Assessment Of Family Functioning Research Articles

“There is still so much ahead of us”—Family functioning in families of palliative cancer patients.

Adopting a systems approach, parental cancer has its impact on patients, spouses, and dependent children. The purpose of the current study was to examine family functioning dependent on parental disease stage and on family member perspective in families of cancer patients with adolescent children. The cross-sectional study was conducted within a German multisite research project of families before their first child-centered counseling encounter. The sample comprised individuals nested within N = 169 families. Analyses performed included analysis of covariance (ANCOVA) and intraclass correlation. Open answers were analyzed following quantitative content analysis procedures. Between 15% and 36% of family members reported dysfunctional general functioning scores. Parents indicated more dysfunctional scores on the Family Assessment Device scale Roles, and adolescents more dysfunctional Communication scores. Regarding assessment of family functioning, there was higher agreement in families with parents in a palliative situation. For adolescents with parents in palliation, incidents because of the disease tend to become more dominant, and spending time with the family tends to become even more important. As our study pointed out, parental cancer, and especially parental palliative disease, is associated with both perceived critical and positive aspects in family functioning. Supporting families in these concerns as well as encouraging perceptions of positive aspects are important components of psycho-oncological interventions for families with dependent children.

Concordance between patient and family reports of family functioning in bipolar I disorder and major depressive disorder.

Despite the extensive literature on family functioning and mood disorders, less is known about concordance between patient- and family-reported family functioning. To address this question, adults with bipolar I disorder (BD; n = 92) or major depressive disorder (MDD; n = 121) and their family members (n = 135 and 201, respectively) were recruited from hospital sources. All patients and their family members completed the Family Assessment Device (Epstein, Baldwin, Bishop. J Marital Fam Ther. 9:171-180, 1983). Intraclass correlation coefficients revealed that, in contrast to the moderate degree of concordance in the MDD sample, degree of concordance between patient- and family-reported family functioning was significantly weaker in BD. Subsequent analysis revealed that this discordance was driven by the reports of the child and young adolescent family members of the patients with BD. Results highlight the importance of collateral reports in the assessment of family functioning, especially among families of patients with BD, in research and treatment.

Adolescents with Type 1 Diabetes: parental perceptions of child health and family functioning and their relationship to adolescent metabolic control

BackgroundAdolescents with Type 1 diabetes (T1D) show less effective metabolic control than other age groups, partly because of biological changes beyond their control and partly because in this period of developmental transition, psychosocial factors can militate against young people upholding their lifestyle and medical regimens. Parents have an important role to play in supporting adolescents to self-manage their disease, but resultant family tensions can be high. In this study, we aimed to assess family functioning and adolescent behaviour/ adjustment and examine the relationships between these parent-reported variables and adolescent metabolic control (HbA1c), self-reported health and diabetes self-care.MethodA sample of 76 parents of Australian adolescents with T1D completed the Child Health Questionnaire –Parent form. Their adolescent child with T1D provided their HbA1c level from their most recent clinic visit, their self-reported general health, and completed a measure of diabetes self-care.ResultsParent-reported family conflict was high, as was disease impact on family dynamics and parental stress. Higher HbA1c (poorer metabolic control) and less adequate adolescent self-care were associated with lower levels of family functioning, more adolescent behavioural difficulties and poorer adolescent mental health.ConclusionsThe implication of these findings was discussed in relation to needs for information and support among Australian families with an adolescent with T1D, acknowledging the important dimension of family functioning and relationships in adolescent chronic disease management.

Evaluación de la dinámica familiar en familias de niños con diagnóstico de asma

ObjectDetermine from this research family functionality in asthmatic children between 7 and 12 years of age. MethodologyCross-sectional study performed from July to September 2010 in six health-care institutions of the city of Medellin, Antioquia, Colombia. The study comprised 50 families having children diagnosed with asthma of whom 22 had uncontrolled asthma, while 28 other children had controlled asthma and served as comparison group. Family functionality was assessed by the Apgar family instrument and an M.D. family therapist while a pediatric pulmonologist made the asthma diagnosis and the clinical evaluation. Associations were explored through the odds ratio (OR) and confidence intervals (CI) 95%. ResultsFamily dysfunction is a factor most commonly associated to families having children with uncontrolled asthma in comparison with those families without such patients (OR = 8.95; CI 95%; 2,4-32.3). The dysfunction is significantly greater in families having children with uncontrolled asthma. ConclusionGiven the frequency of family dysfunction in children with asthma, assessment of family functionality should be considered as part of a comprehensive approach to families with asthmatic children.

Family issues and family functioning of Japanese outpatients with type 2 diabetes: a cross-sectional study

BackgroundPrevious studies confirmed that the control of diabetes is related to family functioning, but the validity of the tools used to assess family functioning in these studies is questionable. Few studies have focused on family issues. In this study, we used a new assessment tool to evaluate family functioning and family issues of patients with type 2 diabetes.MethodsA cross-sectional questionnaire was given to outpatients with type 2 diabetes at a community hospital in Aichi, Japan, between August 2001 and March 2002. First, the patients were asked to answer FACESKGIV-16, which measures cohesion and adaptability, questions regarding family issues, daily lifestyle, and HAD. Physical and serological data were measured. Family functioning, family issues, and relationships between each parameter and family functioning or family issues were analyzed.ResultsOf the 133 participants, 121 (33.3%) had some sort of family issue. Family issues included “Health problems of family members” (40.9%), “Family life cycle issues” (22.7%), and others.The best fit multiple regression model (Adjusted R2: 0.494, p = 0.020) included Plasma Glucose as an independent variable, and the squared value of cohesion score, depression score of HAD, Total calorie intake, Exercise time, Housekeeping time, and BMI were dependent variables. The results show that extremes of family cohesion with either too many or too few issues related to family functioning are correlated with the plasma glucose level.ConclusionsFamily issues were common among patients with type 2 diabetes, and the extremes of family cohesion were associated with the glucose level, in contrast to the common wisdom that a well balanced family leads to good control of diabetes.

Cross-Cultural Adaptation and Validation of the Greek Version of the Family Adaptability and Cohesion Evaluation Scales IV Package (FACES IV Package)

The aim of the present study was to examine the psychometric properties of the Greek version of Family Adaptability and Cohesion Evaluation Scales IV (FACES IV) Package. The original FACES IV displays a six-factor structure with two balanced scales—Balanced Cohesion and Balanced Flexibility—and four unbalanced scales—Disengaged, Enmeshed, Rigid, and Chaotic—and has been shown to have satisfactory internal and test–retest reliability. A total of 584 family members agreed to participate in the study. The findings indicated that the Greek version displays similar factor structure to the original version. Cronbach’s α coefficients for the six scales ranged from .59 to .79. The test–retest correlation coefficients ranged between .94 and .97. The Family Communication Scale and the Family Satisfaction Scale demonstrated high internal consistency and test–retest reliability. Thus, the Greek version of the FACES IV Package appears to be a valid and reliable instrument to be used in both research and clinical assessment of family functioning.

The French Version of the Family Assessment Device

To validate a French version of the Family Assessment Device (FAD), a well-known self-report questionnaire assessing family functioning in clinical and research settings. A French adaptation of the FAD was administered to 3 groups of subjects: a nonclinical group (n = 115), relatives of psychiatric patients (n = 102), and medical patients and their relatives (n = 106). Temporal stability was assessed by test-retest intraclass correlations. Internal consistency was measured by Cronbach alpha reliability coefficients. Discriminant validity was explored, comparing the scores of the 3 groups, using a covariance analysis (ANCOVA). The dimensional structure of the instrument was explored using a principal component analysis, with promax oblique rotation, on the entire sample. The French FAD showed good temporal stability and good discriminant validity across groups. Internal consistency was satisfactory only for the General Functioning (GF) subscale. Factor analysis yielded a 3-factor model. The GF subscale was highly correlated with all of the other subscales. The French version of the FAD provides a valuable tool for assessing family functioning. However, our study failed to identify the theoretical structure of the FAD and suggests that the GF subscale could be used as a better overall indicator of family functioning.

Adolescent and caregiver perception of family functioning: Relation to suicide ideation and attempts

This study assessed the relationship between perceived family functioning and two indicators of suicidality in an adolescent sample. A total of 103 adolescents psychiatrically hospitalized for suicidal ideation and/or behavior completed a battery of self-report questionnaires assessing family functioning, negative affectivity, suicidal ideation in the past week assessed by Beck's Scale for Suicide Ideation (BSS; Beck et al., 1979), and past suicide attempts. Participants' primary caregivers also completed a questionnaire on family functioning. A paired samples t-test evaluated overall discrepancy between adolescent- and caregiver-reported family functioning. Linear and logistic regression models were used to evaluate the simple associations between perceived family functioning and suicidal indicators (BSS and previous attempt status), as well as the associations between perceived family functioning and suicidal indicators after controlling for negative affect. Results indicated that adolescents' ratings of family functioning were significantly worse than caregivers' ratings, and positively associated with BSS scores and a history of suicide attempt. When negative affect was controlled for, adolescent-reported family functioning was significantly associated with BSS, but only trended toward significance with attempt status. Findings suggest that adolescents' perceptions of family functioning may be a key contributing factor to suicidal ideation in adolescents with psychiatric disorders.

The Factor Structure of the Chinese Family Assessment Instrument Adapted for Parent Report

This article reports on a confirmatory factor analytic study of an adapted version of an instrument designed to assess family functioning of Chinese families. The Chinese Family Assessment Instrument, originally designed for completion by adolescents, was adapted for completion by parents. A sample of 700 parent dyads of elementary school children (382 girls and 318 boys) completed the adapted questionnaire. Initial factor analyses showed that the existing five-factor structure used for adolescents' responses was not a good fit for these data. Instead, a four-factor solution emerged where the factors were positive family functioning, negative family functioning, tolerance for family members, and parental understanding. This structure was the same for both mothers and fathers. Further studies of the Chinese Family Assessment Instrument parent adaptation are required to test the factor structure that emerged. Following such studies, validation studies will be required.

Investigating the Validity of a Multirater Assessment of Family Functioning in China

The validity of a multirater assessment of family functioning in 1-child Chinese families was examined using the Relationship-Specific Chinese Family Assessment Instrument (RS-CFAI), developed based on the Chinese Family Assessment Instrument (Shek, 2001, 2002). Data were collected from 506 families in Beijing consisting of 2 parents and 1 child. The Confirmatory Factor Analysis (CFA) models and the dyadic-level CFA models were tested in the framework of the multitrait multirater strategy to demonstrate the validity of the RS-CFAI. The results indicated that there are 3 factors (activity, affect, and control) in the RS-CFAI within different family subsystems. The social relations model (SRM) was also used to explain the characteristics of the 1-child family, providing evidence of the convergent and discriminative validity of the RS-CFAI. The goodness-of-fit of the SRM and CFA models indicates that the RS-CFAI is a valid tool for assessing family functioning among 1-child families in China.

The mediating effects of family functioning on psychosocial outcomes in healthy siblings of children with sickle cell disease

Children with siblings coping with chronic illness experience stresses and disruptions in daily life as families work together to care for the affected child. Research suggests that children and adolescents with sickle cell disease (SCD) may be at risk for adjustment problems, impaired psychosocial functioning, and reduced quality of life. These potential stressors affect the child with SCD as well as their caregivers and other family members. This study examined the role of family functioning on the psychosocial functioning of healthy siblings of children with SCD. Participants were 65 healthy African-American siblings of children with SCD with a mean age of 11.19 years (range: 7-16) and their primary caregiver. Caregivers completed questionnaires assessing family functioning and child adjustment including demographic surveys, the Family Relations Scale (FRS), and the Child Behavior Checklist (CBCL). Increased number of emergency room visits (β = -0.28, P < 0.05) predicted poor psychosocial adjustment in siblings. Family functioning mediated this effect (β = 0.27; P < 0.05). High levels of family expressiveness (total score, r = -0.34; P < 0.01), support (total score, r = -0.54; P = 0.001), and low levels of family conflict (total score, r = 0.41; P < 0.001) were associated with improved adjustment among healthy siblings of children with SCD. Awareness of the possible negative psychosocial outcomes of living with a sister or a brother with SCD is important for clinicians. In particular, interventions that focus on family expressiveness, support, and conflict are indicated for this population.

Commentary: Family Assessment in Pediatric Psychology

The theoretical and research literatures on links between family functioning and pediatric chronic health conditions are extensive both in their comprehensiveness and depth. On the other hand, the assessment of family relationships is no easy task and there appear to be gaps between the quality of our family assessment methods and our theories, research methodologies, and clinical endeavors (Kazak, 2008). Why is the assessment of family functioning so challenging? First, when studying families, the focus of one’s research questions can be on individuals (e.g., the functioning of mothers, fathers, children), dyads (e.g., relations between mothers and children, relations within sibling pairs), the family system (e.g., the level of cohesiveness in the family as a whole), or any combination of these. Second, the same individual may serve different roles within the family (e.g., a mother could also be a spousal partner; an adolescent is a child but could also be a sibling). Third, there are different methods of assessment that can be employed with families (e.g., questionnaires, observational methods, interviews, daily diaries) and these methods often yield nonoverlapping or divergent data. Fourth, with our assessment methods, we are attempting to evaluate the functioning of the families where the individuals themselves as well as their health status are changing over time. Finally, such research is particularly challenging in families with individuals who have chronic health conditions because the assessment of family functioning can be based on generic and/or illness-related family assessment methods. Despite such challenges, empirical studies of families are among the most common types of research in the field of pediatric psychology and have been the basis for entire volumes and special issues of journals. In fact, one of the co-editors of the current special issue authored a review of 29 of the most commonly used family-based measures in pediatric psychology and concluded that the database for 19 of these measures had advanced to the point where they could be classified as “well-established” (Alderfer et al., 2008). Although this is an impressive number of high-quality measures, Alderfer et al. (2008) also advanced several recommendations for those who seek to further the quality of family assessment in the field of pediatric psychology. First, they maintained that many family measures were developed on general populations and that little is known about the psychometric quality of these measures in samples of individuals with chronic health conditions. Second, they suggested that we need more studies that focus on fathers and siblings and that the literature on the effects of factors such as family structure and ethnicity on family functioning in pediatric populations is less well developed. Finally, they suggested that we lack knowledge concerning the clinical utility and treatment sensitivity of our family-based measures (Alderfer et al., 2008). Although one issue of a journal could not possibly address all of the challenges of family assessment or the recommendations of Alderfer et al. (2008), the current special issue moves the field forward by providing new measures (including the development of noncategorical and disease-specific measures of various aspects of family functioning), novel uses of previously developed measures, and new approaches to integrating across existing measures. The contributors are all to be commended for the value of their research in advancing the field of pediatric psychology. In this commentary, we first discuss the many strengths of the articles in this issue. Next, we evaluate the evidence base for the family-based instruments included in these papers by using the checklist for measure development and validation, which we published in the Journal of Pediatric Psychology in 2009 (Holmbeck & Devine, 2009). Finally, we discuss research that is needed to continue our progress in the area of family assessment.

Development and psychometric properties of the OCD Family Functioning (OFF) Scale.

Obsessive-compulsive disorder (OCD) influences not only patients but also family members. Although the construct of family accommodation has received attention in OCD literature, no measures of overall family functioning are currently available. The OCD Family Functioning (OFF) Scale was developed to explore the context, extent, and perspectives of functional impairment in families affected by OCD. It is a three-part, self-report measure capturing independent perspectives of patients and relatives. A total of 400 subjects were enrolled between 2008 and 2010 from specialized OCD clinics and OCD research studies. Psychometric properties of this scale were examined including internal consistency, test-retest reliability, convergent and divergent validity, and exploratory factor analyses. Both patient and relative versions of the OFF Scale demonstrated excellent internal consistency (Cronbach's alpha coefficient = 0.96). The test-retest reliability was also adequate (ICC = 0.80). Factor analyses determined that the OFF Scale comprises a family functioning impairment factor and four OCD symptom factors that were consistent with previously reported OCD symptom dimension studies. The OFF Scale demonstrated excellent convergent validity with the Family Accommodation Scale and the Work and Social Adjustment Scale. Information gathered regarding emotional impact and family role-specific impairment was novel and not captured by other examined scales. The OFF Scale is a reliable and valid instrument for the clinical and research assessment of family functioning in pediatric and adult OCD. This will facilitate the exploration of family functioning impairment as a potential risk factor, as a moderator and as a treatment outcome measure in OCD.

Family Adaptability among Urban African-American Women with Hypertension

African-American women are at greater risk than other women for complications related to hypertension. This study examined relationships between hypertension, pulse pressure, body mass index, family adaptability, family cohesion, and social support among 146 urban African-American women. Significant relationships were found between family adaptability and systolic blood pressure ( P = 5 .03) and between adaptability and pulse pressure ( P ≤ .01). Based on study results, practitioners should routinely assess family functioning, specifically family adaptability, in African-American women who are at risk for or diagnosed with hypertension to minimize complications.

Designing and implementing a longitudinal study of children with neurological, genetic or metabolic conditions: charting the territory

BackgroundChildren with progressive metabolic, neurological, or chromosomal conditions and their families anticipate an unknown lifespan, endure unstable and often painful symptoms, and cope with erratic emotional and spiritual crises as the condition progresses along an uncertain trajectory towards death. Much is known about the genetics and pathophysiology of these diseases, but very little has been documented about the trajectory of symptoms for children with these conditions or the associated experience of their families. A longitudinal study design will help to close this gap in knowledge.Methods/DesignCharting the Territory is a longitudinal descriptive, correlational study currently underway with children 0-19 years who are diagnosed with progressive neurological, metabolic, or chromosomal conditions and their families. The purpose of the study is to determine and document the clinical progression of the condition and the associated bio-psychosocial-spiritual experiences of the parents and siblings age 7-18 years. Approximately 300 families, both newly diagnosed children and those with established conditions, are being recruited in six Canadian cities. Children and their families are being followed for a minimum of 18 months, depending on when they enroll in the study. Family data collection will continue after the child's death if the child dies during the study period. Data collection includes monthly parental assessment of the child's symptoms; an annual functional assessment of the child; and completion of established instruments every 6 months by parents to assess family functioning, marital satisfaction, health status, anxiety, depression, stress, burden, grief, spirituality, and growth, and by siblings to assess coping and health. Impact of participation on parents is assessed after 1 year and at the end of the study. Chart reviews are conducted at enrollment and at the conclusion of the study or at the time of the child's death.DiscussionKnowledge developed from this study will provide some of the first-ever detailed descriptions of the clinical symptom trajectory of these non-curable progressive conditions and the bio-psychosocial-spiritual aspects for families, from diagnosis through bereavement. Information about developing and implementing this study may be useful to other researchers who are interested in designing a longitudinal study.

Family Nursing Research for Practice: The Finnish Perspective

This article summarizes the efforts of the Department of Nursing Science, University of Tampere, Finland, to advance knowledge about family nursing over the past 15 years. Definitions of family, family nursing, and family nursing science are offered. Programs of research include families' experiences of care received in health care settings, family violence and child maltreatment, and the psychometric development of instruments to assess family functioning and family health. Research is currently examining the effectiveness of family nursing interventions. Recommendations are offered to strengthen collaboration between family nursing researchers, educators, and practitioners at the local level and initiate greater collaboration between family researchers at the interdisciplinary and international levels.

Family Adaptation 18 Months After Traumatic Brain Injury in Early Childhood

The purpose of this study was to examine family adaptation to a traumatic brain injury (TBI) in young children during the first 18-month postinjury, when compared with children who had an orthopedic injury. A concurrent cohort/prospective research design was used with repeated assessments of children aged 3 to 6 years with TBI or orthopedic injury requiring hospitalization and their families. Shortly after injury and at 6-, 12-, and 18-month postinjury, parents of 99 children with TBI (20 severe, 64 moderate, 15 mild) and 117 with orthopedic injury completed standardized assessments of family functioning, parental distress and coping, injury-related burden, and noninjury-related parent stressors and resources. Mixed models analyses examined group differences in parental burden and distress adjusted for race and social demographic factors. Both moderate and severe TBI were associated with higher levels of injury-related stress than orthopedic injury, with stress levels diminishing over time in all groups. Severe TBI was also associated with greater psychological distress on the Brief Symptom Inventory but not with more depressive symptoms. Family functioning and social resources moderated the relationship of TBI severity to injury-related burden and caregiver distress, respectively. Lower child adaptive skills were associated with poorer family outcome but group differences remained even when controlling for this effect. Severe TBI in young children has adverse consequences for parents and families during the first 18-month postinjury. The consequences lessen over time for many families and vary as a function of social resources.

VACATION AND FAMILY FUNCTIONING

This study explores the unique interplay of family vacation travel, family cohesion, and family communication through a sample of 265 family travelers. The results reveal that family vacation contributes positively to family bonding, communication and solidarity. Family interaction styles differ during the family leisure travel process. Two types of families are identified differing on the dimension of cohesion, corresponding to separated and connected families. Three types of families are identified differing on the dimension of adaptation, corresponding to flexible, confused and structured families. This research represents an attempt to use a unique theoretical framework to empirically assess family functioning in the leisure travel setting.

Students' assessment of family functionality and attendance of religious instruction in school

The goal of the research presented in this paper was to study the relations between students' estimation of the real and desired state of family functionality and attendance of religious instruction in school. The results obtained on the sample of 421 secondary school students of the third grade, who opted for attending religious instruction at the beginning of this level of schooling (263 students) or for attending the alternative elective subject - civic education (158 students). For assessing relevant dimensions of the real and desired state of family system functionality, the standardized instruments were used - FACES III (cohesion and flexibility of the family) and F-COPES (strategies of family's overcoming of problems). For collecting data on sociodemographic characteristics of respondents and their families, as well as the assessment of effects of attending religious instruction on the family, we used the Student Questionnaire, constructed for the purposes of this research. Based on the analysis of the obtained results, we reached the conclusion that in certain aspects there are differences in students' assessment of the real and desired state of family functionality, depending on the elective subject they attend, as well as that it can be stated with great probability that some of the measured family characteristics are significantly correlated with the effects of religious instruction on students and their family as a whole.

Family functioning and posttraumatic stress disorder in adolescent survivors of childhood cancer.

This study investigated family functioning and relationships between family functioning and posttraumatic stress disorder (PTSD) in adolescent survivors of childhood cancer. To assess family functioning, 144 adolescent cancer survivors 1 to 12 years post-cancer treatment (M = 5.3 years) and their parents completed the Family Assessment Device (FAD). To assess PTSD, adolescents were administered a structured diagnostic interview. Nearly half (47%) of the adolescents, one fourth (25%) of mothers, and one third (30%) of fathers reported poor family functioning, exceeding the clinical cutoff on 4 or more FAD subscales. Families in which the cancer survivor had PTSD (8% of the sample) had poorer functioning than other families in the areas of problem solving, affective responsiveness, and affective involvement. Three fourths of the adolescents with PTSD came from families with categorically poor family functioning. A surprisingly high rate of poor family functioning was reported in these families of adolescent cancer survivors. Adolescents with PTSD were more than 5 times as likely to emerge from a poorly functioning family compared with a well-functioning one. This study provides evidence that family functioning is related to cancer-related posttraumatic reactions in adolescent survivors.