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."     

Evaluating the Quality of Social Work Supervision in UK Children’s Services: Comparing Self-Report and Independent Observations

Understanding how different forms of supervision support good social work practice and improve outcomes for people who use services is nearly impossible without reliable and valid evaluative measures. Yet the question of how best to evaluate the quality of supervision in different contexts is a complicated and as-yet-unsolved challenge. In this study, we observed 12 social work supervisors in a simulated supervision session offering support and guidance to an actor playing the part of an inexperienced social worker facing a casework-related crisis. A team of researchers analyzed these sessions using a customized skills-based coding framework. In addition, 19 social workers completed a questionnaire about their supervision experiences as provided by the same 12 supervisors. According to the coding framework, the supervisors demonstrated relatively modest skill levels, and we found low correlations among different skills. In contrast, according to the questionnaire data, supervisors had relatively high skill levels, and we found high correlations among different skills. The findings imply that although self-report remains the simplest way to evaluate supervision quality, other approaches are possible and may provide a different perspective. However, developing a reliable independent measure of supervision quality remains a noteworthy challenge.     

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.     

The challenge of creating ‘alternative’ images of ageing: Lessons from a project with older women

This article analyses two participatory projects designed to engage older women in the creation of new imagery of old age. While it was hoped that this imagery would offer an ‘alternative’ to mainstream depictions or indeed offer older women a presence amidst the much noted absence of images of older women, the brief left it open to the professional photographers recruited to the project and to the participants themselves to direct the representations. In recent years, critical gerontologists have repeatedly called for artistic challenges to conventional ways of imaging old age. By working with two groups of older women, the intention was that ‘ordinary’ older women (non-celebrity, non-artist) could be included in that challenge and imagery created which would show the lives of older women honestly. In the case of the two projects described here, professional photographers were enlisted to give visual form to the women's views on ageing and their lives as older women and deliver ‘exhibition quality’ images. Important factors in determining the types of images produced included the artistic style and preferences of the photographers and their respective ages, both of which are explored here. In-depth analysis of some of the images produced shows that while they did not succumb to the usual ‘heroes of ageing’/‘bodily decline’ binary (Featherstone & Hepworth, 2005), they did not escape other dualistic categorisations. The images can be broadly viewed as nostalgic/melancholic or humorously carnivalesque. This finding is evidence of how difficult it is to create ‘alternative’ images of older women which defy established modes of categorisation.     

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.