Understanding family functioning in mothers and daughters with obesity.

PURPOSE: This study sought to understand family functioning surrounding weight in Mexican American women with obesity. METHODS: Semi-structured in-depth interviews were conducted with mothers and adult daughters (N = 116). RESULTS: Thematic analysis identified five themes. 1) The communication process drives perception of supportive messages. Messages perceived as non-supportive consist of directives as interventions, confirmation of faults, and critical compliments whereas supportive consist of compliments, encouragement, empathetic listening, and disclosure. 2) Acculturation differences interfere with intergenerational alliance. Differences involve dissonance in communication, behavioural expectations, and weight-related practices. 3) Maladaptive conflict responses contribute to relational strain. These responses include avoidance, withdrawal, and defensiveness. 4) Role transformations alter the generational hierarchical relationship. Daughters serve as role models, caregivers, or collaborators. 5) Low communal coping heightens psychological distress. It does so by challenging family roles, increasing social isolation, and compromising social support. CONCLUSION: Obesity interventions for Mexican American women may benefit from targeting relational skills to improve family functioning.

Improving Relational Functioning in Mother-Daughter Dyads With Obesity.

Family-level interventions have the potential to address intergenerational obesity among Mexican American women. Given that poor family functioning is associated with worse weight loss outcomes, this study tested a weight management program aimed at improving relational functioning in mothers and daughters with obesity. Mexican American mothers and their adult daughters were randomly assigned to participate in a 16-week group-based standard behavioral (SB) weight loss program without or with relationship skills training (SRT). Relational functioning was assessed via observational behavioral coding using the Global Structural Family Rating Scale. General relational functioning and specifically positive alliance patterns and conflict avoidance improved significantly more in the SRT group than in the SB group. Average weight changes included percent weight loss of -5.6% in the SRT group versus -3.9% in the SB group and body mass index reduction of -2.2 kg/m2 in the SRT group versus -1.2 kg/m2 in the SB group. More participants in the SRT group (75%) than in the SB group (40%) tended to achieve at least 3% weight loss. Greater changes in positive alliance patterns increased the likelihood of losing 3% of body weight. Improving relational functioning in mother-daughter dyads may promote favorable outcomes in a behavioral weight loss intervention.

Out of textbook and [almost] into the clinic: Case simulation in integrated care training.

INTRODUCTION: A growing recognition of the need for specialized training to prepare health care providers to work in integrated care (IC) settings requires innovative methods to educate learners. There is an opportunity to provide IC trainees with relevant experiential opportunities to practice these techniques using simulation-based learning, a well-established training approach in medical education. METHOD: This pilot study sought to examine the feasibility of using simulation-based learning in the interprofessional training of Marital and Family Therapy (MFT) and Family Nursing Practitioner (FNP) trainees in relevant integrated care competencies. Participants included 26 learners (21 MFT and five FNP). The case simulation event involved students completing a video telehealth clinical encounter involving a warm handoff. Clinical faculty observed trainees, completed a checklist designed specifically for the event, and provided feedback directly after the event. RESULTS: Trainees reported high satisfaction with the use of simulation-based learning. Observational coding revealed that trainees successfully implemented many elements of a warm handoff, however, aspects involving interprofessional communication, brief intervention, and follow-up planning appeared more challenging. DISCUSSION: Increased utilization of interprofessional case simulation training in masters and doctoral level behavioral health programs could help accelerate the development of a competent integrated care workforce. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recruiting and training multilingual family therapists: A content analysis of COAMFTE-accredited marriage and family therapy program websites.

Among U. S. Limited English Proficiency (LEP) communities, language needs and preferences create significant barriers to accessing quality healthcare and contribute to growing physical and mental health disparities. To mitigate these barriers, it is critical to recruit and train a new generation of linguistically diverse providers, including marriage and family therapists (MFTs). This study examined how Marriage and Family Therapy (MFT) program website content promotes a commitment to recruiting and training multilingual MFTs. The study sample consisted of all currently accredited programs (N = 122) and included coding for the presence or absence of (a) an explicit commitment to multiculturally and linguistically informed training, (b) specialized multilingual training and supports, and (c) multilingual faculty involved in training multilingual students or engaged in related scholarship. Results indicate that a majority of MFT programs are communicating a commitment to multiculturally informed training, but the same is not true of linguistically responsive training.

Teaching family-oriented care to family medicine residents: Evaluation of a family skills curriculum.

INTRODUCTION: Family-oriented care is at the heart of family medicine (FM) practice, yet research suggests an unmet need for family skills training in FM residencies. The purpose of this study is to evaluate family-oriented (FO) attitudes and observed skills of FM residents before and after completion of a longitudinal family skills curriculum. METHOD: We assessed FO attitudes and observed skills of second-year FM residents (N = 12) using the "Family in Medicine" Q-sort exercise (Q-sort) and the Family-Centered Observation Form (FCOF) before and after completion of the family systems "Practicum" portion of a 20-week psychosocial medicine curriculum. Residents were observed in 19 pre- and 15 post-Practicum encounters. RESULTS: With regard to attitudes, 10 of 12 (83%) residents had a moderate to strong affinity for the FO viewpoint pre-Practicum; 9 of 12 (75%) maintained or strengthened their FO viewpoint post-Practicum. With regard to observed skills, FO visit content increased post-Practicum; 10/15 (67%) post-Practicum encounters included FO comments or questions compared to 5/19 (26%) pre-Practicum encounters. DISCUSSION: In this curriculum evaluation, we found our FM residents to have strong baseline FO attitudes that generally became stronger after a family skills curriculum. FO behaviors increased post-Practicum, though were still demonstrated relatively infrequently, which may be related to a variety of factors. Future directions include increasing experiential FO learning opportunities during Practicum and revising and validating the FCOF. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

That's not my name.

In this brief article, the author states that beyond her family context, she has come to rec ognize the privilege and responsibility she has as a provider and an educator to promote inclusivity. When she meets a new patient or a new learner, particu larly those from different linguistic backgrounds than her own, she acknowledges that it may be hard for her to say their name, placing the burden to practice and be open to correction on herself. Some might argue names are trivial-what does it matter if someone pronounces your name cor rectly?-but we know it's not. Our names are one way we become visible or invisible to those around us. When we ask someone if we can call them something other than their name, we are communi cating (oftentimes, inadvertently) that their name is not worth the effort, that there is something wrong with it, something wrong with them. We have a responsibility to engage in culturally and lin guistically congruent practices and an obliga tion to model what it means to treat our learners and patients with dignity, starting with saying their names. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.

A medida que los tratamientos familiares factuales para el consumo de sustancias y los problemas de conducta en los adolescentes ganan terreno, la investigación de vanguardia trasciende los ensayos aleatorizados de eficacia teórica para abordar preguntas, por ejemplo, cómo funcionan estos tratamientos y cómo difundirlos mejor en entornos comunitarios. Un factor clave para la difusión eficaz es la fidelidad al tratamiento, que se refiere a implementar una intervención de una manera consecuente con un manual establecido. Si bien la mayor parte de la investigación de fidelidad es cuantitativa, el presente estudio ofrece un análisis clínico cualitativo de fallas de la fidelidad en un ensayo grande multicéntrico de eficacia real de Terapia Familiar Breve y Estratégica (BSFT) para el abuso de drogas en los adolescentes, donde los desarrolladores de la BSFT capacitaron a terapeutas de la comunidad para que apliquen esta intervención en sus propias agencias. Utilizando informes de casos y grabaciones de vídeo de sesiones de terapia, un panel independiente de expertos evaluó primero 103 casos con escalas de fidelidad cuantitativa basadas en el manual de BSFT y el marco estratégico estructural más amplio que respalda la intervención de la BSFT. Como la fidelidad fue generalmente baja, el panel revisó todos los casos cualitativamente para reconocer tipos o categorías emergentes de fallas de la fidelidad. Surgieron diez categorías de fallas caracterizadas por omisiones del terapeuta (p. ej.: el terapeuta no hizo participar a familiares clave, no pensó en grupos de tres) y licencias (p. ej.: desvío del modelo, formulaciones/intervenciones no sistémicas). De estas opciones, la falla en "no pensar en grupos de tres" pareció básica y particularmente problemática, lo cual refleja el lugar fundamental de esta idea en la teoría y la terapia estructural. Aunque nuestras observaciones estén sujetas a un posible sesgo, estas ponen de manifiesto posibles obstáculos a la hora de exportar un tratamiento familiar complejo como la BSFT a entornos comunitarios. Estos resultados también subrayan la importancia de la fidelidad al tratamiento en la investigación sobre terapia familiar.

Capitalizing on Scientific Advances to Improve Access to and Quality of Children's Mental Health Care.

The majority of mental health problems begin in childhood or adolescence. The potential benefits of early identification and treatment of such problems are well established, and models of effective mental health interventions for children have proliferated in recent decades. However, barriers in access to care and challenges in assuring delivery of high-quality care significantly limit the public health impact of services for children and families. Specifically, the majority of children who need mental health care do not receive it, and when children are in care, many do not receive interventions that are most likely to have the greatest positive impact. A commitment to social justice requires significant improvement in access to care and quality of care to maximize human potential. The purpose of this manuscript is to highlight promising scientific advances in the development of effective mental health services for children and families, as well as the vexing challenges of actually delivering these services to those most in need. Key challenges to be discussed include disparities in access to care and quality of care, including race/ethnic disparities and complexities of navigating the multi-sector mental health service system for children, and difficulties in implementing effective intervention models more consistently in community care. The authors will propose practice and policy reform recommendations to address these challenges. Copyright © 2017 John Wiley & Sons, Ltd.

Parallel demand-withdraw processes in family therapy for adolescent drug abuse.

Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw processes in brief strategic family therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began. Participants were 91 families who received at least four sessions of BSFT in a multisite clinical trial on adolescent drug abuse (Robbins et al., 2011). Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug-use days that adolescents reported in timeline follow-back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated. Results suggest that attending to parallel demand-withdraw processes in parent-adolescent and therapist-adolescent dyads may be useful in family therapy for substance-using adolescents.