Interactive Genetic Counseling Role-Play: A Novel Educational Strategy for Family Physicians

Background Family physicians (FPs) are increasingly involved in delivering genetic services. Familiarization with aspects of genetic counseling may enable FPs to help patients make informed choices. Purpose Exploration of interactive role-play as a means to raise FPs’ awareness of the process and content of genetic counseling. Methods FPs attending two large Canadian family medicine conferences in 2005 were eligible—93 participated. FPs discussed a case during a one-on-one session with a genetic counselor. Evaluation involved pre and post intervention questionnaires Results FPs’ baseline genetic knowledge was self-rated as uniformly poor. Baseline confidence was highest in eliciting family history and providing psychosocial support and lowest in discussing risks/benefits of genetic testing and counseling process. Post-intervention, 80% of FPs had better appreciation of family history and 97% indicated this was an effective learning experience. Conclusions Role-play with FPs is effective in raising awareness of the process and content of genetic counseling and may be applied to other health disciplines. This research was funded by: The Canadian Institutes of Health Research (CIHR) Institute of Genetics, The Genetics Education Project (funded by the Ontario Women’s Health Council), and GeneSens (funded by a CIHR Interdisciplinary Capacity Enhancement Team Grant).     

Economic Disadvantage in Complex Family Systems: Expansion of Family Stress Models

Economic disadvantage is associated with multiple risks to early socioemotional development. This article reviews research regarding family stress frameworks to model the pathways from economic disadvantage to negative child outcomes via family processes. Future research in this area should expand definitions of family and household to incorporate diversity and instability. This expansion would be particularly relevant for research among low-income ethnic minority families and families with young children. This line of research would highlight specific pathways to target to prevent the onset of early parental and child dysfunction.     

早期经验对儿童心理发展的影响

儿童早期经验包括产前环境、出生时身体状况、出生后家庭养育和学前教育经历等,这些方面对儿童心理能力发展有重要而长期的影响。该文基于国外新近开展的大型纵向研究,对胎儿期母亲的情绪行为特征,出生状况,出生后母亲工作状况,父亲教养行为,学前教育状况等对儿童认知能力、学业成就、社会行为等的预测作用,以及种族、性别、家庭经济地位等背景因素在两者之间的调节作用进行了介绍,最后对我国设计和开展相关研究提出了建议。     

Longitudinal Model Predicting Self‐Concept in Pediatric Chronic Illness

Although self‐concept has been identified as salient to the psychosocial adjustment of adolescents dealing with a chronic illness (CI), little research has focused on its predictors it. Given that depression and parent–child attachment have been linked to self‐concept in the population at large, the goal of this study was to evaluate these relationships longitudinally in a sample of adolescents with CI. Using participant data from the Mastering Each New Direction (MEND) program, a 3‐month psychosocial, family based intensive outpatient program for adolescents with CI, we employed multilevel modeling to test longitudinal changes in self‐concept, as predicted by depressive symptoms and parent–child attachment, in a sample of 50 youths (M_age = 14.56, SD_age = 1.82) participating in MEND. Both “time spent in the program” and decreases in depressive symptoms were associated with increases in self‐concept over time. Higher baseline levels of avoidant attachment to both mother and father were also associated with greater initial levels of self‐concept. Targeting depressive symptoms and supporting adaptive changes in attachment may be key to promoting a healthy self‐concept in pediatric CI populations. The association between avoidant attachment and higher baseline self‐concept scores may reflect differences in participants’ autonomy, self‐confidence, or depression. Limitations of the study include variability in the amount of time spent in the program, attrition in final time point measures, and the inability to fully examine and model all potential covariates due to a small sample size (e.g. power).     

Integrated,Family‐based,Partial Hospital Treatment for Complex Pediatric Illness

This paper describes a unique treatment program for complex pediatric illness. The Hasbro Children's Partial Hospital Program uses a family systems orientation, integrated care, and a partial hospital setting to treat children with a wide range of pediatric illnesses that have failed outpatient and inpatient treatments. We have treated more than 2000 children with at least 80 different ICD‐9 diagnoses. The multidisciplinary treatment team functions as a meta‐family for children and their families who present with illness and family beliefs that impede successful outcomes with standard care. The three features: family systems orientation, integrated care, and partial hospital setting, hopefully interact to create an environment that helps families expand and modify their explanatory models regarding participating in effective medical care. The goal of treatment is for both children and their parents to feel empowered to take control of the illness. Parents completing standardized measures at intake describe their children and families as experiencing significant emotional distress, low levels of general family functioning, and poor quality of life. Although the children are described as having distinct behavioral differences, the families are described as responding to the experience of a seriously ill child in similar ways. A treatment program that addresses the noncategorical aspects of how families respond to illness while addressing the specific diseases of the children can allow children and their families to respond favorably to treatment.     

Evaluating Supervision Models in Functional Family Therapy: Does Adding Observation Enhance Outcomes?

This study examined the effects of observation‐based supervision Building Outcomes with Observation‐Based Supervision of Therapy (BOOST therapists = 26, families = 105), versus supervision as usual (SAU therapists = 21, families = 59) on (a) youth externalizing behavior problems and (b) the moderating effects of changes in family functioning on youth externalizing behaviors for adolescents receiving Functional Family Therapy (FFT). Exploratory analyses examined the impact of supervision conditions on youth internalizing problems. In 8 community agencies, experienced FFT therapists (M = 1.4 years) received either BOOST or SAU supervision in a quasi‐experimental design. Male (59%) or female (41%) adolescents were referred for the treatment of behavior problems (e.g., delinquency, substance use). Clients were Hispanic (62%), African American (19%), Non‐Hispanic White (12%), or Other (7%) ethnic/racial origins. Therapists (female, 77%) were Hispanic 45%, African American (19%), White Non‐Hispanic (30%), or other (4%) ethnic/racial backgrounds. Analyses controlled for the presence or absence of clinically elevated symptoms on outcome variables. Clinical outcomes were measured at baseline, 5 months, and 12 months after treatment initiation. Clients with externalizing behavior above clinical thresholds had significantly greater reductions in problem behaviors in the BOOST versus the SAU conditions. Clients below thresholds did not respond differentially to conditions. Supervisors in BOOST had more experience with the FFT model; as such, the observed results may be a result of supervisor experience. The BOOST supervision was associated with improved outcomes on problem behaviors that were above clinical thresholds. The findings demonstrate the importance of addressing client case mix in implementation studies in natural environments.     

Beyond the Couple: A Qualitative Analysis of Successful In‐law Relationships in Iran

In‐laws can play a significant role in the success or failure of marriages around the world. In the Middle East, recent quantitative research indicates that having trouble with in‐laws is a major predictor of divorce in Iran. To explore this further, we undertook a qualitative (grounded theory) analysis of in‐depth interviews with 17 Iranian daughters‐in‐law, five sons‐in‐law, three mothers‐in‐law, three fathers‐in‐law, and three expert family clinicians. Emergent concepts, themes, and coding categories were consistent with a Family Triad Model (FTM) of successful marital and in‐law relationships, wherein each spouse must (a) form we‐ness with their partner, (b) establish flexible boundaries between themselves and their families of origin, and (c) join their in‐laws. A higher‐order core category suggested that optimal couple and family functioning depends on the coherence or balance of these functions across the triadic role components of spouse, child‐in‐law, and family‐in‐law (or family‐of‐origin). In the changing cultural context of Iran, where blood relations have traditionally held primacy over marital relations, such triadic coherence appears crucial to marital success, at least from the perspective of many women. Our FTM results also highlight the importance of taking in‐laws into account when planning educational, preventative, or clinical interventions.     

Latina/o Children Living With an Immigrant Mother With Depression: Developmental and Cultural Nuances in Recognition and Coping

The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers’ mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationship with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths’ attributions and coping strategies. This inquiry involved focus groups with 12 participants aged 9–16 years to explore their perspectives on maternal depression. All youth had participated in a 12‐week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture‐specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.     

What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation “common factors informed family therapist,” and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.     

The effects of work- and family-related transitions on young people’s perception of being adult

Using a nationwide sample of 2656 eighteen- to twenty-nine-year-olds, the first part of the present study addressed the question of how non-traditional as compared to traditional living arrangements related to young people’s self-perception of being either adolescent or adult. Being in a romantic relationship increased the likelihood of feeling adult. Modern adult living arrangements (living alone in a single household or sharing an apartment with peers) increased the likelihood of feeling adolescent. Employing a longitudinal sample of 461 twenty- to twenty-seven-year-olds, changes in job status and sources of income were studied with regard to their connections to the emergence of subjective adulthood or the regression to subjective adolescence, respectively. No association between adult or adolescent self-perception and issues of work and material autonomy was found, but the emergence of subjective adulthood was related to romantic relationships and parenthood. Findings are discussed with reference to young people’s volatile living conditions and transient commitments implied by social change.