Usability and decision support systems in emergency management

The actors in charge of an emergency response are confronted with severe difficulties in coordination and decision making, especially in major accidents. To facilitate coordination, various decision support systems (DSS) integrated in communication systems have been developed. However, many DSS in the rescue service organizations are afflicted with under-use and other usability problems. Drawing on both a literature review and an analysis of recently obtained survey data from rescue personnel concerning usability of common communication system in Swedish emergency organizations, this paper addresses the issue of usability of DSS. It is concluded that the impetus for developing DSS in many cases has been the technological possibilities per se, not taking the decision makers task structure and contextual factors into account. It is argued that priority should be given to functions that provide a visual overview of the event and facilitate storing of the series of decisions made during the response.     

STRUCTURAL ELEMENTS IN FRANZ KAFKA'S THE METAMORPHOSIS

Kafka's The Metamorphosis is not only a masterpiece of modern literature, but also a work that exemplifies many ideas of structural family therapy. In this essay I have examined how this novels embodies concepts such as parentified children, enhancement, intergenerational boundaries, coalitions and triangles, structural dysfunction, and structural thinking on anorexia nervosa.     

Being central to decision making means I am still here!: The essence of decision making for people with dementia

The ability to make choices and decisions, and to have those decisions upheld, is central to self-determination. For people living with a diagnosis of dementia, however, it can be difficult to remain involved in decision making. While many studies show that people with mild or moderate dementia have the ability to participate in decision making, there are also indications that the attitudes of those around them, including health professionals and family carers, can sometimes be a barrier, and there is generally little understanding about the nature of decision making for this population. This small pilot study draws on van Manen's approach to phenomenology to explore the essence of decision making for people living with dementia. The findings highlight the importance of remaining central to decision making, and the key role that subtle support from carers plays in enabling this.     

Family involvement in small,local nongovernmental organizations

The involvement of family members in nongovernmental organizations (NGOs) has been largely overlooked in the literature on the nonprofit and voluntary sector. This study draws on the family business literature to explore the main features of family involvement and the implications for organizational survival and effectiveness. It shows that the family is an important research variable. Exploring the NGO sector in India, the article demonstrates that family involvement can significantly influence the management of human and material resources, governance, and decision making. Although there are several advantages to family involvement, a large overlap of family and organization can threaten credibility and legitimacy. Family‐based NGOs must stress their value orientation to counter negative perceptions.     

An Anti-Introspectivist View of Career Decision Making

This article reviews 50 years of empirical literature on career decision making, summarizing 10 things the field knows “for sure.” An anti-introspectivist view of career decision making is then presented, developed by applying findings from cognitive and experimental social psychology to career decision making. This view holds that most processing performed by the human mind for decision making and behavior initiation is not performed at a conscious level and that reflection on those processes may be futile, and detrimental to good decisions. Although the anti-introspectivist perspective challenges many strongly held assumptions, it provides a plausible explanation of some of the difficulties encountered by decision makers and those who counsel them.     

Explicit Versus Implicit Family Decision-Making Strategies Among Mexican American Caregiving Adult Children

Changing U.S. demographics make it increasingly vital to investigate experiences of Latinos caring for aging parents, with specific emphasis on how these families, who often value family closeness, make decisions about caregiving. This study investigates relationships among use of implicit versus explicit decision-making strategies, generation since immigration, and orientation toward family. Findings suggest that those with more recent immigration to the United States were more likely than those who immigrated longer ago to describe family decision making about their parents' care as implicit. Those that were classified as using predominately implicit decision making were also found to be not significantly different from those classified as predominantly explicit with regard to their overall support of a collective orientation toward family. There were exceptions to this, however, regarding two specific aspects of orientation toward family: engagement in shared activities with family members and avoiding family conflict by making choices that are consistent with the family values. In both cases those categorized as implicit expressed stronger endorsement of these specific values. These findings suggest that the relationship between family decision-making strategies, generation since immigration, and orientation toward family is more complex than suggested previously in the literature. Implications for future research and practice are offered.     

THE EFFECTIVENESS OF FAMILY THERAPY IN THE TREATMENT OF ADOLESCENTS WITH CONDUCT DISORDERS AND DELINQUENCY

A literature review was conducted on recent studies using family therapy approaches to the treatment of conduct disorders in adolescents. Results from studies conducted since the Shadish et al. (1993) meta-analysis on the effects of family and marital therapies are included. Barriers to effective treatment are identified, costs of care are discussed, and a variety of systems of care in which family interventions are embedded are reviewed.     

THE PARENTAL ALLIANCE FOLLOWING DIVORCE: AN OVERVIEW

The empirical literature on the postdivorce parental alliance was reviewed with a focus on implications for clinical interventions by family therapists. Variables of cooperation and conflict between parents, individual parenting style, and personal adjustment were significantly interrelated and a range of co-parenting behaviors related to these variables was documented. A typology of divorcing families can be useful in predicting risks for child difficulties and in developing appropriate parenting plans. Clinical interventions need to be tailored to the unique characteristics and resources of a given family and can speak to multiple points of the family system.     

THE PROBLEM OF THE SIBLING AS THE REFERRING PERSON*

This paper is the first concerning observations gathered at our Center during studies of the treatment of families with a chronically psychotic member.' It draws the attention of family therapists to a danger not uncommon in such cases, one that arises when the person referring his family of origin is a sibling of the index patient and, in many ways, the most “competent” and prestigious family member. The theoretical part of the paper and the clinical example that follows are intended to demonstrate how this pitfall can be turned into a springboard for therapeutic success.     

The effect of unemployment on children and adolescents

Unemployment is a stressful life event that affects not only the job loser, but also impacts the person's social network. This network includes family members. However, most of the research on unemployment has focused on the effect of job loss on the former worker. This paper reviews this limited literature in order to identify what the potential impact of unemployment is on children. The reason for doing so is to add to the knowledge base that has demonstrated that economic policy decisions have a substantive effect on many aspects of societal health and wellbeing. Information on what these effects are in regard to children and families might serve to inform decision makers in developing appropriate social policy. This information is also an aid that would help professionals in the planning and delivering of needed services.     

Problematic Integration and Family Communication about Decisions at the End of Life

Making a decision on behalf of a family member at the end of life (EOL) is a highly uncertain and anxiety-ridden experience. To examine how families navigate this complex, emotionally stressful situation, Problematic Integration theory was applied as a lens for understanding EOL decision experiences managed in the context of the family. Drawing on qualitative data from interviews with 22 family members who participated in family conversations about an end-of-life decision, this study demonstrated that family members encounter multiple sources of uncertainty and divergence, including questions regarding whether or not a family member’s life is ending, what the decision should be, and who should make or participate in the decision. Family members’ stories also identified ways in which medical professionals and communication about the wishes of the patient helped family members manage problematic integration. Finally, findings revealed experiences where problematic orientations were not transformed after family members made an EOL decision.     

Least to most restrictive interventions. A continuum for mental health care facilities

While this article does not propose to provide answers to the many questions prompted by the new Patient's Rights CoP (1999) or the newly revised JCAHO standards on seclusion and restraint (JCAHO, 2000), a prudent plan of action for any organization serving patients with a behavioral component to their treatment would be to adopt a policy of least restrictive intervention prior to consideration of seclusion and restraint in response to emergency patient care needs. It was the authors' intent to present a representative sample of the available literature and from that to develop a continuum of intervention possibilities ranging from least to most restrictive. In addition, suggestions found in the literature for implementation of least to most restrictive programs have been provided.     

INTERVENTION PLANNING FOR THE FAMILY OF THE AUTISTIC CHILD: A MULTILEVEL ASSESSMENT OF THE FAMILY SYSTEM*

The clinician working with the family of an autistic child may need to assess the family at several levels. The first level requires an assessment of the behavioral deficits and excesses of the child. The next level examines the family in terms of their behavioral skills and the impediments that occur when they implement behavior change programs. The third level involves assessing the family unit to identify obstacles to change. While many well-functioning families may be stressed by the crises that arise in raising an autistic child, other families are predisposed to dysfunction regardless of the presence of the child.     

THE FAMILY PSYCHE OVER THREE GENERATIONS: THE GENOGRAM REVISITED*

The genogram is a structured method of taking a three-generational family history. This paper describes a variety of ways the clinician can use the genogram in addition to the standard uses described in the literature. It also demonstrates using the genogram as a quasi-projective technique which reveals unarticulated fears, wishes and values of the individuals comprising the family unit. Practical suggestions as to technique in creating genograms are offered, as well as a discussion of when, with whom and under what circumstances genograms should be undertaken.     

Parenting Disputes After Separation and Divorce: Who Needs a Family Lawyer?

Australia's family law system continues to be plagued by serious delays. This article acknowledges the need for legal interventions in post‐separation parenting disputes in which individuals may be at risk, or in cases of genuine emergency. The article next contrasts cases involving significant risk or urgency with the many ‘ordinary’ (even if sometimes complex) post‐separation disputes over parenting in which these circumstances are not present. I argue that in such cases, legal advice, legally informed dispute processes, and court hearings are remnants from earlier attitudes to separation and divorce. These interventions are expensive, frequently destructive of ongoing parental relationships, and at their heart, inappropriate for considering the needs of children. They also divert time and resources from the critical investigative and legal decision‐making processes needed in urgent or risk‐related cases. I propose that legal narratives in ‘ordinary’ post‐separation parenting disputes be replaced by narratives focused on the main drivers of these disputes, which are invariably expressed in terms of relationship difficulties. Such narratives are amenable to facilitative, therapeutic, and systemic interventions aimed at achieving self‐determined resolutions. They contrast markedly with narratives reflecting common law notion of normative resolutions derived from the application of legal precedent. Key issues in the first section of the article are then teased out via the reflections of an imaginary separated parent in an ‘ordinary,’ albeit difficult and emotionally intense, dispute about how to care for the children. In the final section, I offer brief clinical and systemic reflections on past practice and on future narratives focused on individual self‐determination.     

THE FAMILY CRISIS INTERVENTION LITERATURE: WHAT IS MEANT BY “FAMILY”?*

Family crisis intervention is a rapidly growing area of clinical care in family therapy which lacks clear conceptualization, especially with respect to how “family” fits into crisis intervention theory. This paper integrates recent concepts from the family therapy literature into three views: family as background, family as context, and family as a unit. The family crisis intervention literature (56 publications) is reviewed and categorized according to these three views. Clarity in how “family” is viewed and consistency between theory and practice are examined. Recommendations for improving the conceptualization of “family” in family crisis intervention theory and practice are made.     

An exploration of senile dementia and family burden

Chronic organic brain syndrome is a disabling but little understood disease that can be viewed within a family burden perspective. Since senile dementia relates to multi-dimensional functioning and creates various levels of dependency, family burden is a major factor in the decision to institutionalize. Clinical social workers should understand the problems contributing to the burden of a family with a mentally impaired older member. A variety of interventions is possible and these interventions can be used to alleviate many problems of the family and to create a more responsive system of support.     

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.     

THE "INCESTUOUS FAMILY" REVISITED: A CRITICAL ANALYSIS OF FAMILY THERAPY MYTHS

From a feminist perspective, the family therapy literature concerning incest fails to perceive the patriarchal context of abusive behavior and consequently blames the victim. This paper critiques the family therapy literature by drawing on the feminist discourse concerning incest. Several pervasive myths are identified: (a) that fathers and mothers are pathologically disturbed or inadequate; (b) incest is caused by separation and loss; (c) family isolation or a rigid external boundary explains incest; and (d) incest serves a function in maintaining family organization. By analyzing the contradictions arising from these polemical positions, we propose criteria for developing an adequate clinical account of incest.