Family psychoeducation and schizophrenia: a review of the literature

Family psychoeducation has emerged as a treatment of choice for schizophrenia, bipolar disorder, major depression, and other disorders. More than 30 randomized clinical trials have demonstrated reduced relapse rates, improved recovery of patients, and improved family well-being among participants. Interventions common to effective family psychoeducation programs have been developed, including empathic engagement, education, ongoing support, clinical resources during periods of crisis, social network enhancement, and problem-solving and communication skills. Application of family psychoeducation in routine settings where patients having these disorders are usually treated has been limited, reflecting attitudinal, knowledge, practical, and systemic implementation obstacles. Through consensus among patient and family advocacy organizations, clinician training, and ongoing technical consultation and supervision, this approach has been implemented in routine clinical settings.     

Celebrating Ourselves: The Family Reunion Rituals of African‐Caribbean Transnational Families

In the past decade, family reunions have become an important ritualized event among Afro‐Caribbean transnational migrants. Dispersed across a large number of North Atlantic countries, Afro‐Caribbeans have turned to organizing events specifically designed to reunite kinfolk. The rituals constitute a celebration of family as a distinct social group with a kin‐based, lineage‐like identity. Re‐creating kin ties among those spread across different nations and transmitting kin‐based connections to their offspring are the main incentives for holding these rituals. In this article I describe three different recent family reunions, one held in Barbados, one in Grenada, and one in Trinidad and Barbados. I analyse the specific forms these rituals take, relate their differences from the social positioning of the core members of the kin groups and discuss the signifying practices of the reunions for maintaining Caribbean family connections in the diaspora. Finally, I raise questions about how the kin‐based identities constructed in the reunion rituals intersect with race/class, ethnic and national identities.     

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.     

Parents of psychiatrically hospitalized children: A decade of changing perceptions

Psychiatric hospitals for children have changed dramatically during the last decade. The lengths of hospitalizations have been shortened; the psychopathology of children qualifying for admission is more severe, often with neurological or biochemical components. In some hospitals, there has been an increasing emphasis on research. All of these changes have affected the staff's perceptions of the children's parents; these changes appear to have resulted in a more supportive, less critical attitude toward these parents. This may be significant in increasing parents' confidence in coping with their child's illness and their family's stress. The need for empirical, longitudinal research is emphasized.The research mentioned in this article was funded by the American Cancer Society.     

A collaborative model: ambulatory pharmacotherapy for chronic psychiatric patients.

1. Increases in patient acuity and diagnosis related groups limiting hospital lengths of stay have contributed to the heightened demand for structured outpatient programs. 2. The Medication Clinic and Medication Group, a daily functioning outpatient program, is designed to shift the responsibility for medication management from the health-care provider to the patient and family through education and participation. 3. Within the framework of a collaborative practice model, the patient, clinical nurse specialist, and psychiatrist share equal power and responsibility. A phenomenologically oriented approach whereby the health-care provider attempts to understand the patient's illness from the patient's perspective is a crucial component. 4. The Medication Program combines the expertise of nursing and medicine in a complementary fashion, conducive to both revenue-generating activity and cost-effective role use.     

Socialization to dying: social determinants of death acknowledgement and treatment among terminally ill geriatric patients.

Although the vast majority of deaths occur among terminally ill geriatric patients, little is known about the etiology of these patients' death acknowledgement and ultimate type of treatment. Based on interviews with 76 triads composed of physicians, terminally ill patients, and primary caregivers, this study uses the socialization perspective to identify the actors and actions that most strongly affect the patient's death acknowledgment and receipt of exclusively palliative care (i.e., socialization to the dying role). Whereas patient preferences and sociodemographic characteristics do not influence significantly the patient's odds of death acknowledgment, these odds are increased if their primary caregivers accept death, their physicians are not affiliated with a teaching hospital, and the terminal prognosis is disclosed to them and disclosed "matter-of-factly." Patients who acknowledge death, whose agents value pain alleviation over life-prolongation, and whose physicians are not affiliated with a teaching hospital, are substantially more likely to receive exclusively palliative rather than curative terminal treatment.     

An uncertain future: children of mentally ill parents.

Research reports the uncertain outcome of variables affecting the life of a child of an MI parent. Nurses must avoid stereotyping children before assessment; they are to be in the forefront in assessing self-care skills and deficits to guide planning individual interventions for children and MI parents. Long-term research theory-based interventions will enhance mental health in high-risk children and families.     

Caribbean Families: Social and Emotional Problems

Families from the English-speaking Caribbean now comprise 30% of immigrants in New York State. Given the increase of Caribbean referrals to psychiatric hospitals and mental health clinics, it is important to begin examining more seriously the needs of this immigrant group. The concept of mental illness, risk factors that can lead to mental disorders, commonly accepted psychopathological disorders, issues in assessment and treatment as they apply to this cultural group are discussed in this article. A model for treatment—the multiculutral/multimodal/multisystems approach is examined.     

Rethinking Caribbean transnational connections: conceptual itineraries

Abstract In academic debates across the social sciences, transnationalism has increasingly come to denote the cross‐border networks developed by migrants and the ways in which these link geographically distinct places into a single social field. At the same time, the intense focus on linkages between origin and destination groups frequently ends up privileging this binary ‐ home/away ‐ as the only way to map enduring cross‐border linkages. Drawing on two examples of Caribbean practices connecting Toronto and New York, in this article I suggest the traversing of a different spatial terrain and consider the implications of expanding our conceptual itineraries to include these other journeys that so far have tended to fly under the radar in discussions of transnational migration.     

Abuse among rural mentally ill.

Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, and allocations of financial resources. The right to autonomous decision making is not limited to young or middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ill, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion. Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).     

Family life education: a treatment modality.

Family life education is a long-established form of help that continually ramifies into new areas. It aims at healthier family living, and reduction of family breakdown and child placement. Most child welfare personnel know about family life education, and some are practitioners in it. Many, however, may not be familiar with its present extensiveness or method of organization and operation. This personalized account of one agency's program, presented at the CWLA Central Regional Conference in Detroit, 1975, provides useful information.     

Child-Focused Family Therapy: Behavioural Family Therapy Versus Brief Family Therapy

We examined the effectiveness of behavioural family therapy (following the treatment agenda outlined in Fleischman, Horne and Arthur, 1983) and brief family therapy (following the procedures outlined in Fisch, Weakland and Segal, 1985), in the treatment of child psychological disorders. The parents of the 49 children referred to the outpatient unit of a children's hospital completed the Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1983). Three scales of the CBCL were examined to assess the effectiveness of the two therapeutic approaches pre- to post-treatment. Significant pre- and post-treatment differences were found for behavioural family therapy on the Internalizing, Externalizing, and Sum T scales and for brief family therapy on the Internalizing and Sum T scales. Sum T scales represent the sum of scores across all sub-scales of the CBCL. Neither treatment was found to be more effective than the other.     

Family Relocation:

Family domestic relocations for the purpose of employment have increased and indications are that this will continue. Although there are various reasons for relocation which affect its influence, recent research on corporate moves suggests that there are unexplored discrepancies in the findings on how the two genders respond to the relocation. This paper will discuss these differences and will describe how professions unwittingly can contribute to mother and/or wife blaming within the context of family relocation. The results are evident in the literature which produces: (1) a focus on women's responsibility and accountability for the family, to the exclusion of men, and (2) a lack of awareness of the societally prescribed contexts of work and family life that can be oppressive to both women and men. This paper also suggests practice principles that will guide work with family member's adjustment to relocation and that will direct future research.