The Parent Concerns Questionnaire: evaluation of a mothers' self report instrument for the identification of problems and needs in child and family social work

The measurement of problems and needs is a major issue for policy and practice in social work and social service provision. There has, furthermore, in recent years, been an increasing emphasis on gaining an understanding of users or clients' views of needs and service provision. However, there have been few attempts to develop practitioner and ‘client friendly’ ways of gaining information on problems and needs, either on an individual basis, or through the collection of aggregated data which can be used by local authorities as a whole. Where these have taken place there has been little attempt to assess their reliability or validity. This paper reports on the design and development of the Parent Concerns Questionnaire, an instrument designed to obtain the views of mothers in general, and depressed mothers in particular, in families subject to child and family care intervention. The paper reports on the reliability and validity of this instrument, which is presented as appropriate for use, both with families containing depressed mothers and other families subject to child and family care intervention. It may be used to examine problems and needs both on an individual family‐by‐family basis, and through the aggregation of data, on an authority‐wide basis. Copyright © 2000 John Wiley & Sons, Ltd.     

Open Days for NESB Communities: Primary Prevention for Sexual Abuse

The realisation that cultural contexts were impeding access to services for many disadvantaged families and hindering the disclosure of child sexual abuse prompted two agencies to organise collaborative primary prevention strategies. Family groups were convened from the local Cambodian, Vietnamese, Latin American and Arabic‐speaking communities. Focus groups were attended by one or more members of each family. Participants contributed to the formation of a collective understanding that could then be adapted and passed on to other families in their communities. It was observed that once individual families entered this process, isolation diminished and steps towards exploration of the issues could be taken. This paper outlines a process through which family therapists can use primary prevention strategies to reach NESB groups.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

‘Similar but Different’ Conversations: Working with Denial in Cases of Severe Child Abuse

This article describes a particular aspect of a service called ‘Resolutions’ that has been developed at the NSPCC Child and Family Centre in Bristol, England. The Resolutions service works with families where parents and/or carers are disputing responsibility for serious abuse of their children, but where child protection agencies deem at least one of them culpable on a balance of probabilities. The service's general approach to developing partnerships with families is briefly considered, but the article concentrates on a particular approach. This is where parents and/or carers who are disputing abuse of their children roleplay a ‘similar but different’ family. This enables key issues in relation to child abuse to be discussed by the parents and/or carers. It also facilitates the gaining of greater understanding that helps them ensure the future safety of their own and other children.     

‘We need to understand what’s going on because it’s our life’: Using sandboxing to understand children and young people’s everyday conversations about care

Children and young people who live away from birth families (through adoption or being in care) need an understanding of their life story, including reasons for removal from birth family to process what has happened to them and to develop a secure identity. We report data produced with care experienced children and young people using a creative sandboxing method capturing hopes and fears for conversations about care in sand scenes. The themes presented emphasise the need for care-experienced children and young people to be supported to engage in ‘difficult conversations’ about their lives in warm, open and responsive ways.     

Family Discussion Groups for Patients with Chronic Pain: A Pilot Study

This pilot study investigated the benefits of discussion groups for patients with chronic pain and their family members. Nineteen patients with chronic pain and 41 relatives participated in four consecutive groups. Most patients and family members found their participation clearly helpful for themselves and for the family. The group helped them to improve communication, support and mutual relationships, and to better cope with the pain. Reported beneficial factors were experiencing communality, having a place to discuss things with each other, gaining insights, and learning from fellow‐sufferers and their own family. Post treatment, patients also felt less distressed by the pain, less depressed, less insufficient and showed an increase in life‐control and social activities. Moreover, some aspects of the family climate improved, but only in the perception of the family members. The present study points to the value of a multifamily format in chronic pain therapy and suggests the appropriateness of further controlled investigation.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Families' values and attitudes regarding responsibility for the frail elderly: implications for aging policy

This study examines the norms and values associated with care to disabled and frail aging parents, in particular those with regard to the sharing of responsibilities for care between families and formal services, and this within three age cohorts in Quebec, Canada. It is based on a telephone interview of 1,315 people. Factor analysis yielded four factors: (1) family responsibility; (2) uncompromising family obligations; (3) acceptance of services; (4) distrust of services. Analyses of the data indicate that all three age cohorts consider that families have responsibilities for their aging family members, at the same time that they score very high on the acceptance of service scale. This article discusses these seemingly paradoxical results and their implications for aging policy.     

The family's role in person-centered care: practice considerations

Effective implementation of person-centered care requires a shared understanding and commitment to make it a reality by administrative personnel, direct care providers, and residents and their family members. Long-term care facilities must seek ways to engage residents' families in person-centered care through its training, policies, care planning, and documentation. Doing so may require revisions to policies and work practices, and ongoing leadership efforts to maintain this care framework within the realities of staff turnover and regulatory requirements. Developing protocols and procedures that facilitate family members' communication with staff and build consensus and shared values will result in a system that represents and honors the unique perspectives, values, and needs of each resident receiving care. It is important for facility leadership to set the tone for acknowledging the importance of family involvement in person-centered care by modeling acceptance of concerns and criticisms as valid and by acknowledging that direct care providers, residents, and their family members have a voice in care decisions. Such an approach has the greatest chance of success in promoting person-centered care and the shared values necessary to ensure its successful implementation.     

Prefamily Counseling: Working with Blended Families

According to the literature, approximately 50% of all Americans have some kind of step-relationship. Living in a blended family has become more commonplace, as have significant issues related to family members' adjustment to and day-to-day maintenance of them. In the majority of instances, blended families enter into life together with little awareness of what to expect, common problems blended families experience, and plausible solutions to the difficulties often faced. Based on the current literature and clinical experience, preblended family counseling, a framework approach that brings family members together prior to remarriage or cohabitation, has been developed.     

Having Friends and Influencing People Family Approaches to Peer Problems in Children and Adolescents*

This paper looks at peer relationship problems in children and adolescents from a systemic point of view. The way in which family members typically become involved in these problems and the manner in which their involvement can contribute to maintenance of the difficulties, are discussed. The object of family intervention becomes to bring the child into direct positive relationship with peers whilst involving the family to support the child's initiative and independence, rather than the child's dependence on them, for solutions to problems. Six strategies which have been helpful to families are explained by way of illustration. The therapist's role in the process is also illustrated.     

Families' Values and Attitudes Regarding Responsibility for the Frail Elderly

Abstract

This study examines the norms and values associated with care to disabled and frail aging parents, in particular those with regard to the sharing of responsibilities for care between families and formal services, and this within three age cohorts in Quebec, Canada. It is based on a telephone interview of 1,315 people. Factor analysis yielded four factors: (1) family responsibility; (2) uncompromising family obligations; (3) acceptance of services; (4) distrust of services. Analyses of the data indicate that all three age cohorts consider that families have responsibilities for their aging family members, at the same time that they score very high on the acceptance of service scale. This article discusses these seemingly paradoxical results and their implications for aging policy.     

Cultures of intergenerational transmission in four-generation families

Intergenerational transfers in families are increasingly a topic of interest in the context of reductions in the welfare state and increased longevity. This paper draws upon data from a study of four‐generation families which afforded an opportunity to examine the transfer of material and care resources across family generations. It explores ways in which family members from different generations talked about family obligations and the relevance of the concept ‘cultures of transmission’ in classifying these discourses. It addresses the questions: How far are cultures of transmission familial in the sense of typifying particular families? And how far are they shaped by life course phase and by historical context?     

Carer Participation: Training for People With Intellectual Disabilities in a Chinese Society

People with intellectual disabilities require training to improve independence, and carers are important partners in the process. Studies show that carers are able to motivate family members with intellectual disabilities to participate in training. In addition, family members may serve as cotrainers. To increase carers' participation, it is necessary to empower them with training techniques and develop strategies to relieve their stress. This article aims to explore the effects of carer support to enhance training quality of daily living skills for their family member with intellectual disabilities, through the use of care case studies, in the context of families living in Hong Kong. A model of multiple case studies is adopted. Three cases are analyzed to illustrate various modes of carer participation.     

Relational Ethics and Moral Blindness: Startling Incongruities in Couple and Family Life

This article explores the common experience of working with couples and family members who describe their partners and children as important to them yet at the same time are cavalier, neglectful, ignorant, and even destructive in dealings with their loved ones. People who fail to relate ethically are said to be prone to have stagnant relationships, become corrupt in seeking solutions to moral problems, be more depressed, have poorer health problems, and experience lower quality relationships. This article describes ethical fading and moral blindness in couples and families and in our work as therapists. It argues a relational ethics frame that fosters ethical sensitivity and stronger moral identity both in ourselves and others is an important addition to our therapeutic repertoire.     

A multidimensional and contextual framework for understanding diverse family members' roles in long-term care facilities

Very few studies have explicitly examined the roles of family members in institutionalized settings and how these roles are developed. The most widely used theoretical framework employed in the studies that do exist is Litwak's structural-functionalist framework—the theory of shared functions and balanced coordination. Although Litwak's theory emphasizes the importance of both formal organizations (e.g., long-term care facilities) and primary groups (e.g., family) to optimal care, the framework provides a limited understanding of the roles of family members in long-term care facilities. The first section of this article describes Litwak's framework and then outlines the limitations of this task-assignment approach. By adopting a symbolic interactionist approach and integrating concepts from an ecological perspective and Hughes' concept of career, an alternative, more dynamic, contextual framework for understanding the roles of family members in long-term care settings is presented.     

A qualitative analysis of suicide risk factors,preferred means,and means restriction feasibility within a homeless shelter environment

Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.     

Living together again: families surviving Italian immigration policies

In this article we provide an understanding of the challenges that immigrants have to face to relocate their nuclear families abroad. We will show that immigrants are often forced to leave their dependent relatives behind for much longer than expected, and that, despite their efforts to maintain intimacy at distance, the transnational managing of remittances and care entails certain risks. Both the separation experienced and the living conditions that reunited members face in Italy can make reunification itself a very sensitive moment in the life-course of these families, since the process of adaptation to the receiving society leads relatives to reshape and renegotiate their respective family roles and responsibilities. We are going to highlight how the availability of extended ties can represent a concrete form of support for many immigrant couples and lone mothers both during the separation and in their struggle to reunite their relatives, as well as after the reunification has taken place.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.