Towards an Integrated Approach to a Family Intervention for Co‐occurring Substance Abuse and Schizophrenia

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate.     

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.     

Adolescent Pathways to Co‐Occurring Problem Behavior: The Effects of Peer Delinquency and Peer Substance Use

Delinquency and substance use are more likely to co‐occur in adolescence compared to earlier and later developmental periods. The present study examined developmental pathways to co‐occurring problem behavior from 6th to 10th grade (N = 2,002), testing how peer delinquency and substance use were linked to transitioning between abstaining, delinquency, substance use, and co‐occurring problem behavior. Developmentally, most youth transition from abstinence to delinquent behavior and then escalate to co‐occurring problem behavior. Once co‐occurring problem behavior onsets, remitting to single‐problem behavior or abstinence is unlikely. The impact of peers on problem behavior is domain‐specific when individuals transition from abstaining to a single‐problem behavior, but is more general with respect to escalation of and desistance from problem behavior.     

Family Dynamics and Self‐Injury Behaviors: A Correlation Analysis

This study tested the relationship between family dynamics and self‐injury. A total of 189 participants responded to a web‐based survey collecting information related to previous self‐injury behaviors and family dynamics. Participants were over 18 years old who had used self‐injury (intentionally harming themselves physically to relieve painful emotions without suicidal intent), but who had not used self‐injury for over a year. Results indicated that healthy family dynamics were negatively correlated and associated with higher scores of self‐injury behaviors. This study offers some evidence that family dynamics influence self‐injury behaviors. The implications for family therapy are discussed.     

The Association of Sexual Behavior with Externalizing Behaviors in a Community Sample of Prepubertal Children

Abstract

On the basis of the problem-behavior theory for adolescence, we hypothesized that already during childhood sexual behavior is associated with (non-sexual) externalizing behaviors and tested the hypothesis in a community sample. In the context of a postal questionnaire survey of 6-10 year old children, the parents of 349 girls and 326 boys completed the Child Behavior Checklist (CBCL). The CBCL Sex Problems scale did not differ between genders, ethnic groups, or age groups. For both girls and boys, the scores on the Sex Problems scale correlated significantly but modestly (maximum r = 0.35) with all other CBCL scales; only in boys did the correlations with externalizing behaviors exceed those with other scales. We conclude that children from a community sample who show sexual behavior as defined by the CBCL tend to be the ones with increased behavioral/emotional problems in general, with only modest specificity in symptomatology.     

A Cost–Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness

Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs–benefits of a family systems‐based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi‐prospective study compared the 12‐month pre–post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost–benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.     

From Refrigerator Mothers to Warrior‐Heroes: The Cultural Identity Transformation of Mothers Raising Children with Intellectual Disabilities

This article examines public performances of mothering children with intellectual disabilities through thematic discourse analysis of thirty‐three published memoirs. These data reveal presentations of self that, once consumed and interpreted by public interaction, emerge collectively as a “warrior‐hero” identity, a reformulated archetype in the social construction of a good mother. This archetype places a cultural expectation on mothers to do battle to attain resources and possible cures for their children, ultimately shifting the historical burden on mothers from causing the intellectual disabilities of their children to curing them. The article concludes with a discussion of how this hyperfocus on expert parenting has the potential to leave mothers of children with intellectual disabilities strained and subject to the pitfalls of systems of inequality.     

Immigration and the Family Circumstances of Mexican‐Origin Children: A Binational Longitudinal Analysis

Using data from the birth cohort of the Early Childhood Longitudinal Study (n = 1,200) and the Mexican Family Life Survey (n = 1,013), this study investigated the living arrangements of Mexican‐origin preschool children. The analysis examined children's family circumstances in both sending and receiving countries, used longitudinal data to capture family transitions, and considered the intersection between nuclear and extended family structures. Between ages 0–1 and 4–5, Mexican children of immigrants experienced significantly more family instability than children in Mexico. They were more likely to transition from 2‐parent to single‐parent families and from extended family households to simple households. There were fewer differences between U.S. children with immigrant versus native parents, but the higher level of single parenthood among children of natives at ages 0–1 and the greater share making transitions from a 2‐parent to a single‐parent family suggest ongoing erosion of children's family support across generations in the United States.     

‘No Coward Soul is Mine’: A Family Systems Analysis of the Bronte Family

The Bronte family produced three major authors of the Victorian period, only one of whom, Charlotte, lived to enjoy her fame. Since the beginning, this family has elicited controversy, myth and speculation. The authors attempt an analysis of the complex dynamics of the Brontes, including its constituent ‘family cultures’, parent‐child alliances, sibling bonds and rivalries, the traumatic effects of three early deaths, and the strong theme of secrecy and ‘protection’ in a family dominated by Branwell Bronte's instability and eventual alcoholism. The authors speculate on how this family might have presented for treatment, and invite readers to consider how they, as family therapists, might have responded.     

Influence of a Family‐Focused Substance Use Preventive Intervention on Growth in Adolescent Depressive Symptoms

Preparing for the Drug Free Years (PDFY) is a preventive intervention that targets parenting behaviors, family interaction patterns, and adolescent substance use, factors that have been shown to predict depression among teenagers. Effects of PDFY on trajectories of self‐reported adolescent depressive symptoms from 6th through 12th grade were examined. Latent growth curve modeling was used to analyze data from 429 rural adolescents from schools assigned randomly to an intervention or a control condition. PDFY reduced the rate of increase in depressive symptoms during adolescence. Mediation of the intervention effect on depressive symptoms through reduced polysubstance use was tested; the indirect effect was only marginally significant. Findings have implications for understanding the relationship between adolescent depressive symptoms and substance use, and for preventing these outcomes.     

The Effects of Parenting on the Development of Adolescent Alcohol Misuse: A Six‐Wave Latent Growth Model

Alcohol use increases throughout adolescence. Based on family socialization theory, it was hypothesized that family factors, particularly parental support and monitoring, would influence individual trajectories in the development of alcohol misuse. Six waves of data were analyzed, based on interviews with 506 adolescents in the general population of a northeastern metropolitan area. Using growth‐curve longitudinal analysis, results show that parenting significantly predicts adolescents' initial drinking levels (intercepts) as well as their rates of increase in alcohol misuse (slope). This study provides evidence that effective parenting is an important factor in preventing alcohol misuse.     

Family Migration: The Role of Children and Education in Family Decision‐Making Strategies of Polish Migrants in London

Poland’s accession to the European Union in May 2004 brought many new possibilities and opportunities for Polish migrants to the United Kingdom. However, the focus on individual migrants has underestimated the complex roles of families in migration strategies and decision making. This paper brings together data from two studies of Polish migrants in London. In 2006–2007, we carried out a qualitative study, Recent Polish Migrants in London. That research examined how families may be reconfigured in different ways through migration, for example, transnational networks and splits within families. While the study participants represented varied examples of family reunification, they also revealed the complex decision making processes about leaving, staying, rejoining and returning. In our most recent study, Polish Children in London Primary Schools, we interviewed parents, who had migrated with children, about their experiences and expectations of London schools. This study revealed that the age of children was usually a factor in family migration decision making. There was a common expectation that younger children could easily adapt to a new school and learn English quickly. Drawing on the findings of these two studies, this paper will explore firstly, the variety of family migration strategies and secondly, the factors that inform migrants’ decisions to bring their families (especially children) or to leave them back home. Finally, the paper concludes by considering some of the policy implications of our findings.     

The Effects of Work Demands and Resources on Work‐to‐Family Conflict and Facilitation

This article uses a differential salience‐comparable salience approach to examine the effects of work demands and resources on work‐to‐family conflict and facilitation. The analysis is based on data from 1,938 employed adults living with a family member who were interviewed for the 1997 National Study of the Changing Workforce. The results support the differential salience approach by indicating that time‐ and strain‐based work demands show relatively strong positive relationships to work‐to‐family conflict, whereas enabling resources and psychological rewards show relatively strong positive relationships to work‐to‐family facilitation. The availability of time‐based family support policies and work‐family organizational support is negatively related to conflict and positively related to facilitation, thereby supporting the comparable salience approach.     

The Motherhood Penalty at Midlife: Long‐Term Effects of Children on Women's Careers

The authors build on prior research on the motherhood wage penalty to examine whether the career penalties faced by mothers change over the life course. They broaden the focus beyond wages to also consider labor force participation and occupational status and use data from the National Longitudinal Survey of Young Women to model the changing impact of motherhood as women age from their 20s to their 50s (n = 4,730). They found that motherhood is “costly” to women's careers, but the effects on all 3 labor force outcomes attenuate at older ages. Children reduce women's labor force participation, but this effect is strongest when women are younger and is eliminated by the 40s and 50s. Mothers also seem able to regain ground in terms of occupational status. The wage penalty for having children varies by parity, persisting across the life course only for women who have 3 or more children.     

Telling and Re‐telling Stories: The Use of Narrative and Drawing in a Group Intervention with Parents and Children in a Remote Aboriginal Community

The Let's Start Parent‐Child Program is a manualised parent‐child program which aims to improve educational, social and emotional outcomes for Aboriginal parents and their four‐ to seven‐year‐old children. It has been implemented in the Northern Territory, Australia on the Tiwi Islands and in Darwin since 2005. This paper outlines the adaptation of the program to include narrative approaches, the sharing of stories and the use of expressive arts as a way to build understanding between program leaders and participating families. An example from a recent program is used to illustrate how the sharing of stories and expressive use of art engages and binds group participants together. It supports parents to tell their own stories, to speak about their lived experience, to reconsider aspects of their own and their children's experiences and to achieve an increased awareness of their personal resources and a sense of self‐empowerment. The program is designed and delivered with sensitivity to individual parents, children and families, where cultural and interpersonal differences and different developmental and family situations can be taken into account.     

‘Aprendemos A Convivir’: Conjugal Relations,Co‐parenting,and Family Life Among Ecuadorian Transnational Migrants in New York and The Ecuadorian Andes

The aim of this article is to examine conjugal relations, co‐parenting and family life among Ecuadorian transnational migrants in New York and the Azuayo‐ Cañari highlands of Ecuador. It counters two commonly‐held views of transmigration. Officials and academics often stress the negative impacts of male migration to the USA, arguing that it leads to spousal abandonment. In addition, studies of gender in transnational relationships generally concentrate on women's experiences and lack a more nuanced understanding of men's lives in migration. Based on interviews with both male migrants in New York and women in Ecuador, this research focuses instead on how intact couples work to redefine roles, relationships and family life; how they learn to live side‐by‐side (aprender a convivir). The article begins with an account of men's adjustment to single life in the city, which is then juxtaposed to women's experiences in the sending villages. The main section presents a narrative of one couple, revealing how they handle remittances, communication, child‐raising and their own relationship. Their experiences highlight the tensions and problems faced by young couples starting to form their own autonomous households in a setting increasingly different from that of previous generations. But, despite hardships, such couples often state that their relationship improved after migration.     

Trust,Culture, and Cooperation: A Social Dilemma Analysis of Pro‐Environmental Behaviors

Social dilemmas require a choice between cooperation, or sacrificing for the greater good, and self‐interest. One commonly studied social dilemma is environmental conservation. Previous work suggests that trust predicts cooperation in the form of environmental protection. We contend that this view ignores cultural factors. Building on prior cross‐cultural research, we predict an interaction between strength of social ties and trust on cooperation. Findings from General Social Survey data indicate that low trust levels found in the U.S. South (a collectivist culture) renders trust ineffective at promoting environmental protection. However, trust predicts cooperation in nonsouthern regions (which are more individualist), where trust levels are higher.     

The State of Sex Research in MFT and Family Studies Literature: A Seventeen‐Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients’ sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.     

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000‐2015

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process—though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.