Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.     

The effects of family composition,family health,parenting behavior and environmental stress on children's divorce adjustment

The traditional family composition model of children's divorce adjustment was compared to a family competence model. Subjects included 81 children whose parents remained married, were divorced, or were divorced and subsequently remarried. Divorced families had been separated for between 24 and 48 months. Custodial parents completed questionnaires regarding family functioning, occurrence of stressful life events, and child's psychosocial adjustment. Children completed questionnaires regarding parenting behaviors and self-esteem. A trained examiner conducted a structured diagnostic interview of the child. Multivariate analysis of covariance showed that family composition had a significant effect on the occurrence of stressful events and change in income but not children's adjustment. Hierarchical multiple regression correlations indicated the most powerful predictors of child adjustment were family competence variables which accounted for 21% of the variance in child adjustment scores. In contrast, family composition accounted for only 8% of variance in child adjustment scores. Further, hierarchical multiple regression correlations indicated that higher levels of family functioning were associated with families where parental hostility was low and parents displayed few rejecting behaviors while practicing consistent and appropriate discipline.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

The myth of science education

It is argued that the manner in which we teach science in the high schools represents an outdated positivistic conception of science. The standard presentation of a year of each of chemistry, biology and physics should be replaced by an integrated science plus history, philosophy, and sociology of science which would take a total of three years to complete. A proper appreciation for the true nature of science is essential to the continued health of the scientific enterprise.     

Culture wars: American moral divisions across the adult lifespan

Sociologists have argued that the public moral debate in contemporary America is characterized by a “culture war,” pitting “orthodox” and “progressivist” groups against one another (Hunter, 1991). This study addressed whether the culture war is evident in the moral thinking of ordinary Americans, and whether age-related patterns exist. Sixty fundamentalist Baptists (orthodox) and 60 mainline Baptists (progressivist) evaluated and reasoned about moral issues such as divorce and abortion. Each group was divided evenly into three age groups copsisting of young, midlife, and older adults. Moral reasoning was analyzed in terms of Shweder's (1990) ethics of autonomy, community, and divinity. Within all three age groups, progressivists used the ethic of, autonomy more than orthodox participants. Orthodox participants used the ethic of divinity more than progressivists. Orthodox and progressivist groups did not differ much in their use of the ethic, of community. Very few age group differences were found within the orthodox and progressivist groups. It is concluded that morality is conceived of in markedly different wasy by orthodox and progressivist groups, and that these conceptions are consistent across age groups.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Whose Gene Is It? A Case Discussion About Familial Conflict over Genetic Testing for Breast Cancer

A multidisciplinary group of genetic and other professionals discuss a complex case of familial conflict over access to genetic information. One twin wishes to know the results of her deceased mother's tests for BRCA1 mutations; a second twin objects to researchers making this information available. As the case discussion unfolds, the apparent facts of this case are called into question and the lines of ethical certainty become less clear.