Sustainable Family Care for Children with Disabilities

The majority of parents want to continue caring for their sons and daughters with disabilities at home, and they are expected and actively encouraged to do so. Notwithstanding, and for reasons that are not well understood, a substantial number of parents seek to place their disabled son or daughter out-of-home. The aim of this study was to investigate the attitudes of parent-carers in Alberta, Canada, toward out-of-home placement. The primary objective was to identify factors that may explain why some families, and not others, seriously consider out-of-home placement as an option for their child. This knowledge is vital for developing social care policies and programs that support parents and promote sustainable family care for children with disabilities. A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the family life survey, which incorporated measures of child and family characteristics, sustainability of the daily routine, and out-of-home placement propensity. Results suggest that family placement propensity is inversely associated with the sustainability of the daily routine. Sustainability of the daily routine is, in turn, more strongly associated with social-ecological resources, including parental control-over-work and the adequacy of child care options, than with child characteristics, including activity limitations and behaviour problems. If families have the social-ecological resources they need to create and maintain a daily routine that is congruent with their values and goals, and with the needs, interests and competences of family members, then they are unlikely to give out-of-home placement any serious consideration.     

Serving Families of Children with Developmental Disabilities

Abstract

Increased cultural diversity in the United States and elsewhere in the west requires that the school special services providers be aware of differences among identity groups, and sensitive to how these variations influence parents' perceptions of, and responses to, their child with a developmental disability. Because concern about diversity is relatively recent, the data base for action is virtually nonexistent. Nonetheless, there exists sufficient information to alert the special services provider to such factors as culture, religion, race, and social class in developing service programs. Understanding the values, beliefs, and experiences of families enables one to provide more effective services than does operating with the assumption that everyone views the world through essentially the same lens.     

Service Needs of Foster Families with Children who have Disabilities

We examined the service needs of foster families with children who have disabilities. Foster parents in a large Canadian city were asked “What services or supports would be helpful to you?” The responses to this question were edited for clarity and to eliminate redundancies, and sorted into piles of like statements by a group of 15 foster care professionals. Two types of statistical analysis were applied to the sorting of the statements to describe the relationship between statements and their groupings. The major concepts were identified according to the contents of the cluster and a map was constructed to provide a graphic representation of the conceptualization process. The major services and supports identified in this study were: support in the community, financial support, accommodating school system, good relationships with social workers, responsive professionals, information, comprehensive medical care, services for aboriginal children and families, transitional services, and respite.     

Serving Culturally Diverse Children with Serious Emotional Disturbance and Their Families

Over the coming decades, we can expect that cultural diversity will abound within the U.S. population and the imagery of an American melting pot will long be discarded. One significance of this trend will be the imperative to account for cultural diversity in assessing the needs of children with serious emotional disturbance (SED), to ensure that assessments, diagnoses, and treatments are accurate, fair, and meaningful. To achieve that end, however, will first require that all persons in the fields of education, mental health, social services, and juvenile justice become fully prepared to support children with SED and their families, prepared to bring to the process a sophisticated understanding of the interplay between culture and social behaviors. Nothing less than that level of preparedness will enable practitioners to develop unbiased interventions that competently and sensitively weigh cultural influences and target the needs of diverse students with emotional and behavioral difficulties. In this paper, we present the need for culturally competent practitioners in the area of SED, ways in which service providers can increase their cultural knowledge, and strategies for more effective service with this population.     

Families with Physically Handicapped Children: Social Ecology and Family Systems

This paper reviews research on families with physically handicapped children, and integrates this work within a social ecological perspective. Methodological difficulties in past research that contribute to a lack of consensus in the area are discussed. Research on stresses experienced by various subsystems within families with handicapped children is presented, with recommendations for future family-oriented research and intervention. The interactions of families with handicapped children with their social support networks are reviewed, underscoring the importance of these processes for coping and adaptation.     

Family Impact and Parenting Styles in Families of Children with ADHD

Attention deficit hyperactivity disorder (ADHD) begins in childhood and is characterized by attention deficits, hyperactivity, or impulsiveness that is inconsistent with a child’s developmental level. The effects of ADHD are not limited to the child alone but can affect their familial context, particularly parenting styles. Using data from 68 parents of 6–11-year-old ADHD-diagnosed children, we attempted to identify the predictive variables of two parenting styles: criticism-rejection and permissiveness-indulgence. We analyzed two complex predictive models using structural equation modeling. We hypothesized that family impact variables would mediate the relation between the child’s behavior and parenting. The data showed that the child’s ADHD was only indirectly related to parenting styles, whereas child’s behavior problems had a direct relationship. The results stressed the central role of the child’s behavior on family social life, parents’ marital relationship, and parents’ feelings about their children. These variables mediated the relationship between the children’s disorders and parenting styles. On the other hand, perceived social support had an inverse relationship with this negative family impact, and it even had relevant indirect effects on criticism and permissiveness.     

Mindful Parenting and Care Involvement of Fathers of Children with Intellectual Disabilities

There are few data addressing psychological variables that may explain some variation in parenting by fathers of children with intellectual disabilities. In the present study, we hypothesized that fathers who were more mindful in their parenting role (specifically, fathers who reported more present-centered attention in their relationship with their child) would use less avoidance in relation to their child with intellectual disability and that this would be reflected in increased father involvement in childcare. In a questionnaire survey 105 fathers completed a mindful parenting measure and a measure of parental involvement. Regression analyses revealed that fathers who reported being more mindful as a parent also reported more involvement in child-related parenting tasks and roles related to child socialization. These data suggest that mindfulness in the parenting role may be an important predictor of parenting in families of children with intellectual disabilities. Therefore, interventions designed to increased mindfulness should improve parent–child relationships and ultimately child outcomes.     

Family Microtransitions: Observing the Process of Change in Families with Adolescent Children

To read this article in Spanish, please see this article's Supporting Information on Wiley InterScience (http://interscience.wiley.com/journal/famp). To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). The aim of the study is to explore the process of microtransitions in families with adolescent children. Original methodological procedures were designed in order to have families as the objects of study and to analyze data with particular attention to the family process of change. A family interview focused on the adolescent and family change was conducted with 12 families having an adolescent child. As indicators of change, we used coordination and oscillation. Our results highlight different patterns of family interactions, illustrating various ways through which families deal with change. Conclusive remarks focus on the theoretical relevance of the study, the method and the implications for family practice and policy.     

"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

A Case Study of Liberation Among Latino Immigrant Families Who Have Children with Disabilities

Latino immigrant families with children with disabilities experience multiple sources of oppression during their settlement process in the United States. Unfair social structures and dominant cultural values and norms and the way they influence the immigrants' personal life stories generate a cycle of oppression very difficult to break. This paper presents a case study of how a group of Latino parents carried out a process of liberation fueled by the generation of empowering community narratives (critical awareness leading to transformative action) that resulted from a community-university partnership. Participants initiated a process that led them to discover their own stories of oppression and create new stories; to deconstruct the dominant cultural narratives and modify existing ones; and to understand contexts for power sharing. This joint reflection and increased awareness propelled group members to take action by founding a grassroots organization to redress some of the injustices that were partly responsible for their oppression, thus generating shifts at the personal, relational, and collective levels. In light of the theory of liberation, we discuss the participants' development of critical awareness that led them to take action to address their unmet needs.     

The Relationship between Socio-demographic Characteristics, Family Environment, and Caregiver Coping in Families of Children with Cancer

The factors that influence caregiver coping mechanism preferences after a child’s diagnosis with cancer are not fully understood. This study examines the relationship between caregivers’ socio-demographic characteristics and the coping strategies they use to adapt to childhood cancer. Sixty caregivers of pediatric cancer patients completed a socio-demographic questionnaire, the Family Environment Scale, and the COPE inventory. There were no significant differences in family environment by income or education. Caregiver educational attainment was positively associated with use of planning and active coping styles, while income was not associated with caregiver coping style. Mothers were more likely than fathers to use active coping, instrumental support, religious coping, and emotional support. Men with lower education engaged in greater substance use coping and lower planning. The findings show that educational attainment and caregiver gender influence caregiver coping styles following a pediatric cancer diagnosis and suggest that educational attainment rather than financial resources drive the association between SES and coping. Programs that address educational gaps and teach caregivers planning and active coping skills may be beneficial for parents with lower educational attainment, particularly men.     

Vulnerability and Resilience within Military Families: Deployment Experiences,Reintegration, and Family Functioning

This study examined how family factors that diminish feelings of loss (frequent communication) and reflect system-level adaptation (effective household management) during deployment were associated with enhanced resilience and fewer vulnerabilities during reintegration and, ultimately, the promotion of family functioning following deployment. Multiple reporters from active duty (AD) military families (N?=?214 families; 642 individuals) were examined, including AD members, civilian spouses, and their adolescent offspring. Most service members were men and enlisted personnel (95.3% male; 87.9% enlisted). Most AD and civilian spouses were between the ages of 31 and 40 (68.2% and 72.4%, respectively). Adolescent gender was relatively equal between boys (46.3%) and girls (53.7%), and their average age was 13.58. A SEM assessed the influence of communication frequency (reported by both AD and civilian spouses) and household management during deployment (reported by civilian spouses) on subsequent family functioning (reported by AD spouse, civilian spouse, and adolescent). The mediating role of positive and negative aspects of post-deployment family reintegration (reported by AD spouse, civilian spouse, and adolescent) was also assessed, as indicators of family resilience and vulnerability. Communication during deployment and civilian spouses’ household management during deployment were associated with multiple family members’ reintegration experiences. In turn, reintegration experiences were linked to self-perceptions of subsequent family functioning and, in some cases, other family members’ perceptions of family functioning. Similarities and differences among family members are discussed. While deployment and reintegration create systemic family changes and challenges, results indicated opportunity for growth that can reinforce connections between family members.     

Children with Special Health Care Needs: Impact of Health Care Expenditures on Family Financial Burden

We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child’s health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.     

Experiences of Families Transmitting Values in a Rapidly Changing Society: Implications for Family Therapists

Intergenerational value transmission affects parent–child relationships and necessitates constant negotiation in families. Families with adolescents from rapidly changing societies face unique challenges in balancing the traditional collectivistic family values that promote harmony with emerging values that promote autonomy. Using modern Turkey as an example of such a culture, the authors examine the transmission process in families that hold more traditional and collectivistic values than their adolescent children. Special consideration is given to generational and cultural differences in the autonomy and relatedness dimensions.     

Psychosocial and Life Stress Characteristics of Navy Families: Family Environment Scale and Life Experiences Scale Findings

This study examined the combined responses of husbands and wives within 785 Navy families on five subscales from the Moos and Moos (1981) Family Environment Scale (FES) and from the Life Experiences Scale (LES), a measure of life stress developed by Sarason, Johnson, and Siege1 (1978). Respondents were from the U.S. Navy Atlantic Submarine Fleet, Surface Fleet, Air Wing, and Shore Duty Commands. Major findings indicated that FES subscale means for Navy families compared favorably with national normative data reported by Moos and Moos (1981), and FES scores were not affected by the sailors' point in the deployment cycle or type of command assignment. In contrast, LES scores were significantly related to command assignment and point in the deployment cycle, with significantly lower levels of life stress reported for those sailors and wives assigned to shore duty. Finally, level of life stress was significantly related to family environment characteristics, with higher life stress families reporting lower levels on FES subscales of Cohesiveness, Expressiveness, and Organization, and higher levels on Family Conflict.