Psychiatric Non-institutionalisation: Whose Needs are Served?

This article outlines the social problems experienced by persons with a chronic psychiatric disability, and their families. The disabled person's lifestyle is characterised by poor social and vocational skills, poverty, inadequate accommodation and alienation. Many of these problems increase the dependence of the disabled person, emotionally and financially, on their family of origin. The author suggests that these social problems will only be ameliorated if family members are provided with active support and information, and if hospital and community services are integrated and complementary. The disabled person's quality of life can only be improved by accessible intensive social and vocational rehabilitation programs. As these issues are not being comprehensively addressed at the present time family self-help organisations such as the Association of Relatives and Friends of the Mentally III (ARAFMI) will need to politicise their plight.     

Pacific Islands Families Study: Factors associated with living in extended families one year on from the birth of a child*

Abstract

Using data from the “Pacific Islands Families: the first two years of life (PIF) study”, this paper explores the factors associated with the living arrangements of mothers with a one‐year‐old Pacific child. Three living arrangements are considered: (1) those children who live with immediate family members only; (2) children who live with extended family members including at least one of their grandparents; and (3) children who live with extended family members but do not live with any of their grandparents. Findings of interest include: mothers who were born in New Zealand are much more likely to live in an extended family with the child's grandparent(s) compared to those who came to New Zealand as an adult; and mothers with high New Zealand identity and low Pacific identity being more likely to live with extended family members other than the child's grandparent(s) relative to those with low New Zealand and high Pacific identity.     

Patterns of Social Support in the Middle Childhood to Early Adolescent Transition: Implications for Adjustment

Children's social networks often include close family members, extended family members, and friends, but little is known about interindividual differences in the patterning of support from these sources. In this study, we used person‐oriented analyses to differentiate patterns of support for children undergoing the transition to adolescence. Social network and adjustment data were collected for an ethnically diverse sample of 691 fourth‐ and sixth‐grade children, with a two‐year follow‐up. Cluster analyses identified one pattern of support from both close family members and friends, a second pattern of support from both close and extended family members, and a third pattern of support primarily from close family members alone. Participants receiving support from close family in combination with either extended family or friends were better adjusted than were those without multiple support resources. The results suggest that a meaningful typology of children's social networks can be developed.     

Differences in Problems Faced by Families with a Child Coping with a Serious Emotional Disorder or an Adult Member Coping with Mental Illness

Abstract

Examination of similarities and differences in the issues families face can help determine whether models for families with a child coping with serious emotional disorder (SED/behavioral disorder (BD)) warrant inclusion in, or adaptation of, interventions for families with an adult member coping with a mental disorder. Families attending psycho-education workshops identified problems faced in managing their family member's illness. Composite lists of problems generated by 175 participants were categorized and sorted, using previously established methods for determining reliability and validity. Fourteen categories were identified for children and fifteen for adults, with ten overlapping. Family members attending the child-focused workshops more often listed mood symptoms and problem behaviors. Family members attending the adult-focused workshops more often listed family issues, denial and noncompliance, and positive symptoms of psychosis. Problems identified by families with a child coping with SED/BD may be sufficiently distinct from those of families with an adult coping with mental illness to warrant separate and distinct interventions.     

Mothers in prison: between the public institution and private family relations

This paper explores the practices concerning family relations as described by women inmates in Finnish prisons. The aim is to study how family relations are experienced as family practices in relation to institutional interference on the basis of qualitative interview data (n = 17). The study demonstrates that the prison stay of a family member means an exceptional institutional intrusion in the family's everyday life. A prison's task is to organize a sentence. At the same time, the institution modifies the practices of being a family by allowing or restricting the relations between family members. Consequently, this can be seen as a question of governing the family relations by appraising and standardizing the family. The study demonstrates, firstly, that there is a need to acknowledge and explore the diversity of family relations on the practical level and, secondly, that a wider perspective of family relations in an institutional context can be captured by combining the concepts of institutional and family practices.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

Greater Self,Lesser Self: Dimensions of Self‐Interest in Chinese Filial Piety

While self‐interest is depreciated in Confucian ethics the processes of family relations in traditional China are animated by the self‐interested actions of family members. The paper outlines the Confucian ideology of filial piety which is commensurate with the governance of family life organized hierarchically and through the senior male's management of the joint‐family's collective property. The structure, operations and principles of membership in traditional Chinese families are indicated, highlighting the tensions within them between consanguinity and conjugality and their material bases. The differential operation of self‐interested actions by husbands and wives is also presented. A non‐Confucian model of the relational‐self is outlined in which both the collective context of Chinese families and the self‐interested actions of individual family members within them is explicated.     

Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

Adolescent difficulties during parental deployment and anxiety: A focus on measurement and family processes

Approximately 60% of deployed service members leave behind immediate family members, and although military families tend to be adaptive and resilient, evidence suggests that deployments are challenging and difficulties can arise during transitions and family separation, especially for adolescents. Grounded in the family attachment network model and the ABC-X model of family stress, the current study utilized a sample of 204 military families with an active-duty father, civilian mother and adolescent and examined parents' perceptions of adolescents' difficulties during deployment in relation to all three family members' perceptions of the adolescents' mental health (i.e., anxiety symptoms) following deployment. First, analyses of measurement invariance indicated that service members and civilian parents were generally reporting on the same underlying construct of their adolescents' difficulties during parental deployment. Next, a structural equation model demonstrated considerable overlap in service member and civilian parent reports of their adolescents' difficulties during a parental deployment (r = 0.47). Finally, both parents' perceptions of adolescent difficulties during parental deployment were related to their own perceptions of the adolescent's current anxiety but not to the adolescents' reports of their own anxiety symptoms or to the other parent's report of the adolescents' anxiety symptoms. Findings provide support for utilizing these theories in combination, such that disruptions to the family system, and the attachment relationships within that system, in one stage of the deployment cycle, may imply that there are implications for individual-level functioning, namely, anxiety, in the next stage of the deployment cycle. Findings also underscore the importance of examining our measurement tools and collecting data from multiple family members to understand family processes.     

Contributors to well-being of Chinese left-behind families: A dyadic perspective from family resilience and grandparent–grandchild relationship

There is evidence that grandchildren and grandparents in Chinese left-behind families (CLBF) suffer from immense life stressors. The well-being of both generations is of great concern. Guided by the family adjustment and adaptation response model and ecological model of well-being, the present study aimed to investigate the dyadic associations between family resilience and subjective well-being (SWB) of left-behind grandchildren and grandparents. Furthermore, we explored the extent to which relationship quality accounts for such reciprocal associations. A sample of 130 left-behind grandparent–grandchild (GP–GC) pairs completed self-reported questionnaires. Actor–partner interdependence model (APIM) revealed that both grandchildren's and grandparents' reported family resilience positively associated with their own SWB but not the other's SWB. Grandchildren's and grandparents' perceived relationship quality mediated the association between their perceived family resilience and their own SWB. Moreover, grandchildren-perceived relationship quality mediated the association between grandchildren-perceived family resilience and grandparents' SWB. Meanwhile, grandparent-perceived relationship quality mediated the association between grandparent-perceived family resilience and grandchildren's SWB. The findings highlighted the significance of family resilience and relationship quality in boosting the two generations' SWB in CLBF. The results also suggested that left-behind grandchildren and their grandparents depend on each other. Future intervention programs could be benefitted from integrating the enhancement of family resilience and improvement of grandparent–grandchild relationship quality to promote the well-being of left-behind family members.     

Stages of change and engagement in a family intervention

Prochaska and DiClemente's stages of change model facilitate understanding of engagement difficulties in psychosocial intervention processes. We assessed the link between stages of family change and intervention dropout in a sample of 141 families with relational conflicts between parents and adolescent children. Each family member's stage of change was defined according to three criteria: seeing the conflict as a relational problem, assuming part of the responsibility for the dysfunctional relationship, and understanding one's own mental and emotional states and those of the other family members involved in the conflict (mentalization). Our dropout rate for the sample was 41.8% and was higher for immigrant families. We found a strong association between engagement and the contemplation stage of change, particularly the mother's. In family conflict interventions, participation of all the family members is essential so as raise awareness of the relational aspects of the conflict and the shared responsibility for the conflict and its resolution.     

Hidden champions: Exploring supportive family relationships of youth experiencing homelessness

The relationships that youth experiencing homelessness (YEH) have with supportive family members (i.e. those who provide them with social support) may be protective against risk behaviours and buffer adverse health outcomes. However, little is known about the nature of YEH's supportive family relationships and the type of social support that these family relationships offer them. Thus, we conducted in-depth interviews with 30 YEH to examine the type of social support received from family relationships and to explore the social dynamics of these relationships. We found that many YEH not only continued to maintain relationships with family members after becoming homeless but also received emotional and/or instrumental support from these family members. Beyond providing this type of social support, family members served as a source of motivation for these youth. Additionally, YEH contributed to their family relationships and gained a sense of connectedness in return. Lastly, we found that YEH's family support was influenced by their family circumstances and their need for autonomy. Collectively, our findings suggest there may be a need for interventions designed to strengthen relationships with supportive family members among YEH, who may derive multiple positive benefits from relating with the ‘hidden champions’ in their lives.     

I'm Telling! The Content, Context, and Consequences of Children's Tattling on their Siblings

Tattling on siblings was observed in 40 families with 2- and 4-year-old children. All but 5 children reported sibling misbehaviour to parents with younger siblings tattling largely to recruit parental help in resolving conflict issues, and older siblings tattling both in the context of conflict and merely to inform parents of their siblings' misbehaviour. Parents rarely reprimanded children for tattling, but either ignored it, or responded to information in tattlers' reports regardless of context or whether older or younger children tattled. Children did not tattle equally on all sibling transgressions, but emphasized physical aggression and property damage, issues that also elicited parental discipline. Tattling is discussed in relation to children's understanding of the dynamics and moral standards of family life.     

The beginning of the end of Robert H. Schuller's Crystal Cathedral Ministry: A towering failure in crisis management as reflected through media narratives of financial crisis,family conflict,and follower dissent

In 2010–2011, the Crystal Cathedral Ministry, one of the world's most respected Christian megachurches (Frankl, 1990), endured a series of crisis events culminating with a court ordered sale of its property. This signaled the end of Robert H. Schuller's ministry. This research analyzes dozens of news stories published during the crisis, documenting that the ministry failed to effectively use the media to communicate on vital issues. This failure exacerbated the crisis by allowing, unchecked, a proliferation of news stories portaying the ministry as out of touch, and Schuller family members as quarreling spendthrifts. Despite Schuller's decades of service, national prominence, and ‘positive thinking’ focus, his ministry was overcome by the materialism he purported to stand against. The rapid downfall is an extraordinary event within Christian televangelism. Examining media reporting of it allows important conclusions to be reached about any organization's communication with media gatekeepers in a time of crisis.     

Unemployment,Youth Homelessness and the Allocation of Family Responsibility

The following discussion concerns two issues relating to what is usually called youth homelessness. The first concerns the accommodation expectations for 15 to 17 year olds to reside at their parent's home, which is encouraged by the existing government's policies, and the non-indexation of the unemployment benefit for single 16 and 17 year olds. Assumptions about family responsibility are also discussed and linked with assumptions about family dependency. The second concerns the establishing of a minimum data base from which the quantification of the number of homeless youth can begin. Additional data available, however, suggests that the numbers of young people who might be expected to experience difficulty finding accommodation is much higher than first thought.     

Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Families of adult people with disability: Their experience in the use of services run by social cooperatives in Italy

Social cooperation has historically played a pivotal role in developing socio‐educational services for people with disability, thereby contributing to counteracting the social isolation often associated with this condition. Using a mixed‐method methodology, this study maps the diversity of perspectives on how the use of disability‐related services run by social cooperatives impacts on and becomes meaningful to family life. One hundred twenty‐nine interviews with family members of adults with different kinds of disability were studied using emotional textual analysis. It provides a multi‐dimensional model to read and map the multiplicity of emotional meanings related to disability and the use of services, shedding light on key diversities in how family members emotionally make sense of care and support. The results reveal the importance of supporting family‐carers on two main issues: accessing a less passive representation of their relative with disability; and being able to test and acknowledge limits without succumbing to a sense of powerlessness.     

The Effects of Nursing Home Placement on the Perceived Levels of Caregiver Burden

Providing care for an aging parent can be one of the most fulfilling life experiences for an adult child. It can also be one of the most exhausting physically, emotionally, and financially. A caregiver experiences psychological and emotional changes when their dependent parent or spouse is placed into formal care. This research project uses the Montgomery Borgatta Caregiver Burden Scale, amended with a questionnaire, in a self-administered, anonymous survey to explore perceptions of caregiving burden before and after the nursing home placement periods. This research showed that numerous factors influence caregivers' perceptions of burden and the quality of relationships among family members.     

Parental Mental Illness,Family Living Arrangements,and Child Behavior

The association between family living arrangements and children's behavior problems is examined in 306 children with mentally ill parents. Children living with alternative families (with adoptive or foster parents or with other relatives) display fewer behavior problems than children living with two biological parents, a single biological parent, or a biological and a stepparent. The proportion of mentally ill family members and the degree of mother-child discord explain the vanations in children's behavior problems among the different living arrangements. Thus, in placement decisions, the prevailing legal principle of safeguarding the integrity of the child's biological family should be weighed against the mother-child relationship and the mental health of the family members.