Healthy Family Functioning Research Articles

Prenatally detected de novo apparently balanced chromosomal rearrangements: the effect on maternal worry, family functioning and intent of disclosure

This study aims to assess the impact of prenatal diagnosis of de novo apparently balanced chromosome rearrangements (ABCRs) on maternal stress, family functioning and maternal plans of disclosure of genetic information to their child. All liveborn children with prenatally detected de novo ABCRs in two Australian states over a 10-year period (1994-2003) were retrospectively ascertained. Of 39 eligible cases, 16 (41%) participated in the study. Mothers of these children completed a questionnaire using standardized measures to assess family functioning, parental distress, parent-child interaction and child characteristics, with open-ended questions regarding disclosure. The majority of mothers appeared to experience normal levels of parenting stress, quality of parent-child interaction and healthy family functioning. However, most mothers recalled experiencing a significant degree of worry at the time of receiving their prenatal test results, and some mothers (4/15) reported receiving uncertain or conflicting results. Most mothers (13/15) conveyed an understanding of the importance of disclosing this genetic information to their child, and 12/15 conveyed their intention to make this disclosure. Most mothers reported normal parenting stress and family functioning, despite experiencing significant worry upon receiving results. Some children are at risk of nondisclosure of their carrier status.

Differentiation and healthy family functioning of Koreans in South Korea, South Koreans in the United States, and White Americans.

Inconsistent results have been found in prior research on the Bowen Family Systems Theory concept of differentiation of self and its application to individuals, couples, and families of different cultural backgrounds. In this regard, this study examined the impact of differentiation of self on healthy family functioning, family communication, and family satisfaction with 277 participants including South Koreans living in South Korea, South Korean-born citizens living in the United States, and White Americans living in the United States. Multigroup confirmatory factor analysis identified the measurement invariance of a differentiation scale (DSI-R) used for the three study groups. An analysis of covariance (ANCOVA) found significant differences between White Americans and South Koreans with regard to the level of differentiation. Results of multigroup structural equation modeling (SEM) analyses found a significant association between differentiation of self and healthy family functioning across the three groups with the American group having significantly higher differentiation than the two South Korean groups." Implications for clinical practice and future research are discussed.

Family demands, social support and family functioning in Taiwanese families rearing children with Down syndrome

Down syndrome (DS) affects not only children but also their families. Much remains to be learned about factors that influence how families of children with DS function, especially families in non-Western populations. The purpose of this cross-sectional, correlational study was to examine how family demographics, family demands and social support relate to family functioning as well as the potential mediating effect of social support on the relationship between family demands and family functioning in Taiwanese families of children with DS. One hundred and fifty-five parents (80 mothers and 75 fathers) from 83 families independently completed mailed questionnaires. Data were analysed using a principal component analysis and mixed linear modelling. Families having older children with DS, greater parental education, higher family income, fewer family demands and greater social support contributed to healthier family functioning. Social support partially mediated the effects of family demands on family functioning. Family demographics, family demands and social support appear to be important factors that may play a critical role in how Taiwanese families respond to the birth of a child with DS. Care of children with DS and their families is likely to be more effective if professionals working with these families are aware of factors that contribute to healthy family functioning.

The importance of family functioning, mental health and social and emotional well‐being on child oral health

To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1- to 12-year-old Australian children. The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure. The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4-7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income <$20 000 (P < 0.05). In order to address inequities in the experience of poor oral health, solutions that encompass social, economic and psychosocial dimensions will be required. Integrating intervention strategies that promote oral, healthy family functioning and the mental health of parents and children into existing systems reaching vulnerable community members may improve child oral health outcomes and reduce the unequal distribution of oral disease across the social gradient.

Does Couple and Relationship Education Work for Individuals in Stepfamilies? A Meta‐analytic Study

Recent meta‐analytic efforts have documented how couple and relationship education (CRE) programs promote healthy relationship and family functioning. The current meta‐analysis contributes to this body of literature by examining stepfamily couples, an at‐risk, subpopulation of participants, and assessing the effectiveness of CRE programs for individuals in these relationships. Findings are aggregated from 14 evaluation studies of CRE programs designed for stepcouples. Analyses examine effects by study design (i.e., comparison‐group and one‐group/pre‐post) and within specific domains (i.e., family, parental, and couple functioning). The interventions have, on average, small effects overall (comparison‐group: d = .20; one‐group/pre‐post: d = .23), and slightly larger effects in family and parental functioning when examining specific outcomes (d = .20 to .35). An examination of effectiveness over time reveals that earlier studies (i.e., 1980s and 1990s) show larger effects than more recent studies. Implications for CRE programs for stepfamilies and evaluation needs are discussed.

Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?

Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. Specifically, where one doctor has a continuous relationship with one town or community, albeit spending their rostered time off away from this location, rather than continuity of service with different doctors each time. In this model, doctors spend a fixed number of days at work geographically remote from their home and families, with logistical support (eg housing, transport) provided, followed by a fixed number of days back at home not working. This provides a the doctor with the benefits of remote clinical work plus guaranteed time off at home, a more acceptable roster than in many remote locations at present. This also avoids the complex issue of experienced doctors having to leave remote areas mid-career for the well-documented reasons of spouse employment and children's education, as well as providing easier access to professional development activities. The author followed this path and remains a FIFO doctor after 7 years of continuous service. For FIFO to be effective, there needs to be a commitment from the sponsoring organisation for short, balanced, flexible, family friendly rosters and a positive organizational structure with effective communication between management and front line staff. Evidence shows that families and children with healthy family functioning, who are able to balance separateness and togetherness and are able to readily adjust when circumstances move from stability through change, and have strong communication skills, cope well with FIFO work. The author's employer actively supports his FIFO work arrangements. Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?

Applying Structural Family Therapy with a Mexican-American Family with Children with Disabilities: A Case Study of a Single-Parent Mother

An illustration of one Mexican-American family headed by a single-parent mother is explored to depict the application of Structural Family Therapy. Familism and marianismo are examined as factors impacting healthy family functioning of Mexican and Mexican-American families. Interventions used with the family were joining, structural mapping, enactment and addressing disability and medical related concerns. Learning to create healthy boundaries between parent and children, addressing maternal depression and family economic stressors, and nurturing sibling relationships were areas that impacted this family. Further research is suggested into the application of Structural Family Therapy as a model when working with Mexican and Mexican-American families who have a child with a disability.

Family Functioning, Parenting Style, and Child Behavior in Kin Foster Care

Face-to-face interviews with 120 predominantly African American kin caregivers of children in the child welfare system revealed significant associations between family functioning and child behavior problems. Caregivers who reported healthier family functioning tended to report lower levels of behavior problems by the children in their care. Healthier family functioning related to roles and affective involvement were associated with lower levels of child behavior problems, but, surprisingly, less healthy family functioning related to behavior control was also associated with lower levels of child behavior problems. Caregiver ratings of their parenting styles were related to family functioning but not to their ratings of the child's behavioral functioning. Results of this study suggest several implications for child welfare practice and future research.

A Qualitative Study of Incarcerated Mothers' Perceptions of the Impact of Separation on Their Children

Many incarcerated women are mothers, and their children exhibit various responses to the separation that incarceration commands. This exploratory qualitative study examines incarcerated women's perceptions of the consequences of their illegal activity, confinement, and separation from their children on their offspring. The results indicate that although mothers are concerned about their children, they are typically unable to recognize the negative consequences of their actions on their children and their relationship with their children until beginning intensive treatment. Effective treatment must focus on the woman's personal issues along with their parenting abilities and skills to repair these relationships and promote healthy family functioning.

Black Adults’ Perceptions of Healthy Family Functioning

This study explores Black adults’ perceptions of factors that contribute to healthy family functioning. Qualitative interviews were conducted with 18 Black participants between the ages of 26 and 54. They responded to a question on their perceptions of healthy family functioning. In addition, a semistructured interview was conducted with the eight participants who presented with the richest data. Analysis of the data revealed healthy family functioning to be characterised by effective communication, appropriate affective involvement, well-defined family rules, clear family boundaries and a common religion.

The importance of family to youth living in violent communities

The purpose of this study was to investigate family functioning in the relationship between community violence exposure and 1) self-esteem and 2) confrontational coping in a sample of urban youth. Adhering to the tenets of community based participatory research, academic and community partners collaborated on a cross-sectional study with 110 community dwelling urban youth, ages 10–16 living in a city located in the Northeastern United States. As part of a larger survey, this analysis included selected items on lifetime community violence exposure, family functioning, self-esteem and use of confrontational coping strategies in response to community violence. Over 90% of the youth reported some type of lifetime community violence exposure. Controlling for age and gender, older youth and those with healthier family functioning had higher self-esteem; community violence exposure was not associated with self-esteem. Healthier family functioning was associated with decreased use of confrontational coping, though increasing amounts of community violence exposure was still associated with increased confrontational coping. Family can be protective in violent environments. Results from this study directly informed an intervention aimed at youth violence prevention. This study highlights how psychiatric and mental health nurses may be able to address the complex interplay of factors for youth living in violent environments.

Patterns of Relationships Between Background Characteristics, Coping, and Stroke Caregiver Outcomes

Purpose: Little is known about mediators of stroke caregiver outcomes or patterns of relationships of outcome predictors. We examined relationships between the variable sets of caregiver and stroke survivor characteristics, coping (proposed mediators), and caregiver outcomes. Methods: We assessed 253 dyads prior to discharge from acute rehabilitation. Outcomes were depression, anxiety, preparedness, life change, and family functioning. Coping included problem solving, caregiver appraisal, and unmet resource needs. Multivariate canonical correlation analyses were computed between the sets of variables to identify unique patterns of relationships. Results: Six patterns of significant relationships were found (R =.30 to .84, Ps <.01 to .02). The strongest relationship was that between greater threat appraisal and negative life change, greater anxiety, and lower caregiving preparedness (P < .01). Caregiver characteristics (nonwhite, spousal caregivers) were related significantly to several outcomes (positive life change, lower anxiety, and less healthy family functioning) (R = .43, P <.01) and remained significant after controlling for the effect of mediators (R = .32, P < .02). Conclusion: Findings suggest various patterns of relationships that provide guidance for individualizing early caregiver intervention. Clinicians can build on caregivers’ strengths while identifying threats to adaptation to tailor interventions that promote healthy outcomes.

Resiliency in Poor Single-Parent Families

The primary aim of this study was to identify factors associated with resiliency in poor single-parent families. A cross-sectional survey was used to identify and describe resiliency factors that enable families to maintain healthy family functioning. The 51 families that participated in this study were identified by the nature of the crisis and the developmental phase of the family. A biographical questionnaire and several indexes were completed independently by a parent and a child from each family. The results indicated a significant relationship between the families’ adaptation and intrafamilial support, support from family and friends, family hardiness, a positive approach to problems, and religion. The findings can contribute significantly to future interventions and preventive approaches to foster resiliency in families.

Supporting low-income families with young children: Patterns and correlates of service use

Comprehensive, integrated service systems are increasingly viewed as a promising strategy for supporting healthy family functioning and child development in low-income families, but have shown variable impacts. This paper reports early findings from a longitudinal study of voluntary service use by a sample of low-income families with young children. Mothers ( N = 531) recruited soon after their newborns' birth in 2004 and 2005 from targeted communities in Palm Beach County, Florida are being followed for 8 years to assess service needs, service use, family functioning, and child well-being. A cluster analysis of services used in the second year revealed four distinct patterns of service use: a low-service group receiving mainly health care and food assistance, two moderate-service groups, and a high, multi-service group. These patterns were associated with families' demographic characteristics, nativity, health status, social support, year 1 maternal functioning, and previous service experiences. However, there were no significant differences between the service pattern groups with respect to year 2 maternal depression and parenting practices.

Children with disabilities in the child protective services system: An analog study of investigation and case management

Objective The study used a series of vignettes to investigate how the presence of three disabilities (cerebral palsy, intellectual disabilities, emotional/behavioral disabilities) affects the processes and outcomes of child abuse investigations at two levels of child injury severity (moderate, severe). Method Seventy-five CPS case workers completed study surveys and answered questions in response to a series of eight vignettes. Results This study revealed differences in the responses of CPS case workers when the alleged victim of physical abuse had a disability. Children with disabilities were more likely than children without disabilities to be seen as having characteristics that contributed to their abuse. Most CPS workers felt at least some empathy with abusive parents; empathy was highest when the children had emotional/behavioral disabilities. Services recommended for families of children with disabilities were more likely to be child-focused. Parent-focused services, such as individual counseling and adult anger management, were more likely to be recommended for families of children without disabilities. In general, differences among disability groups and between cases involving children with and without disabilities were more pronounced when the children's injuries were less severe. Even with more severe injuries, such as a concussion or broken bones, the CPS workers still responded differently depending on the disability status of the child victims. Conclusions Recommendations are made concerning the utilization of investigation teams that include disability specialists and the need for further disability-related training for CPS case workers. Practice implications There is a strong need for training related to disability, with an emphasis on attitudes as well as knowledge and skills. The training should include examples of healthy family functioning and positive aspects of parenting a child with a disability to counteract the prevailing perception of disability as a cause of chronic stress and dysfunction; identification of broader ecological contexts in which these families live, including social response to disability and the disability-related service system and; strategies for disentangling the signs of abuse from characteristics of the disability. Interdisciplinary teams should include members from disability-related fields to share expertise and increase communication between systems.

Health-related quality of life and family function following pediatric liver transplantation

This multicenter study compared health-related quality of life (HRQOL) and family function of pediatric liver transplant recipients to those of healthy children to determine if this population differed from a healthy population and to distinguish which pretransplant and posttransplant factors impact HRQOL and family function. HRQOL data from 102 patients achieving 2-year survival were collected with the Infant Toddler Quality of Life Instrument or the Child Health Questionnaire Parent Form 50 parent surveys. Family functioning was assessed with the Family Assessment Device (FAD) completed by each participant's family members. Demographic and clinical information were retrieved from the Studies of Pediatric Liver Transplant database. Recipients 5 years of age and older scored lower than a normative sample in physical health (P < 0.001), general health (P < 0.001), parental emotional impact (P < 0.001), and disruption of family activities (P < 0.001). Younger children, 2 to 5 years of age, scored lower than controls in global health (P = 0.004) and general health perceptions (P < 0.001) but did not differ in subscales measuring physical and psychosocial outcomes. Univariate analysis among the subscales identified demographic but not clinical variables as significant predictors of HRQOL. Mean scores of FAD scales were below published thresholds indicating healthy family functioning. As reported in previous studies, parents of older recipients reported higher levels of stress, although their level of family function appears normal. Significant associations were also observed between FAD scores and demographic variables, suggesting that further investigation of the impact of race, parental marital status, and socio-economic status on the patient rehabilitation process is needed.

Adolescent Autonomy and Family Functioning Are Associated With Headache-related Disability

The aims of this study were to examine the relationships between a range of family factors, including autonomy and general family functioning, on headache outcomes (ie, pain and functional impairment) in adolescents with recurrent headaches. Forty nine adolescents, ages 11 to 16 years, (mean age=13.5 y, 63% female) receiving treatment through pediatric neurology for recurrent headaches were enrolled. Adolescents and their parents completed measures of pubertal status, pain, functional impairment, parental solicitousness, behavioral autonomy, depressive symptoms, and family functioning. Lower levels of adolescent autonomy (r=0.53, P<0.01) and less healthy family functioning (r=0.32, P<0.01) were significantly related to higher levels of functional impairment. In multivariate regression analyses controlling for pain intensity, pubertal status, and depressive symptoms, parent and family variables added significant variance in the prediction of functional impairment (r change=0.21, P<0.05). Both adolescent autonomy (beta=0.38, P<0.05) and general family functioning (beta=0.34, P<0.05) were significant individual predictors of adolescent functional impairment. This study extends research on family factors and adolescent headache-related pain and disability. Future research is needed to discover whether family based interventions helping adolescents to acquire appropriate and supportive levels of autonomy may be useful in reducing headache-related disability.

Factors associated with the mental health of adolescents when a parent has cancer

This study explored factors associated with the mental health in adolescents (ages 11-17; n = 54) within 12 months after a parent had been diagnosed with cancer. A control group was included (ages 11-17; n = 49). A demographic questionnaire, the SF-8 Health Survey, the Youth Self Report and the McMaster Family Assessment Device were used. Similar levels of psychological distress and healthy family functioning were reported in the clinical and the control group. No effect of gender of the ill parent and that of the adolescent was found. A negative correlation was found between the physical health of the ill parent and the mental health of the adolescent. Healthy family functioning correlated with less psychological distress in adolescents with a parent with cancer. Open communication, flexible problem solving and appropriate affective involvement were significant predictors for less psychological distress in the adolescents. The study concludes that a healthy family functioning facilitated the adolescent's adjustment to parental cancer.

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The 'good' family syndrome: social and cultural issues in community and family health.

Many nurses would openly admit to classifying families into two groups, the good families and the 'problem' family. Generally the good family is one that complies with all medical treatments, and behaves appropriately according to frequently unarticulated parameters set by health professionals. Conversely the problem family is one that fails to adhere to prescribed treatment plans, challenges health professionals, is over involved or too detached and oversteps the boundaries of their expected role. Unfortunately too many times families from different cultures end up being labelled as difficult or problematic because of perceived non-conformity to social norms and desired behaviours. They end up in the 'problem' family category due to biased attitudes towards their cultural backgrounds and/or socioeconomic status, despite only trying to cope with the situation from their own frame of reference and understanding. Families from different cultures may lack knowledge of what is appropriate behaviour in healthcare interactions which can result in misunderstandings and conflict. Learning to negotiate in a culture that has different norms and values is not easy when you are feeling vulnerable and ill. Labelling families is discriminatory. Many health professionals are prone to making generalisations about cultures which ignores heterogeneity and leads to erroneous assumptions and stereotypes. This leads to poor understanding which potentially leads to inadequate care.The statistics on cultural groups' health status makes for sobering reading as these families usually have higher rates of illnesses but yet receive little if any preventive healthcare, inadequate health maintenance, and have limited access to health services. Research from the Netherlands suggests that cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socio-economic position (Stronks et al. 2001). Migrant families in particular generally suffer more illnesses, both acute and chronic, than do the general population because of unhealthy living environments, poverty and insufficient medical care. Lack of funds or inaccessibility to health services inhibits some families from seeking treatment for any but severe illness or injury. Alternatively cultural beliefs that value stoicism and self-reliance will prohibit many families from seeking advice or treatment for healthcare concerns. Consequently they only access healthcare services when symptoms have become acute or unbearable. Language barriers and the perception of services as being for the majority population prohibit cultural groups, in particular the elderly, from accessing many statutory and voluntary services.The generally negative view of cultural groups ignores the fact that many such families show tremendous resilience when faced with illness, trauma and unexpected crises. Many families can usually rely on a wide informal network of support such as extended family members, friends and social networks that may not be so evident in other westernised cultures. Families bring patterns of functioning that is unique to each individual family and often families develop their own way of problem solving that facilitates their coping and adaptation. The social capital of extended families and community networks is now being recognised as a significant factor that contributes to families overall functioning and well being. Therefore a theoretical reframing of families from different cultures is required to acknowledge healthy family functioning and provide culturally competent care. Viewing families from a positive perspective rather than a deficit approach would encourage recognition of families' resilience, hardiness and adaptation. Although research is proliferating in this area, there remains a deficit of knowledge about cultural minority families' successful coping strategies and patterns of functioning. Intergenerational communication and support contributes to families' social capital and hence should be respected and valued by health professionals. …