those who were dissatisfied.

Adult↗
PubMed2005

Suggested guidelines for pharmacotherapy curricula in family medicine residency training: recommendations from the Society of Teachers of Family Medicine Group on Pharmacotherapy.

Rational drug use has increasingly received public policy attention in efforts to maintain quality health care at lower costs. Prescribing habits are developed during residency training, and education regarding rational drug use should be an integral part of the residency curricula. Considering that many medical errors in family medicine are related to incorrect medication management, there is need for a focused education in pharmacotherapy. This paper outlines suggested guidelines for pharmacotherapy curricula in family medicine residency training, as recommended by the Society of Teachers of Family Medicine Group on Pharmacotherapy. A pharmacotherapy curriculum should include common conditions managed in family medicine, as well as general principles of pharmacotherapy. This should allow for repeated exposure to core topics over a 3-year cycle and be delivered in various settings (didactic teaching, longitudinal active learning, point-of-care education, and rotations). The curriculum should apply and evaluate pharmacotherapy education according to the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME). Although physician faculty can be responsible for pharmacotherapy education, a clinical pharmacist is uniquely qualified to provide this service. Overall, family medicine residents need comprehensive instruction in pharmacotherapy to develop rational prescribing habits. A structured pharmacotherapy curriculum may assist in achieving this goal and in meeting the ACGME core competencies for residency training.

Curriculum↗
PubMed1991

The family culture: a useful concept for family practice.

Each family can be regarded as a unique small-scale society, with its own internal organization and view of the world or family culture. A crucial aspect of each family culture are those beliefs, behaviors, habits, and life-styles that are either protective of health or pathogenic, depending on the context. For family physicians, the insights of medical anthropology are useful in understanding the role of family culture in health, illness, and medical care.

Anthropology, Cultural↗