COVID-19 Pandemic: Applying a Multisystemic Lens.

The COVID-19 pandemic has a pervasive effect on all aspects of family life. We can distinguish the collective societal and community effects of the global pandemic and the risk and disease impact for individuals and families. This paper draws on Rolland's Family Systems-Illness (FSI) model to describe some of the unique challenges through a multisystemic lens. Highlighting the pattern of psychosocial issues of COVID-19 over time, discussion emphasizes the evolving interplay of larger systems public health pandemic challenges and mitigation strategies with individual and family processes. The paper addresses issues of coping with myriad Covid-19 uncertainties in the initial crisis wave and evolving phases of the pandemic in the context of individual and family development, pre-existing illness or disability, and racial and socio-economic disparities. The discussion offers recommendations for timely family oriented consultation and psychoeducation, and for healthcare clinician self-care.

La pandemia de la COVID-19 tiene un efecto generalizado en todos los aspectos de la vida familiar. Podemos distinguir los efectos comunitarios y sociales colectivos de la pandemia mundial, y el riesgo y el efecto de la enfermedad en las personas y en las familias. Este artículo hace uso del modelo de Sistemas Familiares y Enfermedad (Familly Systems Illness Model) de Rolland para describir algunos de los desafíos únicos que plantea la pandemia desde una perspectiva multisistémica. Destacando el patrón de problemas psicosociales de la COVID-19 conforme avanza el tiempo, el debate enfatiza la interacción emergente de los desafíos que plantea la pandemia en sistemas más grandes como la salud pública y las estrategias de mitigación con procesos familiares e individuales. El artículo aborda los problemas del afrontamiento con innumerables incertidumbres sobre la COVID-19 en la fase de crisis inicial y en las fases posteriores de la pandemia en el contexto del desarrollo individual y familiar, de discapacidades o enfermedades preexistentes, y de disparidades raciales y socioeconómicas. El debate ofrece recomendaciones para una consulta orientada a la familia y una psicoeducación oportunas, así como para el cuidado personal de los médicos de atención a la salud.

CFHA Don Bloch Award acceptance speech, 2018.

Provides John S. Rolland's acceptance speech for the 2018 CFHA Don Bloch Award. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurocognitive Impairment: Addressing Couple and Family Challenges.

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development. Discussion addresses key family and couple issues with mild-to-severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.

Applying a family systems lens to proxy decision making in clinical practice and research.

When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science's evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland's Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record

Advancing family involvement in collaborative health care: Next steps.

Comments on the article "Don Bloch's vision for Collaborative Family Health Care: Progress and next steps" by C. J. Peek (see record 2015-25290-002). C. J. Peek has provided us with a masterful integration of Don Bloch's vision of collaborative family health care and the evolution over the past 20 years of the field. The current author was very fortunate to be part of the initial meeting at Wingspread in 1994. As a family systems-oriented community and public health-trained psychiatrist, my primary focus over 30 years has been on families facing chronic illness and disability and collaborative care efforts in specialty, primary, rehabilitation, and palliative care medicine. In my view, the ability of the health care consumer (patient and his or her family members) and professional worlds to collaborate in a more egalitarian and less hierarchical and wary manner remains a significant constraint to progress.

Facilitating family resilience with childhood illness and disability.

PURPOSE OF REVIEW: The present review describes the clinical utility of a research-informed Family Systems-Illness model and a family resilience framework in helping families meet the challenges of child and adolescent illness, disability, and loss. Together they provide a psychosocial map to guide families through the illness experience over time and to facilitate effective coping and adaptation, thereby enhancing the quality of life for children and their families. Key processes and intervention guidelines of this strengths-oriented, collaborative approach are outlined, with attention to multigenerational, life cycle, and socio-cultural influences. RECENT FINDINGS: A growing body of research on resilience finds that family resources are significant influences in positive adaptation to adversity, such as a major health problem. Research also demonstrates the impact of serious illness on families across the life cycle and the relationship of family dynamics to illness behavior, adherence, and disease course. SUMMARY: The Family Resilience and Family Systems-Illness models offer a framework for collaborative practice to foster optimal coping and adaptation to chronic child and adolescent illness or disability.

Cancer and the family: an integrative model.

The stresses and uncertainties of cancer can be overwhelming for families. The Family System Illness model offers a psychosocial map to address these challenges and to make the inevitable strains more manageable. It provides a set of terms and a common language within a framework that attends to the longitudinal, psychosocial pattern of a health condition within a multigenerational, life cycle, and belief system context. Such a psychosocial framework can facilitate collaborative, effective coping and adaptation, thereby enhancing the quality of life for families affected by cancer. The model's utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings.

Systemic training for healthcare professionals: the Chicago Center For Family Health approach.

There has been increasing interest in family-centered, collaborative, biopsychosocial models of care by health and mental health professionals and consumers. This trend has led to growing demand and development of specialized training in family systems approaches to health care. This article describes the Families, Illness, and Collaborative Healthcare programs developed at the University of Chicago affiliate, the Chicago Center for Family Health. The program philosophy is guided by the following principles: a systems orientation focused on the family, a Family Systems Illness Model, a family resilience framework, a family-centered collaborative model of health care, and a social justice and advocacy orientation. Specific training components that implement these principles are described, including intensive certificate and fellowships; workshops, conferences, and institutes; and consultation and training services for community-based organizations. Discussion includes professional networking opportunities, funding challenges, and policy recommendations.

Toward a biopsychosocial model for 21st-century genetics.

Advances in genomic research are increasingly identifying genetic components in major health and mental health disorders. This article presents a Family System Genetic Illness model to address the psychosocial challenges of genomic conditions for patients and their families, and to help organize this complex biopsychosocial landscape for clinical practice and research. This model clusters genomic disorders based on key characteristics that define types of disorders with similar patterns of psychosocial demands over time. Key disease variables include the likelihood of developing a disorder based on specific genetic mutations, overall clinical severity, timing of clinical onset in the life cycle, and whether effective treatment interventions exist to alter disease onset and/or progression. For disorders in which carrier, predictive, or presymptomatic testing is available, core nonsymptomatic time phases with salient developmental challenges are described pre- and post-testing, including a long-term adaptation phase. The FSGI model builds on Rolland's Family System Illness model, which identifies psychosocial types and phases of chronic disorders after clinical onset. The FSGI model is designed to be flexible and responsive to future discoveries in genomic research. Its utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings.