THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Child health,breast-feeding,and survival in Malaysia: a random-effects logit approach

This study examines the possibility that estimation of the effect of breast-feeding on infant survival is affected by selection bias, in that children who are healthier at birth may be more likely to be breast-fed. Data are from the 1976 Malaysian Family Life Survey. "Ordinary logit models for breast-feeding and survival are estimated, and the results suggest that selection is indeed present. For example, children of higher birth weight appear to be more likely to be breast-fed and likely to survive. In addition, weight at birth and the duration of breast-feeding appear to be linked." Using birth weight as an indicator for the child's health, the authors conclude that "the direct influence of breast-feeding on survival remains of overwhelming importance even after corrections for selection bias are made."     

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.     

Social innovation and the autoimmunity of employability

The purpose of this article is to examine social innovation in the field of youth employment. It addresses both the shortcomings of supply-side approaches that are balanced towards issues such as employability and the impact of key demand side issues including low pay and precarity. The empirical analysis is based upon interviews with young people in employment or training with social innovations as well as interviews with senior policymakers and practitioners whose remit covers these issues. The study concludes by reflecting upon how the conduct of employability can operate as an autoimmune function.     

Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.     

Parents at‐risk and their children: intersections of gender role attitudes and parenting practices

Existing research demonstrates that parent and child gender may influence important aspects of family relationships; however, most research in this area has been conducted with non‐clinical samples. As clinicians, it is important to consider how gender impacts family relationships, particularly among vulnerable families. This study examined the intersections of gender role attitudes and parenting practices among 34 parents involved with the child welfare system and referred for clinical intervention. Using a mixed methods design, themes regarding gender role beliefs and parenting practices were found through qualitative interviews with parents. Findings suggested that fathers felt responsible for financially providing for their families and expressed challenges in communicating with mothers, and mothers described challenges they face because of a lack of father involvement. Parents also discussed a perceived need to monitor daughters closely while fostering the independence of their sons. Results of the qualitative analyses were supported by quantitative findings indicating significant differences in harsh and inconsistent discipline practices and clear expectations for girls compared to boys. The discussion addresses implications for clinicians, including how a feminist family therapy perspective may help promote client influence over traditional gender norms by questioning gender role attitudes and exploring alternate narratives that may impact family dynamics.     

The role of eviction in veterans’ homelessness recidivism*

Eviction is one of the leading causes of homelessness in the U.S.A. Though permanent supportive housing (PSH) helps participants maintain housing, some still leave due to eviction. This study aimed to determine whether eviction is an important predictor of recidivism and time to return to homelessness for participants exiting PSH. The characteristics and post-exit service use of 2802 Veteran PSH participants were analyzed based on exit reason. A Cox proportional hazards survival analysis modeled risk factors for returning to homelessness within 360 days of exit. Compared with other exiters, evicted Veterans remained in the program for less time, were less likely to be receiving service-connected compensation, and used more services – particularly mental health and substance use services – following their exit, and those who returned to homelessness did so more quickly. Identifying participants who might benefit from more intensive services, project-based housing, or income supports may prevent evictions and subsequent returns to homelessness.     

Seed limitation and lack of downed wood,not invasive species,threaten conifer regeneration in an urban forest

Urban forests provide valuable ecosystem services, but their long-term viability is often threatened by low tree recruitment due to seed and/or microsite limitation. Distinguishing between these two causes of low recruitment has important management implications, but has been little studied in urban environments. We tested for seed and microsite limitation in an urban forested park in Seattle, Washington, USA by adding conifer tree seeds and seedlings to experimental plots in which we manipulated microsite conditions by removing invasive ivy (Hedera spp.) and adding deadwood. We found that natural seed production was low, and adding seeds increased the number of observed seedlings. Furthermore, adding deadwood increased seedling survival, whereas removing Hedera did not have strong effects. Seed limitation is frequently addressed through management actions such as sowing seeds and transplanting seedlings, and our results suggest that such actions address a critical barrier to tree recruitment in urban forests. However, we also observed strong microsite limitation. At our study site, microsite limitation can be addressed primarily by adding deadwood and retaining coarse woody debris on site. Addressing microsite limitation may be a critical component of successful management efforts to improve tree recruitment in urban forests, and should not be overlooked. Furthermore, our study highlights the need for active monitoring and data analysis alongside management, since the most apparent threat (widespread cover of an invasive plant in this case) may not be the primary limit on suitable microsite conditions.