Procesos de innovación y mejora en el ámbito de la intervención familiar. El papel de las y los profesionales en la incorporación de buenas prácticas basadas en la evidencia / Innovation and improvement processes in the field of family intervention. The role of practitioners in incorporating evidence-based good practices

El importante esfuerzo que se está llevando a cabo por parte de las administraciones públicas para articular actuaciones de intervención y apoyo familiar dentro de los planes y estrategias estatales, autonómicos y locales, debe ir unido a procesos de innovación y mejora dirigidos a fomentar la calidad de los servicios y programas de atención a la infancia y las familias. En este sentido, hay un claro consenso entre responsables institucionales e investigadores en la necesidad de que las actuaciones de intervención familiar sean prácticas y programas basados en la evidencia. En este artículo se reflexiona sobre el papel central de las y los profesionales para la incorporación de buenas prácticas basadas en la evidencia en el ámbito de la intervención familiar, concluyendo sobre la necesidad de identificar y promover las competencias interprofesionales propias del trabajo con familias para garantizar la calidad de los servicios de atención familiar (AU)

he important effort that is being carried out by the public administrations to articulate family intervention and support actions within state, regional and local plans and strategies must be linked to innovation and improvement pro-cesses aimed at promoting the quality of services and programs for children and families. In this sense, there is a clear consensus between institutional managers and researchers on the need for family intervention actions to be practical and evidence-based programs. This article reflects on the central role of professionals for the incorporation of evidence-based best practices in the field of family intervention, concluding on the need to identify and promote the workforce skills in family intervention to guarantee the quality of family care services. (AU)

Actitudes de profesionales del ámbito de la intervención familiar hacia las prácticas basadas en la evidencia / Attitudes of family intervention professionals towards evidence-based practices

A la hora de poner en marcha procesos de innovación en los servicios de intervención familiar que supongan la incorporación de programas basadas en la evidencia (PBE), es fundamental considerar el papel que desempeñan los/as profesionales, ya que de ellos depende en gran parte la fidelidad y calidad de la implementación de los programas. Este estudio se centra en analizar las actitudes de profesionales hacia las prácticas basadas en la evidencia, así como su percepción y valoración del Programa de Intervención Familiar (PIF), desarrollado en el Ayuntamiento de Pamplona (España) dentro de la cartera de servicios de preservación familiar. Los participantes fueron los/as 27 profesionales que aplican el PIF, que cumplimentaron la escala Evidence-Based Practice Attitude Scale (EBPAS) y la de Expectativas y Valoración Inicial del PIF (EVI-PIF). Los resultados obtenidos mostraron la relación existente entre las actitudes hacia las prácticas basadas en la evidencia y algunas características de los/as profesionales. Asimismo, también se encontró relación significativa entre una alta valoración del PIF y unas actitudes positivas hacia los PBE. Estos resultados avalan la importancia de las actitudes profesionales como elementos que pueden facilitar o dificultar los procesos de innovación y mejora en los servicios de atención e intervención familiar (AU)

When implementing innovation processes in family intervention services that involve the incorporation of eviden-ce-based programmes (EBP), it is essential to take into consideration the role played by professionals, since the fidelity and quality of the implementation of the programmes largely depends on them. This study focuses on analysing the attitudes of professionals towards EBP, as well as their perception and assessment of the Family Intervention Programme (FIP), developed in the family prevention services of Pamplona City Council (Spain). The participants in the study were the 27 professionals who implement the FIP, who completed the Evidence-Based Practice Attitude Scale (EBPAS) and he Expectations and Initial Assessment of the FIP (EVI-FIP). The results obtained showed the relationship between attitudes towards evidence-based practice and some characteristics of the professionals. A significant relationship was also found between a high valuation of the FIP and positive attitudes towards EBP. These results support the importance of professional attitudes as elements that can facilitate or hinder innovation and improvement processes in family care and intervention services. (AU)

"No me taladres la cabeza". Cómo tratar al adolescente que rechaza ser tratado / "No em foradis el cap". Com tractar l’adolescent que rebutja ser tractat / "Don't drive me crazy". Dealing with adolescents who refuse to get treatment

En la clínica encontramos adolescentes con síntomas serios, que no tienen consciencia de conflicto, y relaciones familiares que no les hanpermitido diferenciase de su familia. En estos casos, proponemos una intervención familiar con el objetivo de resolver las distorsiones patológicas que bloquean el desarrollo del adolescente. Presentamos un caso clínicoen el cual se pueden observar las vicisitudes de la intervención familiar y como ésta facilita la evolución de lapsicoterapia individual.(AU)

A la clínica, trobem adolescents ambsímptomes seriosos, que no tenen consciència de conflicte i relacions familiars que no li han permès diferen-ciar-se de la família. En aquests casos, proposem una intervenció familiar adreçada a resoldre les distorsions patològiques que bloquegen el desenvolupament de l'adolescent. Presentem un cas clínic en el qual es podenobservar les vicissituds de la intervenció familiar i com aquesta facilita l'evolució de la psicoteràpia individual.(AU)

In our clinical work, we find adolescents with severe symptoms, who are not aware of the conflict, and family relationships that have notallowed them to differentiate themselves from their family. In these cases, we propose a family interventionto resolve the pathological distortions that block the adolescent's development. We present a clinical case inwhich we can observe the vicissitudes of family intervention and how it facilitates the evolution of individualpsychotherapy.(AU)

Intervención Familiar, Clínica Psicológica e Intervención Psicosocial. Trazos para la Comprensión de una Complementariedad / Family Intervention, Psychological Clinic and Psychosocial Intervention Stroke for the Understanding of a Complementary / Intervenção Familiar, Clínica Psicológica e Intervenção Psicossocial. Traços para a Compreensão de uma Complementaridade

Resumen Introducción. Los estudios de familia en Colombia, como campo disciplinar que aplica teorías, conceptos y metodologías de otras disciplinas, evidencia, desde su apuesta epistemológica, el reconocer a la familia como un objeto de conocimiento científico que apropia y produce conocimiento. Objetivo. de este artículo es analizar el método de generación de conocimiento en la intervención familiar, la clínica psicológica y la intervención psicosocial en un grupo de veinte profesionales de las Ciencias Sociales de las ciudades de Medellín y Manizales. Materiales y Métodos. investigación cualitativa, con enfoque hermenéutico. Se privilegió la entrevista semiestructurada para la producción de información; la sistematización y análisis se realizó con el software Atlas Ti, versión 6.0. Resultados. el entrecruzamiento de las categorías intervención familiar, clínica psicológica, intervención psicosocial y generación de conocimiento, permite vislumbrar una apuesta educativa y complementaria, que ofrece un acompañamiento desde y para las familias, en la cual reconocen capacidades y recursos para afrontar su cotidianidad. Conclusión. la intervención familiar, la intervención psicológica y la intervención psicosocial, como apuesta ético - política del profesional de las Ciencias Sociales, debe permitir el desarrollo de procesos críticos - reflexivos en los cuales las familias son agentes de su propio cambio.

Abstract Introduction. Family studies in Colombia, as a disciplinary field that applies theories, concepts and methodologies of other disciplines, shows, from its epistemological commitment, the recognition of the family as an object of scientific knowledge that appropriates and produces knowledge. Objective. of this paper is to analyze the methods of generation of knowledge in familiar intervention, psychological clinic and psychosocial intervention with a group of professionals of Science Social of Medellín y Manizales of Colombia. Materials and methods. Qualitative research, with focus on hermeneutics. It was used the semi-structured interview was used to produce information. The analysis it was made with the software Atlas-Ti, versión 6.0. Results. the dialog of the category familiar intervention, psychological clinic, psychosocial intervention and generation of knowledge permit disern an educational conviction and complement, for offer an accompanying from the families. For this is necessary recognice capacities and resources for confront the reality. Conclusion. familiar intervention, psychological clinic and psychosocial intervention as focus ethical-political of the professional of Science Social must allow the development of critical in which the families are agents of its chance.

Resumo Introdução. Os estudos da família na Colômbia, como campo disciplinar que aplica teorias, conceitos e metodologias de outras disciplinas, mostra, desde seu compromisso epistemológico, o reconhecimento da família como objeto de conhecimento científico que se apropria e produz conhecimento. Objetivo. deste artigo é analisar o método de geração de conhecimento em intervenção familiar, clínica psicológica e intervenção psicossocial em um grupo de vinte profissionais das Ciências Sociais das cidades de Medellín e Manizales. Materiais e métodos. pesquisa qualitativa, com abordagem hermenêutica. A entrevista semiestruturada foi privilegiada para a produção de informações; a sistematização e análise foram realizadas com o software Atlas Ti, versão 6.0. Resultados. o cruzamento das categorias intervenção familiar, clínica psicológica, intervenção psicossocial e geração de conhecimento, permite vislumbrar uma aposta educativa e complementar, que oferece suporte de e para famílias, na qual reconhecem capacidades e recursos para enfrentar seu cotidiano. Conclusão. a intervenção familiar, a intervenção psicológica e a intervenção psicossocial, como compromisso ético-político do profissional das Ciências Sociais, devem permitir o desenvolvimento de processos crítico- reflexivos em que as famílias sejam agentes da sua própria mudança.

Rehabilitación psicosocial e intervención familiar en personas con trastorno dual / Psychosocial rehabilitation and family intervention for people with dual disorders

En el trastorno dual confluyen dos trastornos graves y crónicos que aún hoy son un desafío a las redes de atención sanitaria y social. En ese contexto las familias desempeñan un papel importante en el mantenimiento de estas personas en la comunidad. El trastorno dual se asocia con una serie de efectos negativos sobre el entorno familiar, con mayor carga de cuidados y conflictos. Para este artículo, se han revisado cuatro modelos de intervención familiar en el trastorno dual. Conclusiones. La intervención familiar ha demostrado ser un importante elemento del tratamiento del trastorno dual. Los cuatro programas de intervención presentados coinciden en unos componentes comunes: intervención uni/multi familiar, bases teóricas de los modelos de probada eficacia, psicoeducación, entrenamiento en comunicación, resolución de problemas y la entrevista motivacional transversal a todo el programa. Aun así persisten áreas que no mejoran y los resultados no son concluyentes, por lo que es necesario seguir buscando fórmulas que apunten hacia recursos terapéuticos más flexibles según las necesidades y circunstancias de cada una de estas personas. (AU)

In dual disorder, two serious and chronic disorders converge that are still a challenge to health and social care networks. In this context, families play an important role in keeping these people included in the community. Dual disorder is associated with a series of negative effects on the family environment, with a greater burden of care and conflict. For this article, four models of family intervention in dual disorder have been reviewed. Conclusions. Family intervention has proven to be an important element of dual disorder treatment. The four intervention programs presented coincide in share some common components: single / multi-family intervention, theoretical bases of the models of with proven efficacy, psychoeducation, communication training, problem solving, and the motivational interview across the entire program. Even so, some areas still persist without improvements and areas that do not improve persist and the results are not conclusive, so it is necessary to continue looking for formulas that point towards more flexible therapeutic resources according to the needs and circumstances of each of these people. (AU)

Psychosocial rehabilitation and family intervention for people with dual disorders / Rehabilitación psicosocial e intervención familiar en personas con trastorno dual

In dual disorder, two serious and chronic disorders converge that are still a challenge to health and social care networks. In this context, families play an important role in keeping these people included in the community. Dual disorder is associated with a series of negative effects on the family environment, with a greater burden of care and conflict. For this article, four models of family intervention in dual disorder have been reviewed. Conclusions. Family intervention has proven to be an important element of dual disorder treatment. The four intervention programs presented coincide in share some common components: single / multi-family intervention, theoretical bases of the models of with proven efficacy, psychoeducation, communication training, problem solving, and the motivational interview across the entire program. Even so, some areas still persist without improvements and areas that do not improve persist and the results are not conclusive, so it is necessary to continue looking for formulas that point towards more flexible therapeutic resources according to the needs and circumstances of each of these people. (AU)

En el trastorno dual confluyen dos trastornos graves y crónicos que aún hoy son un desafío a las redes de atención sanitaria y social. En ese contexto las familias desempeñan un papel importante en el mantenimiento de estas personas en la comunidad. El trastorno dual se asocia con una serie de efectos negativos sobre el entorno familiar, con mayor carga de cuidados y conflictos. Para este artículo, se han revisado cuatro modelos de intervención familiar en el trastorno dual. Conclusiones. La intervención familiar ha demostrado ser un importante elemento del tratamiento del trastorno dual. Los cuatro programas de intervención presentados coinciden en unos componentes comunes: intervención uni/multi familiar, bases teóricas de los modelos de probada eficacia, psicoeducación, entrenamiento en comunicación, resolución de problemas y la entrevista motivacional transversal a todo el programa. Aun así persisten áreas que no mejoran y los resultados no son concluyentes, por lo que es necesario seguir buscando fórmulas que apunten hacia recursos terapéuticos más flexibles según las necesidades y circunstancias de cada una de estas personas. (AU)

Comunicación en familias que acompañan a pacientes en la clínica psiquiátrica "Nuestra Señora del Sagrado Corazón" (Medellín-Colombia) / Communication in families that accompany to patiens in the Psychiatry Clinic "Nuestra Señora del Sagrado Corazón" (Medellín-Colombia)

Resumen Este artículo se propuso interpretar la comunicación de familias de pacientes vinculados a intervenciones grupales en una Clínica Psiquiátrica de Medellín (Colombia). Se utilizó el enfoque cualitativo y se desarrolló a partir de las propiedades vinculadas a la dimensión de comunicación familiar. Este estilo de investigación se mantiene en la tradición hermenéutica, que siguiendo a Galeano (2004) da prioridad a los relatos de los participantes para captar las interpretaciones que ellos hacen de sus propias realidades. Los resultados sugieren que la comunicación en el acompañamiento familiar a pacientes se sostienen en tres dimensiones: "La paradoja comunicativa", "Otras alternativas de comunicación" y "Los tiempos narrativos referidos a la enfermedad mental". Se concluye que los síntomas del paciente involucran a la familia como sistema y éstos fueron construcciones intersubjetivas.

Abstract The aim of this study was to understand the communication in families of patients participating in group interventions in a Psychiatric Clinic of Medellin (Colombia). This was a qualitative research, and we carried it out according to the family communication construct. Results suggest that communication in family support towards patients have three dimensions: "Communicational paradox", "Other communication alternatives" and "Narrative times about mental illness". We concluded that the symptoms presented by the patient involve the family as a system and these were subjective constructions.

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active-Duty Military Parents.

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active-duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active-duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross-influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.

Family Interventions for Schizophrenia and the Psychoses: A Review.

Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.

Efficacy of a family intervention program for prevention of hospitalization in patients with schizophrenia. A naturalistic multicenter controlled and randomized study in Spain.

BACKGROUND: According to most relevant guidelines, family psycho-educational interventions are considered to be one the most effective psychosocial treatments for people with schizophrenia. The main outcome measure in controlled and randomized studies has been prevention of relapses and admissions, and encouragement of compliance, although some questions remain about its applicability and results in clinical practice. OBJECTIVES: The aim of study was to evaluate the efficacy and implementation of a single family psychoeducational intervention in 'real' conditions for people diagnosed with schizophrenia. METHODS: A total of 88 families were randomized in two groups. The family intervention group received a 12 months psychoeducational treatment, and the other group followed normal standard treatment. Assessments were made at baseline, at 12 and at 18 months. The main outcome measure was hospitalization, and secondary outcome measures were clinical condition (BPRS-E) and social disability (DAS-II). RESULTS: A total of 71 patients finished the study (34 family intervention group and 37 control group). Patients who received family intervention reduced the risk of hospitalization by 40% (P = .4018; 95%CI: 0.1833-0.6204). Symptomatology improved significantly at 12 months (P = .4018; 95%CI: 0.1833-0.6204), but not at 18 months (P = .4018; 95%CI: 0.1833-0.6204). Social disability was significantly reduced in the family intervention group at 12 months and 18 months. CONCLUSIONS: Family psychoeducational intervention reduces hospitalization risk and improves clinical condition and social functioning of people with schizophrenia.

Tratamiento con intervenciones psicosociales en la fase aguda y de mantenimiento del paciente adulto con diagnóstico de esquizofrenia / Psychosocial Interventions in Acute and Maintenance Treatment of Adult Patients Diagnosed With Schizophrenia

Objetivos: Determinar cuáles son las estrategias psicosociales efectivas para mejorar los desenlaces en adultos con esquizofrenia tanto en la fase aguda como de mantenimiento de la enfermedad, con el fin de realizar recomendaciones dentro de la Guía de Atención Integral para el diagnóstico, tratamiento e inicio de la rehabilitación psicosocial de los adultos con esquizofrenia. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se adoptó y actualizó la evidencia de la guía NICE 82, que contestaba la pregunta acá planteada. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: La psicoeducación y la intervención familiar mostraron ser eficaces en comparación con el tratamiento usual para prevención recaídas y hospitalizaciones, disminuir la carga familiar y mejorar la adherencia al tratamiento. El entrenamiento en habilidades sociales fue eficaz para mejorar síntomas, funcionamiento social y calidad de vida. No obstante, la calidad de la evidencia fue baja. No había suficiente evidencia sobre la eficacia de la terapia ocupacional, pero al considerar las preferencias de los pacientes y que es una intervención altamente empleada, se sugirió su inclusión en la atención. Conclusión: Se recomienda ofrecer para el tratamiento de la esquizofrenia, psicoeducación, entrenamiento en habilidades sociales e intervenciones familiares. Además, se sugiere el uso de terapia ocupacional en el contexto hospitalario o ambulatorio.

Objectives: To determine the effectiveness of the psychosocial strategies designed to improve the outcomes in adults with schizophrenia in both, acute and stable phase of the disorder. This evidence is used to propose recommendation in the guidelines of integral attention for the diagnosis, treatment and psychosocial rehabilitation of adults with schizophrenia. Methods: A guideline for clinical practice was developed using the methodological framework of the Ministerio de la Protección Social to collect evidence and grading recommendations. A search, evaluation and synthesis of evidence were carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Results: The psychoeducation and family intervention showed higher efficacy, compared with the usual treatment, to prevent relapses and hospital readmissions, to reduce family burden and to improve adherence to treatment. The social skill training was effective to improve symptoms, social functioning and quality of life. However, the quality of evidence was low. There was not enough evidence about the efficacy of occupational therapy, but considering patients preferences and its wide clinical utilization, the GDG suggested its inclusion. Conclusion: Psychoeducation, family intervention and social skill training are recommended to be offered for the treatment of schizophrenia. Furthermore, occupational therapy is suggested for inpatients and outpatients with the disorder.

[Psychosocial Interventions in Acute and Maintenance Treatment of Adult Patients Diagnosed With Schizophrenia]. / Tratamiento con intervenciones psicosociales en la fase aguda y de mantenimiento del paciente adulto con diagnóstico de esquizofrenia.

OBJECTIVES: To determine the effectiveness of the psychosocial strategies designed to improve the outcomes in adults with schizophrenia in both, acute and stable phase of the disorder. This evidence is used to propose recommendation in the guidelines of integral attention for the diagnosis, treatment and psychosocial rehabilitation of adults with schizophrenia. METHODS: A guideline for clinical practice was developed using the methodological framework of the Ministerio de la Protección Social to collect evidence and grading recommendations. A search, evaluation and synthesis of evidence were carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS: The psychoeducation and family intervention showed higher efficacy, compared with the usual treatment, to prevent relapses and hospital readmissions, to reduce family burden and to improve adherence to treatment. The social skill training was effective to improve symptoms, social functioning and quality of life. However, the quality of evidence was low. There was not enough evidence about the efficacy of occupational therapy, but considering patients preferences and its wide clinical utilization, the GDG suggested its inclusion. CONCLUSION: Psychoeducation, family intervention and social skill training are recommended to be offered for the treatment of schizophrenia. Furthermore, occupational therapy is suggested for inpatients and outpatients with the disorder.

Previniendo el maltrato infantil: descripción psicosocial de usuarios de programas de intervención breve en Chile / Preventing child abuse: psychosocial description of clients of brief intervention programs in Chile

El estudio describe características y factores de riesgo para el maltrato y la negligencia infantil, en 591 niños y adolescentes, sus figuras parentales y familias atendidas por ocho programas de intervención breve (PIB) “Viviendo en Familia”, subvencionados por el Servicio Nacional de Menores (SENAME) y ejecutados por la Protectora de la Infancia, en Chile. Los resultados revelan la existencia de problemáticas de mediana complejidad en el entorno, competencias parentales, interacciones familiares, seguridad familiar y bienestar del niño. Aproximadamente, tres de cada cuatro cuidadores muestran indicadores de alto riesgo para el maltrato infantil y/o negligencia, especialmente en su salud mental, lo que debe ser considerado por los equipos para la planificación de un trabajo coordinado con la red local de salud...

The study describe characteristics and risk factors for child abuse and neglect, in 591 children and adolescents, their parents and families served by eight brief intervention programs (PIB) “Viviendo en Familia”, funded by the Chilean National Service of Children (SENAME) and implemented by Protectora de la Infancia (a non-profit organization) in Chile. The results revealed the existence of problems of moderate complexity, on the environment, parental competencies, family interactions, family safety and child well-being. About three of each four caregivers show signs of high risk for the abuse or neglect of children, especially in their mental health, a topic that must be considered by the staff to develop a plan of coordinated work with the local network of health services...