The Maudsley Model of Family Therapy for Children and Adolescents with Anorexia Nervosa: Theory,Clinical Practice,and Empirical Support

The aim of this paper is to present the Maudsley model of family therapy for children and adolescents with anorexia nervosa, one that integrates principles and skills from a variety of models. The Maudsley model is of prime importance because of its non‐pathologising approach to families, because its techniques have been published in sufficient detail for standardised application by clinicians, and because of its strong history of empirical support. It is also a model that integrates both modernist and constructivist influences from the history of family therapy.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Case Management with Families Receiving Public Assistance: Results from an Empirical Evaluation

ABSTRACT

This article describes the results from a family-based case management demonstration program which served families in North Carolina during the period of 1990 to 1993. The model for the program was based on the family investment initiative strategy developed by the George Washington University Center for Policy Studies. Entitled the Family Investment Initiative, the goal of the program was to assist families receiving AFDC to reach economic self-sufficiency. Results indicate that this family-based case management approach has promise for helping AFDC-dependent families achieve economic self-sufficiency. Implications of the results for social work case management practice with families are discussed.     

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage.     

Families' experience of a single session therapy framework in advanced allied health practice for children with neurodevelopmental and behavioural disabilities: A thematic analysis of qualitative data

Single session therapy (SST) has emerging evidence for facilitating meaningful therapeutic change in a small number of consults, rather than more traditional long-term therapies. This study aimed to explore and describe the parent/caregiver and child experience with advanced allied health practitioners (AAHP) using SST for children with developmental disabilities, by understanding key characteristics of the consultation that led to therapeutic change. Eligible families attending an AAHP outpatient clinic for children with developmental and behavioural concerns participated in one to four SST consultations around their identified areas of need. Semi-structured interviews were conducted with 38 parents and 12 children, from 37 different families. Thematic analysis was used to analyse interviews. Demographic information was gathered through parent interviews and by reviewing hospital records. Four key themes emerged relating to the characteristics of the consultation that led to a positive experience for families: (1) the art of mutual presence; (2) the value of time; (3) the power of understanding; and (4) the trust of action. These attributes were influenced by the overarching complexities of the AAHP, the parent's and child's interpersonal skills, and the organisational mechanisms influencing patient care. Parents and children reported clinical change during the consult through increased understanding, and being heard, valued, and respected for their individual decisions on how to manage their child's and family's needs. This study provides preliminary evidence that utilising SST for children and families with developmental and behavioural needs facilitates a positive experience valued by families. SST, with a focus on a family's individual identified areas of concern, was valued and effective when delivered by AAHP. This suggests that SST, when appropriately administered by experienced and trained health practitioners, is useful for families dealing with children with developmental and behavioural challenges.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Open Adoption and Post-Adoption Birth Family Contact: A Comparison of Non-Relative Foster and Private Adoptions

This study used data from the National Survey of Adoptive Parents (NSAP) to compare post-adoption contact in families with non-relative private domestic and foster care adoptions. This study is the first to use a nationally representative sample to examine and compare the extent of post-adoption contact in both private and foster adoptions. The results suggest that children adopted from foster care were less likely to experience post-adoption contact with their birth families than children adopted privately despite the fact that they were more likely to have lived with their birth families.     

Facilitating a multidisciplinary parent support & education group guided by Allen's developmental health nursing model

Parents are generally the primary source of support and nurturing for children experiencing an eating disorder; yet, they often feel blamed for the illness. Guided by the developmental health model, the group focused on parents' competence and helped them share solutions; reframed situations related to development in adolescence and mid-life; and shifted the emphasis to process to help parents understand behaviors. Parents became partners in helping their children recover by sharing solutions and creating learning opportunities from adversity.     

Sources of Double Disadvantage for People with Disabilities Living in Remote and Rural Areas of New South Wales, Australia

This study demonstrates how people with disabilities living in remote and rural areas experience double disadvantage in regard to receipt of services. They tend to experience similar disadvantages to other remote and rural dwellers (as compared with their urban counterparts), but these disadvantages are compounded by those associated with living in an environment which does not cater for the needs of people with disabilities. Findings display how geographical, physical, cultural, social and psychological factors within the external environment create disadvantages for the individual. The project involved data collection from people with disabilities, disability groups, service providers, families and carers through consultations and field trips. Major issues emerging from consultations were concerned with: transport and distance, isolation, the need for more consumer involvement, the nature of service provision (appropriateness, flexibility, co-ordination and location), the need for community and professional disability awareness education, protection of rights, carers and respite care, accommodation and housing, education, employment, information dissemination and access to specialised equipment. Comparison with overseas studies indicates that findings from this Australian study have applicability in other countries which have large remote and rural areas.     

Promoting low-income preschoolers’ school readiness through a text messaging intervention

The aim of the study is to evaluate the effects of a language-rich math content text message intervention as a way to promote child literacy outcomes for children enrolled in 15 Head Start centers participating in Jumpstart. Two-hundred and fifty-eight families were randomly assigned to treatment (language-rich math text) or control (information about kindergarten enrollment) conditions. Families received text messages in English, Spanish, or written Chinese. Parents reported on children’s fall entry skills and family demography. Teachers reported on children’s interest in math and literacy. Children were directly assessed on literacy skills to determine if the language-rich math content increased literacy skills. Structural equation models reveal no main effects for the sample of 258, but subgroup analyses by language show intervention effectiveness. For families receiving text messages in English, effectiveness depended on children’s fall letter and shape knowledge for increasing phonological awareness (English). The intervention appears most effective for Spanish-speaking families by increasing children’s math and literacy interest, definitional vocabulary, and print knowledge. Limitations and finding implications are discussed.     

Navigating post-trauma realities in family systems: Applying social constructivism and systems theory to youth and family trauma

Trauma affecting youth and families takes a variety of forms, from random one-time events such as accidents and natural disasters to chronic and highly personal trauma from child abuse or intimate partner violence. Though trauma has received increasing attention in theory and intervention research over the last several decades, the prevailing theories and treatments have limitations due to a linear perspective focused on the trauma problems of the individual. This is particularly concerning given the high dropout rates for trauma-focused treatments and the complexities of intergenerational trauma that cannot be adequately conceptualised at the level of the individual. To inform and improve family-based treatment of youth and family trauma, this paper proposes a theoretical framework informed by social constructivism and systems theory. Social constructivism upholds that reality is constructed through communication as an adaptive process for survival, with multiple potential realities possible. Systems theory promotes a non-linear view of causality within a system, such that the structure and properties of a system determine outcomes more than the inputs that go into the system. Together, the principles of these meta-theories contradict the orthodox focus on traumatic events causing trauma symptoms, and instead imply that family-based treatment should focus on helping families shift assumptions and dynamics that sustain the problem in the present. The joint application of a social constructivism–systems theory framework for trauma introduces several new principles to inform family-based treatment: (a) post-trauma realities; (b) mutual survival; (c) power–justice balance; and (d) adaptive reorganisation. The implications of these principles for youth and family trauma treatment will be discussed. Future intervention development and research should consider these principles in the ongoing effort to improve family therapy for youth and family trauma.     

Fragile: handle with care. Protecting babies from harm

Babies can often place demands on their carers which at times can feel unbearable. Parenting is the most difficult task that most people undertake, and yet it is also the one for which most receive little to no training. Parents under stress may be reluctant to ask for help, often adopting the belief that they should instinctively know what to do. Some professionals may also share this view, which may mean that they are less able to identify and support families who are struggling. Copyright © 2002 John Wiley & Sons, Ltd.     

Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.     

Effects of Employment-Based Programs on Families by Prior Levels of Disadvantage

This study examines how welfare and employment policies affect subpopulations of low-income families that have different levels of initial disadvantage. Education, prior earnings, and welfare receipt are used to measure disadvantage. The analysis of data from experiments suggests that employment-based programs have no effects on economic well-being among the least-disadvantaged low-income, single-parent families, but they have positive effects on employment and income for the most-disadvantaged and moderately disadvantaged families. These programs increase school achievement and enrollment in center-based child care of children only in moderately disadvantaged families. The most-disadvantaged families are found to increase use of child care that is not center based. Parents in these families experience depressive symptoms and aggravation. The findings raise questions about how to support families at the lowest end of the economic spectrum.     

Hardiness of Foster Families and the Intent to Continue to Foster

ABSTRACT

Recent research in the area of foster care has examined a number of external factors that may influence foster family retention. However, insufficient research has been devoted to the question of foster family hardiness, or internal strengths of foster families, and how it may affect retention. Hardiness in families means that families possess a belief that they can control or influence events of their experience, feel deep commitment, and anticipate change as a positive challenge. Additionally, hardy families exhibit a confidence in their abilities. Utilizing the Family Hardiness Index, this research reports findings from a study of 82 foster families from one southeastern United States metropolitan area. Foster families who reported an intent to continue to foster scored higher on the Family Hardiness Index than families from a non-clinical sample. Foster families who reported an intent to continue also scored higher than those foster families who reported they did not intend to continue. Logistic regression indicated that higher levels of hardiness and fewer years of licensure as foster parents were significantly associated with intent to continue to foster. The study also discusses implications of hardiness screening of prospective foster families and its potential value for improving support to and retention of foster parents, thus increasing stability and service efficacy for the children they serve.     

Responses of children and adolescents to a fire in their homes

House fires are a common occurrence in the United States, often happening as isolated, personal disasters. This qualitative study examines the responses of 12 children, ages 6 to 17, who were survivors of 12 separate home fires in a Mid-Atlantic city. Two thirds of the families involved were single-parent families receiving public welfare. Children were interviewed between three and four months after the fire. Nine categories concerning the fire experience and its aftermath were identified: exposure, loss, displacement, attribution, stress responses, changes in relationships, self-report of changes in behavior, child's perception of parent's stress and child's view of adulthood and the future. Psychosocial themes that emerged included a sense of fear and blame, sleep disturbances, and a sense of vulnerability. Parents rated their children on a quantitative measure of behavior and social competence. The behavior rating scale revealed that half of the parents rated their child's adjustment after the fire as not normal. Children's reactions to larger-scale disasters are indicated. Implications of these findings for social work practice are discussed.This study was supported by a grant from the Hassel Foundation, Philadelphia, PA.     

Hispanic Parental Experiences of Learning a Child Identifies as a Sexual Minority

Sexual minority youth (SMY) who do not feel loved and supported by their families face greater challenges and often experience various health disparities. The coming out process is often difficult for all SMY and their families. Although there is limited research on the impact of sexual orientation disclosure on families, there is even less that focuses exclusively on Hispanic families. This qualitative study explores the impact on a sample of Hispanic parents of having a child come out as lesbian, gay, or bisexual. The results demonstrate that although coming out is often challenging for SMY and their families, these challenges may be exacerbated for Hispanics due to cultural factors that contribute to children living at home longer and negative reactions to being gay. Parental reactions, impacts of disclosure on the family, and the impact of cultural factors are discussed. This study helps illuminate how cultural factors influence the coming out experience of Hispanic parents. These findings are important for understanding the experiences of these families to provide culturally appropriate resources for families navigating the coming out process.     

The Family Experience of the Crisis of Involuntary Treatment in Mental Health

While policy and practice standards emphasise the importance of engaging and supporting families of people with mental health problems, many families have reported feeling unsupported and distanced from treatment and care planning in acute inpatient units. There has been little systematic interest in the changing role and experiences of families throughout the emergence of illness, crisis, seeking of treatment, and subsequent recovery. Nineteen in-depth interviews were conducted with the next of kin of 17 people who had been admitted under an Involuntary Treatment Order in a large metropolitan hospital in the Brisbane region. A general inductive approach was used to analyse the data. While hospital admission was described as a time where, ideally, families were able to let go of being responsible for their relative's behaviour and let the health care professionals take over, for many this did not occur. We suggest four critical elements for providing recovery-oriented support to families. These include: (a) ensuring that families feel that their relative is safe and receiving the care needed; (b) keeping the family informed about their relative's progress; (c) ensuring families have access to information about the mental health system, and (d) working in partnership with the families.

IMPLICATIONS

• Family wellbeing is improved when they feel part of a supportive team.

• Instituting an open policy where families can contact ward staff easily and access information about the person they care for may alleviate families’ anxieties and minimise stress.

• Family work is enhanced when health professionals acknowledge families’ relationships, expertise, and understanding of their family member.

     

Self-concept and attitudes toward adoption: a comparison of searching and nonsearching adult adoptees

This study showed that nonsearchers and searchers are different from each other on almost every measure that was applied. Research on and experience with searching adult adoptees should not be applied to nonsearching adult adoptees. Likewise, research on and experience with nonsearching adult adoptees should not be generalized to searchers . The results of this study do not support the belief that adoptees, in general, have low self-concepts and identity conflicts, or that adoptees need information about their biological families and reunions to resolve their identity conflicts. Although the sample of pre- and post-reunion searchers was small, reunions did not make a significant difference in self-concept or identity conflicts, as measured by the TSCS . The results of this study do not support the theoretical bases often cited to justify open records. Specifically, adult adoptees in this study do not have negative self-concepts, did not experience poor adoptor - adoptee relationships, and the majority did not experience revelation of adoptive status as disruptive or late. Although significant differences exist between the comparison groups, an important finding is that of all the adult adoptees, the majority scored above the sixtieth percentile on the TSCS and had positive scores on the Attitude Toward Parents Scales. Furthermore, they were happy growing up, with only 12% reporting being unhappy. These findings support the conclusions of Day [1979] and Norvell and Guy [1977] as well as the belief that adoption is a legitimate way of building families.(ABSTRACT TRUNCATED AT 250 WORDS)     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.