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.

Barry Jacobs, 2016 recipient of the CFHA Don Bloch, MD Award.

The Don Bloch Award is presented annually by the Collaborative Family Healthcare Association (CFHA) to a person who has made singular contributions to forwarding the cause of collaborative family health care. The 2016 Don Bloch Award was presented to Dr. Barry Jacobs, a licensed clinical psychologist and family therapist who exemplifies Don's intellectual, behavioral and relational attributes. (PsycINFO Database Record

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.

Evaluating a multiple-family group access intervention for refugees with PTSD.

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.

Family-oriented patient care through the residency training cycle.

OBJECTIVE: Because family oriented patient care improves patient outcome and reduces family burden, clinical family skills of communication, assessment, alliance, and support are part of core competencies required of all residents. Teaching residents to "think family" as part of core competencies and to reach out to families requires change in the teaching environment. METHODS: This article advocates teaching residents family skills throughout the training years as an integrated part of routine patient care rather than in isolated family clinics or a course in "family therapy." It reviews family skills required of residents in all treatment settings and family skills that are specific to inpatient, emergency room, outpatient, and consultation-liaison services. RESULTS: Families can be seen in multiple treatment settings throughout resident training using recent research to support appropriate interventions for patients and caregivers. CONCLUSION: The process of establishing change in the training environment requires a commitment on the part of the training faculty to include families, but is possible within the current training framework.

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.

Family skills for general psychiatry residents: meeting ACGME core competency requirements.

OBJECTIVE: The authors discuss the knowledge, attitudes, and skills needed for a resident to be competent in supporting and working with families, as mandated by the residency review committee (RRC) core competencies. METHODS: The RRC core competencies, as they relate to patients and their families, are reviewed. The Group for Advancement of Psychiatry (GAP) presents an operational version of these core competencies. RESULTS: Methods of assessment, challenges in teaching, and ways of overcoming programmatic constraints are outlined. Examples of training programs that offer ways of integrating the teaching of family skills into existing programs are described. CONCLUSIONS: The implications of the current RRC core competency requirements pertaining to families have the potential to change the training environment substantially. The GAP Family Committee proposes recommendations to facilitate the training of residents in family skills.