Family Admission Decisions As a Therapeutic Tool

The decision admit a disturbed adolescent to a mental hospital is all too often made by a hard-pressed duty psychiatrist, late in the day, but early in his training. The effects of this decision may well reverberate down the generations. At the Unit for younger adolescents at Hill End Hospital, St. Albans, Hertfordshire, England ( 5 ), the family, not the psychiatrist, makes the decision. This approach is based on the observation that when families eject their youngsters, parental authority is often disintegrating. Referral for admission provides a golden opportunity, not only for reversing the ejection process, but also for forging, on the anvil of a profoundly important decision, a more viable family authority structure. Therapeutic leverage is made available at the very heart of the family problem.     

Religion As Experience in the Family

The simple fact is that whatever is seen or heard has its impact on the person seeing or hearing it. Anything that is seen and/or heard by a person asks that person to make an explanation to himself about it. As we've seen so many times before, if there is no opportunity to check out the explanation, then that explanation becomes the “fact.” The “fact” may be accurate or inaccurate, but it will be the basis upon which the individual will base his actions and opinions. This is the reason I believe so many children grow up to be adults who see themselves as versions of saints or devils instead of living, breathing human beings who feel.     

The Family in Us: Family History,Family Identity and Self-Reproductive Adaptive Behavior

This contribution is an essay about the notion of family identity reflecting shared significant experiences within a family system originating a set of signs used in social communication within and between families. Significant experiences are considered as experiences of events that have an immediate impact on the adaptation of the family in a given socio-ecological and cultural context at a given historical time. It is assumed that family history is stored in a shared “family memory” holding both implicit and explicit knowledge and exerting an influence on the behavior of each family member. This is described as transgenerational family memory being constituted of a system of meaningful signs. The crucial dimension underlying the logic of this essay are the ideas of adaptation as well as self-reproduction of systems.     

The History of Family Therapy in South Africa

The history of family therapy in South Africa is presented from 1960 up to the present. The early days leading to the establishment of the South African Association of Marital and Family Therapy, national conferences, publications, national and international links are discussed.     

The Effectiveness of Family History Questionnaires in Cancer Genetic Counseling

The number of individuals receiving genetic counseling for hereditary breast and ovarian cancer syndrome has steadily risen. To triage patients for genetic counseling and to help reduce the amount of time needed by a genetic counselor in direct patient contact, many clinics have implemented the use of family history questionnaires. Although such questionnaires are widely used, scant literature exists evaluating their effectiveness. This article explores the extent to which family history questionnaires are being used in Ontario and addresses the utility of such questionnaires in one familial cancer clinic. By comparing the pedigrees created from questionnaires to those updated during genetic counseling, the accuracy and effectiveness of the questionnaires was explored. Of 121 families recruited into the study, 12% acquired changes to their pedigree that led to a revised probability estimate for having a BRCA1 or BRCA2 mutation and 5% acquired changes that altered their eligibility for genetic testing. No statistically significant difference existed between the eligibility for genetic testing prior to and post counseling. This suggests that family history questionnaires can be effective at obtaining a family history and accurately assessing eligibility for genetic testing. Based on the variables that were significantly associated with a change in probability estimate, we further present recommendations for improving the clarity of such questionnaires and therefore the ease of use by patients.     

Crisis Reactions of College Freshmen As a Function of Family Support Systems

This study explored the relationship between family support system availability and crisis reactions of entering freshman college students. Self-report measures, including distance from home, anticipated weekend visits with family, and number of family relatives residing in the college community, were investigated in relation to the crisis variable. The availability of the student's family was inversely correlated with his or her crisis score. This article emphasizes the need for primary group support and discusses implications for intervention.     

Occupational Endeavor As Life History: Anne Roe

As an exemplar of the fulfilled and integrative life, Harvard Professor Emerita Anne Roe provides a model of both personal and professional achievement. In her adult life the roles of researcher, administrator and teacher have been in dialectical interaction with those of wife and mother defined in the normative terms of the times. Her work, complicated by years of chronic illness, has been concerned with the intellectual functions of normal, aphasic and mentally disordered adults; behavior of newborn infants; status of foster children from different backgrounds; the effects of alcohol; personalities of artists and scientists; the psychology of occupations; behavior and evolution; the psychology of creativity; and the relations between early experiences and career patterns. Professional recognition has taken many forms, including entry in the World Who's Who in Science in which she and her husband George Caylord Simpson, the evolutionist, are separately listed for achievement in distinct fields. Forced curtailment of professional life has led to development in arts and crafts as a new occupational endeavor.     

Using a Family History Intervention to Improve Cancer Risk Perception in a Black Community

Few studies examine the use of family history to influence risk perceptions in the African American population. This study examined the influence of a family health history (FHH) intervention on risk perceptions for breast (BRCA), colon (CRC), and prostate cancers (PRCA) among African Americans in Pittsburgh, PA. Participants (n = 665) completed pre- and post-surveys and FHHs. We compared their objective and perceived risks, classified as average, moderate, or high, and examined the accuracy of risk perceptions before and after the FHH intervention. The majority of participants had accurate risk perceptions post-FHH. Of those participants who were inaccurate pre-FHH, 43.3%, 43.8%, and 34.5% for BRCA, CRC, and PRCA, respectively, adopted accurate risk perceptions post-FHH intervention. The intervention was successful in a community setting. It has the potential to lead to healthy behavior modifications because participants adopted accurate risk perceptions. We identified a substantial number of at-risk individuals who could benefit from targeted prevention strategies, thus decreasing racial/ethnic cancer disparities.     

Self-Reported Questionnaire Detects Family History of Cancer in a Pancreatic Cancer Screening Program

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death; approximately 5–10% of PDAC is hereditary. Self-administered health history questionnaires (HHQs) may provide a low-cost method to detail family history (FH) of malignancy. Pancreas Center patients were asked to enroll in a registry; 149 with PDAC completed a HHQ which included FH data. Patients with FH of PDAC, or concern for inherited PDAC syndrome, were separately evaluated in a Prevention Program and additionally met with a genetic counselor (GC) to assess PDAC risk (n?=?61). FH obtained through GC and HHQ were compared using Wilcoxon signed-rank sum and generalized linear mixed models with Poisson distribution. Agreement between GC and HHQ risk-assessment was assessed using kappa (κ) statistic. In the Prevention Program, HHQ was as precise in detecting FH of cancer as the GC (all p?>?0.05). GC and HHQ demonstrated substantial agreement in risk-stratification of the Prevention Program cohort (κ?=?0.73, 95% CI 0.59–0.87.) The sensitivity of the HHQ to detect a patient at elevated risk (i.e., moderate- or high-risk) of PDAC, compared to GC, was 82.9% (95% CI 67.3–92.3%) with a specificity of 95% (95% CI 73.1–99.7%). However, seven patients who were classified as average-risk by the HHQ were found to be at an elevated-risk of PDAC by the GC. In the PDAC cohort, 30/149 (20.1%) reported at least one first-degree relative (FDR) with PDAC. The limited sensitivity of the HHQ to detect patients at elevated risk of PDAC in the Prevention Program cohort suggests that a GC adds value in risk-assessment in this population. The HHQ may offer an opportunity to identify high-risk patients in a PDAC population.     

Investigation of the Use of a Family Health History Application in Genetic Counseling

The paper-based pedigree is the current standard for family health history (FHH) documentation in genetic counseling. Several tools for electronic capture of family health data have been developed to improve re-use and accessibility, data quality and standardization, ease of updating, and integration with electronic medical records. One such tool, the tablet-based Proband application, provides a flexible approach to data capture in dynamic and diverse clinical settings. This study compared Proband FHH collection to paper-based methods and investigated the usability of Proband in a clinical setting. After one use by 23 genetic counselors and students, Proband had 91% accuracy with a FHH audio scenario, which was significantly less (p?<?0.001) than paper’s 96% accuracy. These differences were attributed to incorrect or missing ages of grandparents (p?<?0.001) and great-aunts/uncles (p?=?0.012) and missing documentation of consanguinity (p?<?0.001). Possible explanations for these differences include greater experience with paper FHH documentation and pre-populated prompts for consanguinity on the paper template used. Proband’s perceived usability increased with use, with individual System Usability Scores increasing between first and last use (p?=?0.033). We conclude that tools for dynamic, provider-driven FHH documentation such as Proband show promise for improving risk assessment accuracy and quality patient care.     

Socioeconomic Status and Perceived Expectations As Measures of Family Influence

This is a study of changes in the educational plans of a longitudinal group of 255 males over grades 8, 9, 10, and 11. Subjected to testing and confirmed is the hypothesis that the student's perceived interaction with parents, regardless of socioeconomic status, is more directly associated with his educational plans than is socioeconomic status itself. The results also suggest that peers do not exceed parents in their influence upon adolescent plans when both sources of possible influence are measured by the same method.     

Cancer Genetics Service Interest in Women with a Limited Family History of Breast Cancer

Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.     

Impact of Genetic Counseling in Women with a Family History of Breast Cancer in Italy

As the impact of breast cancer (BC) risk assessment in asymptomatic women with a family history of BC had never been explored in Italy, we performed a study on a retrospective series of women who had undergone BC risk assessment. To this aim, a semi-structured telephone interview was administered to 82 women. Most participants considered the information received as clear (96.2 %) and helpful (76.8 %). Thirty-eight (46.3 %) stated that their perceived risk of BC had changed after the counseling: for 40.2 % it had decreased, for 6.1 % increased; however, women highly overestimating their risk at the baseline (≥4-fold) failed to show improvements in risk perception accuracy. Sixty-six women (80.5 %) stated they had followed the recommended surveillance, while 19.5 % had not, mainly due to difficulties in arranging examinations. Most women (89.0 %) had shared the information with their relatives, with 57.3 % reporting other family members had undertaken the recommended surveillance. BC risk assessment was associated with high rates of satisfaction and had a favorable impact on risk perception in a subgroup of women. The impact on surveillance adhesion extended to relatives. Organized programs for identification and surveillance may help identify a larger fraction of at-risk women and overcome the reported difficulties in arranging surveillance.     

A Life History Model of the Alcoholic Family

Research and clinical interest in the alcoholic family has tended to outpace the development of family-oriented conceptual models of alcoholism. A family development perspective has been almost totally absent, despite the chronic, longitudinal nature of alcoholism. A life history model is proposed that uses the concepts of the “alcoholic system,” family homeostasis, and the “family alcohol phase” as its building blocks. Chronic alcoholism tends to produce distortions in the normative family life cycle. These distortions and their clinical implications are discussed, using four case histories as illustrations of the concepts proposed. The model is also examined in the light of current research findings about the alcoholic family.