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Family systems in the context of child risk: an observational analysis

Description

Family plays an important yet understudied role in the development of psychopathology during childhood, particularly for children at developmental risk. Indeed, much of the research on families has actually concentrated more on risk processes in individual family members or within-family

Family plays an important yet understudied role in the development of psychopathology during childhood, particularly for children at developmental risk. Indeed, much of the research on families has actually concentrated more on risk processes in individual family members or within-family subsystems. In general, important and complex associations have been found among family-related constructs such as marital conflict, parent-child relationships, parental depression, and parenting stress, which have in turn been found to contribute to the emergence of children's behavioral problems. Research has begun to emerge that certain family system constructs, such as cohesion, organization, and control may influence children's development, but this research has been limited by a focus on parent-reports of family functioning, rather than utilizing observational methods. With notable exceptions, there is almost no observational research examining families of children at developmental risk. This study examined the longitudinal relations among family risk and family system constructs, as well as how family systems constructs mediated the relations between family risk and child outcome. Further, the study examined how developmental risk moderated these relations. The sample followed 242 families of children with and without developmental risk across the transition-to-school period. Family risk factors were assessed at 5 years, using parental reports of symptomatology, parenting stress, and marital adjustment, and observational assessments of the parent-child relationship. Family system constructs (cohesion, warmth, conflict, organization, control) were measured at age 6 using structured observations of the entire family playing a board game. Child behavior problems and social competence were assessed at age 7. Results indicated that families of children with developmental delays did not differ from families of typically developing children on the majority of family system attributes. Cohesion and organization mediated the relations between specific family risk factors and social competence for all families. For families of typically developing children only, higher levels of control were associated with more behavior problems and less social competence. These findings underscore the importance of family-level assessment in understanding the development of psychopathology. Important family effects on children's social competence were found, although the pathways among family risk and family systems attributes are complex.

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Date Created
2012

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Implementation of a Family-Based Obesity Intervention Within a Pediatric Primary Care

Description

Background: 
Approximately 1 in 5 U.S. school-aged children are obese. There are many known health complications associated with obesity including premature death. Family-based obesity interventions that promote healthy lifestyle habits are effective at enabling children to make changes needed to

Background: 
Approximately 1 in 5 U.S. school-aged children are obese. There are many known health complications associated with obesity including premature death. Family-based obesity interventions that promote healthy lifestyle habits are effective at enabling children to make changes needed to avoid long-term health complications associated with obesity. The purpose of this evidence-based practice intervention was to evaluate the effectiveness of a family-based obesity intervention on familial lifestyle behaviors related to nutrition, physical activity, and screen time.

Methods:
Two overweight-obese children (according to CDC criteria) ages 8-12 years old visiting a pediatric primary care clinic in a suburban neighborhood located in the southwest region were recruited to participate in this evidence-based practice intervention based on inclusion and exclusion criteria. Familial lifestyle behaviors were assessed using the Family Health Behavior Scale (FHBS) prior to receiving an educational intervention addressing nutritional, physical activity, and screen time recommendations and again after following these recommendation for 6-weeks. Additionally, scheduled follow-up phone calls were made every 3 or 6-weeks addressing any parental questions that surfaced. Data was insufficient for statistical analysis, however, anecdotal recommendations for future implementation of this intervention resulted.

Results:
Of the two patients who participated, pre- and post-intervention data was only attainable from one patient. That patient did have improved scores within each of the 4 FHBS subscales (parent behaviors, physical activity, mealtime routines, and child behaviors). Overall, 11 of the 27 behaviors assessed improved, 12 behaviors resulted in no change, and 4 behaviors worsened. Recommendations related to a more successful implementation of this intervention in the future include improved provider participation (buy-in), utilization of broader inclusion criteria, consideration of the implementation time-frame, and application of the Health Belief Model for addressing existing barriers for each patient prior to implementing the intervention.

Conclusions:
In order to determine the effectiveness of this intervention a larger sample size and completed post-intervention data are needed. The small sample size and lack of post-intervention data inhibits proper data analyzation and significance from being determined.

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Date Created
2018-05-02

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Equine Assisted Learning: An Evidence-Based Intervention for Families

Description

Background: It is estimated that 50% of all mental illness arises prior to age 14, an incident attributed in part to disruptions and imbalances within the family system. Equine assisted learning is a complementary and alternative approach to family therapy

Background: It is estimated that 50% of all mental illness arises prior to age 14, an incident attributed in part to disruptions and imbalances within the family system. Equine assisted learning is a complementary and alternative approach to family therapy which is being used increasingly to promote mental health in both adults and children. This study sought to build and deliver an evidence-based, family-centered equine assisted learning program aimed at promoting family function, family satisfaction and child social-emotional competence, and to measure its acceptability and preliminary effect.

Method: Twenty families with children 10 years and older were recruited to participate in a 3-week equine assisted learning program at a therapeutic riding center in Phoenix, Arizona. Sessions included groundwork activities with horses used to promote life skills using experiential learning theory. The study design included a mixed-method quasi-experimental one-group pretest posttest design using the following mental health instruments: Devereaux Student Strengths Assessment, Brief Family Assessment Measure (3 dimensions), and Family Satisfaction Scale to measure child social-emotional competence, family function, and family satisfaction, respectively. Acceptability was determined using a Likert-type questionnaire with open-ended questions to gain a qualitative thematic perspective of the experience.

Results: Preliminary pretest and posttest comparisons were statistically significant for improvements in family satisfaction (p = 0.001, M = -5.84, SD = 5.63), all three domains of family function (General Scale: p = 0.005, M = 6.84, SD = 9.20; Self-Rating Scale: p = 0.050, M = 6.53, SD = 12.89; and Dyadic Relationship Scale: p = 0.028, M = 3.47, SD = 7.18), and child social-emotional competence (p = 0.015, M = -4.05, SD 5.95). Effect sizes were moderate to large (d > 0.5) for all but one instrument (Self-Rating Scale), suggesting a considerable magnitude of change over the three-week period. The intervention was highly accepted among both children and adults. Themes of proximity, self-discovery, and regard for others emerged during evaluation of qualitative findings. Longitudinal comparisons of baseline and 3-month follow-up remain in-progress, a topic available for future discussion.

Discussion: Results help to validate equine assisted learning as a valuable tool in the promotion of child social-emotional intelligence strengthened in part by the promotion of family function and family satisfaction. For mental health professionals, these results serve as a reminder of the alternatives that are available, as well as the importance of partnerships within the community. For therapeutic riding centers, these results help equine professionals validate their programs and gain a foothold within the scientific community. Additionally, they invite future riding centers to follow course in incorporating evidence into their programs and examining new directions for growth within the mental health community.

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Date Created
2019-05-02