Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.     

A family-based, developmental-ecological preventive intervention for high-risk adolescents

Family-based preventive intervention has emerged as a promising modality for preventing antisocial behavior problems in youth. This article introduces an intensive, family-based preventive intervention for high-risk adolescents: Multidimensional Family Prevention. Multidimensional Family Prevention combines the advantages of standard prevention models (curriculum based and protection focused) with those of psychosocial treatment models (assessment based and problem focused). The model's main features are described: theoretical foundations (risk and protection theory, developmental psychopathology, ecological theory), guidelines for constructing a multidomain prevention program (family and peer relationships, school and prosocial activities, drug use and health issues, cultural themes), and strategies for tailoring and implementing five flexible intervention modules (adolescent, parent, interactional, extended family, extrafamilial). Implemented in the family's home, the intervention works to create a resilient family environment that supports the basic adolescent developmental goals of renegotiated attachment bonds within the family and durable connections with prosocial institutions.     

Methods of Engagement in Family-Based Preventive Intervention

Family-based prevention programs have shown promise in preventing drug use and antisocial behavior in high-risk youth. Multidimensional family prevention (MDFP) is an intensive, family-based counseling program in which a family-specific prevention agenda is crafted with each family. This collaborative, individualized approach to intervention requires a high degree of engagement on the part of families. The main challenges of engagement are discussed, and the main features of an engagement strategy are described: capturing the interest of the family and assessing risk and protective factors within the specific ecological context of the family in order to create a working agenda for preventive intervention.     

Developing culturally effective family-based research programs: implications for family therapists

Recently, some family scholars have developed greater sensitivity to the relative neglect of families of color in clinical and empirical research. Consequently, a proliferation of research elucidating many nuances of ethnic families has come to the forefront, containing a wealth of knowledge with useful implications for family therapists and other mental health providers. The findings of these studies hold enormously important implications for how family therapists can better engage and accommodate families of color in therapy. In this article we discuss some of the etiological and methodological issues associated with planning, conducting, and disseminating family-based prevention and intervention research programs with ethnic minority families.     

Harnessing the strength of families to prevent social problems and promote adolescent well-being

The family context exerts notable influence on many domains of adolescent development and well-being. Recent research indicates that the family has the power not only to help youth get back on course after problems emerge, but that the family can also play a critical role in preventing problems for youth by reducing the severity of a problem or mitigating its occurrence. The purpose of this paper is to outline the promise and challenges of family-based approaches to prevention in social work practice. Research and theory have identified numerous risk and protective factors in the family. Prevention programs that address these risk and protective factors have shown strong evidence of reducing youth risky behavior. Program effects vary based on the strength of program implementation. Agencies often face barriers to implementation including maintaining model fidelity, engaging families, and sustaining funding. Implications for practice and policy are discussed.     

Predictors of substance use and family therapy outcome among physically and sexually abused runaway adolescents

There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual. Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting fiamily systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions.     

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.     

Paternal incarceration and the family: Fifteen years in review

Since the turn of the 21st Century, research has highlighted the use of the American criminal justice system as a forager of young, low‐income, low‐educated, men of color, but less is known about how these men exist within such realities and construct meaningful relationships in their families. Research in the early 2000s has focused on how paternal incarceration affects these men, their partners, and their children. However, there is limited research about how these men understand fatherhood and the mechanisms for how paternal incarceration disrupts relationships and exacerbates inequality in the larger family system. Highlighting the consequences to family and child well‐being, the incarceration literature is beginning to focus on the variational and complicated experiences that families cope with when a father is incarcerated. This paper reviews the literature since the early 2000s, tracing what is known about incarcerated fathers and consequences for their children and families. In doing so, this paper discusses both the evolution of the literature and how more research about family processes is needed to understand the dynamic experiences of families and caregivers who manage periods of confinement during the age of mass incarceration in America.     

Family-Based Social Capital Considerations as Predictors of Attainments Among Appalachian Youth

The purpose of this study was to explore social and human capital theory in application to status attainment research using a sample of 463 low-income youth from rural Appalachian families. Comparisons were made between social capital variables based in the family of origin and social interaction variables based in the broader community as influences on the status attainment of youth. Surveys of youth were conducted during a ten-year longitudinal study (i.e., three assessments conducted during fifth/sixth grades and eleventh/twelfth grades, and for ages twenty-one/twenty-two). Path analyses confirmed some of the social interaction hypotheses but demonstrated eve greater support for individual human and family social capital variables in explaining young adult attainment outcomes. Support was provided for the inclusion of family-based social capital variables as a means of gaining a broader understanding of youth attainment.     

Examining risk,strengths, and functioning of foster families: Implications for strengths-based practice

ABSTRACT

Foster families provide safe and stable homes for children and youth who are removed from their homes due to maltreatment. Despite the stressors associated with bringing children in and out of a family’s home, many maintain healthy family functioning and continue fostering for many years serving an essential function in the child welfare system. This study sought to understand the factors that explained higher levels of family functioning within foster families. Collaborating with one statewide public child welfare agency, 681 licensed foster parents participated in an online survey that examined the association between family functioning with family strengths and risk factors. Findings from this study can inform strengths-based practice including training, assessment, and interventions for new and existing foster families to strengthen families and improve the well-being of children and youth in their care.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Foster family acceptance: Understanding the role of foster family acceptance in the lives of LGBTQ youth

LGBTQ youth in the child welfare system have historically received very little attention. The limited research available suggests that they encounter a number of disparities and double standards when compared to straight youth. The current study examines the role that foster family acceptance plays in the lives of LGBTQ youth as they navigate the child welfare system. The experiences of LGBTQ foster care alumni who had accepting foster family experiences are compared to those who had rejecting experiences. Findings suggest that foster family acceptance plays a pivotal role in creating an affirming and inclusive environment for LGBTQ youth. Similarly, findings provide further evidence for the need to educate, train, and recruit affirming and accepting foster families.     

Integrative module-based family therapy: application and training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.     

Affective disorders

Depression is a heterogeneous disorder with lifetime prevalence of "major depressive disorder" estimated to be 16.2%. Although the disorder is common and impairs functioning, it often goes untreated, with less than adequate response even when treated. We review research indicating the likely value of utilizing currently available, well-validated, couple- and family-based treatments with depressed individuals, and we provide empirically based treatment decision rules to guide effective application of marital and family interventions for depression in clinical practice. We suggest that traditional forms of couple-based intervention may be most appropriate for discordant, depressed couples, whereas nondiscordant, or mildly distressed, depressed couples may respond well to forms of intervention that have become available more recently and which focus on strengthening the dyad as a source of support. We also discuss parent training as an intervention for depression and describe briefly the directions for future research to enhance couple-based treatment for depression.     

Working with parents of spinal cord injured adolescents: A family systems perspective

Concepts from family systems theory are used to facilitate understanding of the needs of families coping with the spinal cord injury of an adolescent. Five assumptions derived from systemic principles are discussed as related to assessment and family functioning. Related suggestions are given for assisting parents in dealing with this non-normative stressor and its long-range effects on the adolescent and family.     

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.     

Clinical family assessment: applying structured measurement procedures in treatment settings*

This article describes the use of a battery of structured family measurement procedures to conduct systematic, comprehensive assessments of families who enter treatment. The measures are derived from family research and include self-report questionnaires and structured observation of family interactions. The assessment is multimodal, and examines the entire family unit, the marital subsystem, the individual family members, and the larger social context affecting a family. Two case examples are presented which demonstrate how the structured assessment data are combined with clinical theory and other information about a family to generate initial hypotheses about the functioning of the family system and likely avenues for therapeutic intervention.     

Early intervention and identification: finding the family

Following the growth of early intervention programmes for very young children with special educational needs and their families in the 1960s and 1970s, there came a reflective period during which the efficacy of early intervention was questioned (Marfo and Kysela, 1985). This was followed in the 1990s by a challenge to narrow interpretations of effectiveness in favour of a more holistic analysis of the benefits of intervention programmes for the whole family (Buckley, 1994). It was suggested that more attention should be given to the quality of relationships being established between the child and family members and the context in which early intervention programmes are delivered. Families themselves have begun to assert this (Fitton, 1994; Hebden, 1985) and recent legislation, both in the UK and abroad, has underlined the need for strong interdisciplinary approaches to meet the diversity of special educational needs that exist in our child population. This multidisciplinary approach necessitates a change of focus. It recognises the parent, with their child, as central, implicit and fundamental to the early intervention team, and endorses their right to request appropriate access to services. The model also gives parents the freedom to expand the concept of the family to include extended family and friends (for example, Ballard, 1994). Other parent-empowering initiatives include parent-to-parent schemes (Hornby, 1989 and 1995) which increase the capacity of families to provide resources to other families. The days of professionals as experts have passed. This change in approach to families of children with special educational needs will challenge some professionals and demand a radical reappraisal of the structure of their role and their style of delivery of early intervention, but, if we want quality early intervention, such a review is fundamental to re-establishing its place as a valid and valuable resource to families.     

Empirically supported family-based treatments for conduct disorder and delinquency in adolescents

Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief strategic family therapy. In addition to summarizing the theoretical and clinical bases of these treatments, their results in efficacy and effectiveness trials are examined with particular emphasis on any demonstrated capacity to achieve favorable outcomes when implemented by real-world practitioners in community practice settings. Special attention is also devoted to research on purported mechanisms of change as well as the long-term sustainability of outcomes achieved by these treatment models. Importantly, we note that the developers of each of the models have developed quality assurance systems to support treatment fidelity and youth and family outcomes; and the developers have formed purveyor organizations to facilitate the large-scale transport of their respective treatments to community settings nationally and internationally.     

Cost-effectiveness of family-based substance abuse treatment

In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.