Couple and family interventions for high mortality health conditions: A strategic review (2010-2019).

The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.

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.

Integrating Spirituality into MFT Training: A Reflexive Curriculum and Qualitative Evaluation.

When clients enter the therapy room they bring unique spiritual beliefs and values in with them; however, marital and family therapists (MFTs) often lack training to assist in this important area of diversity. Current training recommendations encourage therapists to explore their own spirituality to identify personal limitations that may occlude positive client outcomes; however very little information exists on the implementation and usefulness of this type of training. This article will describe a curriculum and report results from a qualitative study of students who participated in a reflexive spirituality practicum course offered in a COAMFTE accredited doctoral program at a private, religious institution. Through this, we hope to provide a training model to further spiritual integration activities in MFT.

Enhancing residents' compassionate communication to family members: A family systems breaking bad news simulation.

INTRODUCTION: Surgical residents often need to break bad news (BBN) to patients and family members. While communication skills are a core competency in residency training, these specific skills are rarely formally taught. We piloted a simulation training to teach pediatric surgical residents how to compassionately BBN of an unexpected, traumatic pediatric death to surviving family members. This training was unique in that it was influenced by family systems theory and was a collaborative effort between our institution's surgery residency and medical family therapy (MedFT) programs. METHOD: This study provides outcomes of surgery residents' communication skills, attitudes, and self-perceptions after a BBN simulation activity with standardized family members at a major academic teaching hospital. Each resident participated in two 30-min simulations and received feedback from observers. Outcome data were collected through self-assessments completed before, immediately after, and 6 months after the simulation. Participants were 15 surgery residents, and MedFT students served as simulated family members and trainers. RESULTS: A statistically significant change with medium to large effect sizes in participant self-reported perceptions of skill and confidence were documented and maintained over 6 months. Responses to open-ended questions supported practice changes in response to the training. DISCUSSION: This collaborative training promoted significant improvement in resident compassionate communication skills. The curriculum was highly valued by the learners and resulted in sustained application of learned skills with patients and families. Our novel approach was feasible with promising results that warrant further investigation and could be reproduced in other institutions with similar programs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.

Paternal depression during pregnancy and postpartum: An international Delphi study.

BACKGROUND: Fathers are at risk for depression during a mother's gestation and postpartum. Assessment, detection, and treatment are hampered by the lack of consensus on this issue. The purpose of this study was to reach expert consensus through the Delphi method on the defining factors of depression in peripartum fathers. METHODS: Purposive sampling resulted in the surveying of 14 international expert panelists. The study used a modified Delphi approach in which experts participated in two rounds of open-ended and scale questionnaires, followed by two rounds of opportunities to adjust their responses and/or comment on evolving data until consensus was achieved. RESULTS: Experts responded to 10 questions on terminology, diagnostics, symptomology, risk/protective factors, biological factors, assessment tools/protocol, cost implications, and key stakeholders. Of these 10 questions presented for discussion, the analysis resulted in 197 coded themes. Consensus was met for 119 of the 197 coded responses (60.41%). LIMITATIONS: Diversity of opinion within this Delphi Study was excluded for the sake of consensus. Regression to the mean may have occurred after continuous surveying and when evolving results were shared with panelists. Critics of Delphi methodologies have pointed to the issue of small expert samples typically used and the subjectivity of "expert." CONCLUSION: Consensus identified diagnostic criteria and symptomology that differentiates the paternal experience of peripartum depression. Experts indicated the importance of a father's social context, biological risk factors, limitations of current assessment tools, key stakeholders, and potential financial costs. Stakeholders on this issue would benefit from translating consensus into assessment and treatment.

Improving Clinician Attitudes of Respect and Trust for Persons With Sickle Cell Disease.

OBJECTIVE: To test the effect of 1 high-intensity, and 1 reduced-intensity, educational intervention designed to improve health care provider attitudes toward youth with sickle cell disease (SCD). METHODS: We exposed a regional sample of pediatric health care providers to a 2.5-day high-intensity educational and experiential intervention using videos about the SCD patient experience. Additionally, we traveled to a different set of regional health care institutions and offered pediatric providers a reduced-intensity intervention, consisting of a 90-minute lunchtime in-service centered on our same set of videos about the patient's experience. We assessed the impact of both interventions by taking pre/post measurements of the negative and positive attitudes expressed by participating providers toward patients with SCD. RESULTS: Both interventions tested elicited improvements in the SCD attitudes expressed by the pediatric providers as suggested through a reduction in measured negative attitude scores (20.0 vs 12.1, P < .001), and an improvement in positive attitude scores (67.1 vs 72.2, P < .001). Further testing suggested that the high-intensity intervention elicited a stronger effect than the reduced-intensity intervention across multiple attitudinal domains. CONCLUSIONS: Video-based interventions can be used to improve the attitudes of pediatric providers toward patients with SCD. The availability of interventions of varying intensities provides greater flexibility in designing efforts to advance the quality of SCD care through the improvement of provider attitudes.

Narrative-informed medical family therapy: using narrative therapy practices in brief medical encounters.

Effective mental health practice in a medical context is a collaborative "both/and" relationship between therapists, patients, and health care team collaborators. The biomedical model that is most often used in health care is an important piece of a patient's healing, and narrative therapy brings an excellent patient and family centered addition to this framework. Using this model, behavioral health therapists can help patients understand how their experiences of illness may be shaped by larger social discourses and how they may then choose which of these messages about illness fit for them and which do not. Narrative therapy additionally facilitates the goals of medical family therapy (agency and communion) through engaging patients as experts in their own illness experience and facilitating a sense of control over the different ways that they choose to draw on support and cope with their illness-related challenges. In this article, we discuss the benefits of using narrative therapy in brief behavioral health encounters within medical settings and include implications for behavioral health practitioners interested in using this modality to better meet the needs of patients and families.