John S. Rolland

Parental illness and disability: a family systems framework

Coping with the strains and uncertainties of parental illness and disability can be a monumental challenge. The Family Systems-Illness Model offers a psychosocial map to address this challenge and make the inevitable strains more manageable. Attending to the longitudinal psychosocial pattern of a condition within a multigenerational, life cycle and belief system context can provide the kind of structure – a common language that facilitates collaborative, creative problem solving and quality of life for families where a parent has a serious health problem. Some of the major challenges in families facing parental illness are addressed.

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.

The TAFES multi-family group intervention for Kosovar refugees: A feasibility study

The object of this study was to describe a feasibility study of the Tea and Families Education and Support (TAFES) intervention used in a group of newly resettled adult refugees from Kosova. The subjects were 86 newly resettled Kosovar refugees in Chicago who gave informed consent to participate in an investigation of the TAFES intervention. All subjects received family home visits, and most participated in the TAFES multi-family groups. The instruments were administered to adult participants before and 3 months after the intervention. The TAFES program had contact with 61 Kosovar refugee families, of which 42 families (69%) engaged in TAFES groups, including families with educated and working members. Several characteristics were associated with engaging in TAFES groups and included lower monthly family income and higher age of the first child. The uncontrolled postintervention assessments demonstrated increases in social support and psychiatric service use associated with engagement in the TAFES group. Participants also showed time changes in scale scores assessing trauma mental health knowledge, trauma mental health attitudes, and family hardiness. This study provides preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies.

A family approach to severe mental illness in post-war Kosovo.

Abstract This study describes the effects of a psychoeducational multiple—family group program for families of people with severe mental illness in post—war Kosovo that was developed by a Kosovar—American professional collaborative. The subjects were 30 families of people with severe mental illnesses living in two cities in Kosovo. All subjects participated in multiple—family groups and received family home visits. The program documented medication compliance, number of psychiatric hospitalizations, family mental health services use, and several other characteristics, for the year prior to the groups and the first year of the groups. The families attended an average of 5.5 (out of 7) groups, and 93% of these families attended four or more meetings. The uncontrolled pre- to post—intervention comparison demonstrated decreases in medication non—compliance and hospitalizations, and increases in family mental health service use. The program provided training for mental health professionals, led to policy change in the Ministry of Health, and resulted in dissemination to other community mental health centers. This study provides preliminary evidence that a collaboratively designed and implemented psychoeducational, multiple—family program is a feasible and beneficial intervention for families of people with severe mental illness in impoverished post—war settings.

Family-oriented patient care through the residency training cycle.

ObjectiveBecause 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.MethodsThis 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.ResultsFamilies can be seen in multiple treatment settings throughout resident training using recent research to support appropriate interventions for patients and caregivers.ConclusionThe 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.

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 sciences evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rollands 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

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 Dons intellectual, behavioral and relational attributes. (PsycINFO Database Record

Preparing for Leadership Roles in Healthcare Settings

As ambassadors for Medical Family Therapy (MedFT), training in leadership skills should start when we are students. Then, throughout our training and as we grow in our careers, we should be continuously building competency in research, training, policy, and practice. Through confidence and competence, leaders emerge and are able to offer innovative ways to serve diverse populations and improve systems of care. Leaders in MedFT have many roles and have been recognized in academic, community-based, and healthcare environments for their systemic lens. This chapter highlights ways to prepare for leadership roles as well as stories of challenges and triumphs experienced by leaders.