THE EFFECTIVENESS OF FAMILY INTERVENTIONS IN THE TREATMENT OF PHYSICAL ILLNESS

Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

Infant feeding and asthma: is breast milk best?

Asthma is the most commonly occurring chronic childhood disease in the United States and is the leading cause of hospitalization and missed school days. In this article, I examine whether differences in asthma diagnosis can be attributed to differences in breastfeeding incidence and duration. Using data from the Fragile Families and Child Wellbeing Survey, I examine whether unobserved heterogeneity in the breastfeeding decision plays a role in childhood asthma propensity. I use the recursive bivariate probit framework to account for potential endogeneity by modeling the breastfeeding and asthma equations jointly. Results indicate that after accounting for the unobserved heterogeneity found in infant feeding practices, breastfeeding leads to lower rates of asthma diagnosis in children at age one. Breastfeeding for at least 3 months appears to have the strongest effects in children diagnosed at age one. However, there are no discernible effects of breastfeeding on the incidence of asthma by age three. These results indicate that breastfeeding can result in lower rates of wheezing and better respiratory health in small children.     

Childhood mental health and adult family relationships: How ADHD shapes experiences with intimate unions and parenthood

Increasingly recognized as a chronic condition that can endure across the life course, childhood attention-deficit/hyperactivity disorder (ADHD) is associated with less stable family formation and more strain around intimate unions (dating, cohabitation and marriage) and parenthood. This article reviews and evaluates multidisciplinary research on childhood ADHD, intimate unions and parenthood, with the purpose of motivating future sociological research in this area. The paper is organized into three general sections. First, I provide an overview of information on ADHD including its diagnosis and treatment, cross-disciplinary etiologies, and sociodemographic correlates. Next, I blend sociological perspectives on labeling and stigma, social stress, and the life course to consider the role of ADHD-related stigma in shaping associations of childhood ADHD with family formation processes (intimate unions and parenthood) and family functioning (relationship quality and communication) in adulthood. Finally, I discuss opportunities for future sociological research on childhood ADHD and adult family relationships that have the potential to contribute both to empirical research on childhood ADHD and adult family relationships, as well as to sociological research at the intersection of family and health.     

Predicting Children's Asthma Hospitalizations: Rural and Urban Differences in Texas*

Abstract Asthma is the number one chronic health condition facing children today; however, little is known about rural‐urban inequalities in asthma. This “area effects on health” study examines rural‐urban differences in childhood asthma hospitalizations within the state of Texas using negative binomial regression models. Effects associated with residence on the Texas‐Mexico border, where the majority of rural Texas children live, are also considered. Neighborhood‐level social class and proportion of the population that was native‐born Hispanic were significant predictors of asthma hospitalizations, independent of rural‐urban location. Conversely, proportion African American, Native American, and foreign‐born Hispanic, not a citizen; median year of home construction; and neighborhood location on the Texas‐Mexico border were conditional on urban‐rural location, and the strength of these predictors was stronger in rural areas. This suggests that locational and social factors intersect in marginalized spaces (like the rural and border regions of Texas) to create vulnerability to asthma hospitalizations.     

Do children in foster care receive appropriate treatment for asthma?

Asthma is the most common childhood chronic disease, and children in foster care have the highest rates of chronic conditions of any studied child population. The purpose of this study is to determine whether there are disparities in asthma management and health care utilization between children in foster care and other children covered by Medicaid in the state of Illinois. We use performance measures developed by the state child welfare system as well as those developed by the National Committee on Quality Assurance and used throughout the country. The study sample was drawn from linked administrative data on children in foster care and paid Medicaid claims. In order to determine the influence of living arrangement setting within the child welfare system, children in foster care were further grouped according to whether they lived in a stable home setting, a stable congregate care setting, or other living arrangement. We found that children living in home settings performed better on most performance measures than income-eligible Medicaid children. In contrast, children with asthma living in congregate care were particularly vulnerable as reflected in poor asthma care measurements and high utilization of hospitalizations despite positive performance on indicators of medication use. This population presents a significant challenge to the child welfare and health care delivery systems.     

The effectiveness of family interventions for physical disorders

This article reviews the evidence for the effectiveness of family interventions in the prevention and treatment of physical disorders. Pathways by which families influence physical health and a typology of family interventions are described. Family intervention studies, particularly randomized clinical trials, are reviewed in four clinical areas: family caregiving of elders, childhood chronic illness, spouse involvement in chronic adult illnesses, and health promotion/disease prevention. Implications for family clinicians and recommendations for future research are presented.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

Sibling caring roles and responsibilities when a child suffers from a chronic illness

Siblings' lives and well-being are potentially affected in profound ways when their brother or sister suffers from a chronic illness in childhood. The shift in the care of chronically ill children from the hospital to the home in recent years has had an impact on family relationships and interactions. Whilst studies on caregiving have focused on the parental care of children who are chronically ill; siblings may nevertheless take on some caring roles and responsibilities. This article intends to make a novel contribution to the sociological literature on siblings, caring, and chronic illness by presenting a review of the literature addressing siblings' caring roles and responsibilities in families of children with a chronic illness. Knowing about the caring roles and responsibilities undertaken by siblings when a brother or sister has a chronic illness, may be beneficial to healthcare professionals and influence their caring practice. In addition, this work may contribute to a better understanding of family relationships and further improve healthcare policies.     

Childhood behavioral and emotional disorders

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.     

Intervention research in couple and family therapy: a methodological and substantive review and an introduction to the special issue

This article serves as an introduction to this third version of research reviews of couple and family therapy (CFT) that have appeared in this journal beginning in 1995. It also presents a methodological and substantive overview of research in couple and family therapy from about 2001/2002 to 2010/2011 (the period covered in this issue), while also making connections with previous research. The article introduces quantitative research reviews of family-based intervention research that appear in this issue on 10 substantive areas including conduct disorder/delinquency, drug abuse, childhood and adolescent disorders (not including the aforementioned), family psycho-education for major mental illness, alcoholism, couple distress, relationship education, affective disorders, interpersonal violence, and chronic illness. The paper also introduces the first qualitative research paper in this series, as well as a paper that highlights current methodologies in meta-analysis. The first part of this article rates the 10 content areas on 12 dimensions of methodological strength for quantitative research and makes generalizations about the state of quantitative methodology in CFT. The latter part of the papers summarizes and makes comments on the substantive findings in the 12 papers in this issue, as well as on the field as a whole.     

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.     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

The Children's Depression Scale in Family Therapy: Hearing the Hurt

In this article I review the changes in thinking about childhood depression since the 1950s, with an emphasis on the struggles to find language for childhood depression. My interface with these changes is described, with a particular focus on the development of the Children's Depression Scale (CDS). Clinical applications of family therapy using the CDS in treatment of childhood depression are then illustrated with a composite case example. The idea is developed that depression in children can be seen as a blocked communication, and that increasing emotional expressiveness in families is an appropriate therapeutic aim and intervention. The relevance of the historical context to current practice is considered.     

Substance Abusing Mothers with a History of Childhood Abuse and Their Children's Depressive Symptoms: The Efficacy of Family Therapy

This study examined the associations among maternal history of childhood abuse, substance use, and depressive symptoms and the change in children's depressive symptoms in therapy. Mothers (N = 183) were randomly assigned into either a family or an individual treatment condition. Mothers were assessed for their childhood abuse retrospectively, baseline depressive symptoms, and substance use, whereas their children's depressive symptoms were measured five times during 1.5 years. Maternal childhood abuse was associated with a slower decline in child depressive symptoms through elevated maternal depressive symptoms, only in individual treatment. Maternal substance use further moderated this mediation pathway. This study supports the efficacy of family therapy in protecting children of mothers with a substance use disorder and a history of childhood abuse.     

Child-Oriented Family Therapy Outcome Research: Comparisons Between Brief Family Therapy and an Alternative Treatment

This paper is concerned with outcome research in child-oriented family therapy. Nine investigations comparing brief family therapy with an alternative treatment were critically reviewed. All of the studies were vulnerable to criticisms on design and methodological grounds. Problem areas included: specification of therapeutic techniques, confounding of therapeutic variables, equivalence of therapist factors, measurement of outcome, adequacy of measures and appropriate use of control groups. All studies concluded that childhood problems could be treated successfully with brief family therapy techniques. However, in the light of the design problems listed above, these conclusions should be treated tentatively.     

An evaluation of collaborative interventions to improve chronic illness care. Framework and study design

The author's dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of implementation, patient-level processes and outcomes, and organizational and team factors associated with success. Despite challenges in timely recruitment of sites and patients, data collection on 37 participating organizations, 22 control sites, and more than 4,000 patients with diabetes, congestive heart failure, asthma, or depression is nearing completion. When analyzed, these data will shed new light on the effectiveness of collaborative improvement methods and the CCM.     

Relational Family Therapy as an Aid Toward Resolving the Trauma of Sexual Abuse in Childhood in the Process of Separation in the Couple Relationship

Relational family therapy (RFT) is a psycho‐organic therapeutic approach that combines intrapsychic dynamics with interpersonal mechanisms and a systemic perspective. This integrative model is based on the assumption that the repetitive patterns of relationships in early childhood repeat in adulthood. It often happens that a sexually abused individual will later unconsciously be attracted to someone with whom they will relive the abusive atmosphere and dynamics from childhood. The purpose of this contribution is to present the RFT approach for dealing with sexual abuse. We will present a case study with individual segments from therapy with a woman, who previously had been sexually abused and was separated from her partner.     

Marital Therapy,EMDR, Herman's Model of Recovery from Trauma The Journey of One Woman and Her Family

Judith Herman (1992, page 183) delineates a three stage model of recovery from trauma: 1) Safety, 2) Remembrance and Mourning, 3) Reconnection. She criticises current treatment methods for their failure to make a difference in the “constrictive symptoms of numbing and social withdrawal … and marital, social and work problems do not necessarily improve”. Family therapy has been criticised often for insufficient focus on emotion and general sensations. This case analysis will illustrate how these shortcomings can be successfully addressed with the use of marital counselling and EMDR. The use of multiple treatment approaches contributed to one client's resolution of recent trauma due to a car accident, of past crises due to marital infidelity and early childhood abuse, with significant changes for her in her current family as well as in her family of origin. Theoretical implications for “family therapy” are raised.     

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.