RESUMEN

OBJECTIVE: To pilot informed consent materials developed for Aboriginal parents in a vaccine trial, and evaluate their design and the informed consent process. METHODS: Cross sectional quantitative and qualitative survey of 20 Aboriginal and 20 non-Aboriginal women in Alice Springs. Information about the proposed research was presented to Aboriginal participants by an Aboriginal researcher, using purpose designed verbal, visual, and written materials. Non-Aboriginal participants received standard materials developed by the sponsor. Questionnaires were used to evaluate recall and understanding immediately and five days later. Qualitative analysis of Aboriginal participants' interviews was performed. RESULTS: There were no differences between the groups in understanding of diseases prevented by the vaccine, the potential risks of participating, or the voluntary nature of participation. Most Aboriginal participants had difficulty with the concept of a "licensed" versus "unlicensed" vaccine. The non-Aboriginal group had a good understanding of this. Aboriginal participants identified the use of the flipchart, along with a presentation by a doctor and Aboriginal health worker, as preferred delivery modes. Group presentations were preferred rather than one-on-one discussions. The use of the questionnaire posed considerable methodological difficulties. CONCLUSIONS: A one-off oral presentation to Aboriginal participants is unlikely to produce "informed consent". Key but unfamiliar concepts require identification and particularly considered presentation.

Asunto(s)

RESUMEN

Random assignment was made of 182 clinically referred marijuana- and alcohol-abusing adolescents to one of three treatments: multidimensional family therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). Each treatment represented a different theory base and treatment format. All treatments were based on a manual and were delivered on a once-a-week outpatient basis. The therapists were experienced community clinicians trained to model-specific competence prior to the study and then supervised throughout the clinical trial. A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake, termination, and 6 and 12 months following termination. Results indicate improvement among youths in all three treatments, with MDFT showing superior improvement overall. MDFT participants also demonstrated change at the 1-year follow-up period in the important prosocial factors of school/academic performance and family functioning as measured by behavioral ratings. Results support the efficacy of MDFT, a relatively short-term, multicomponent, multitarget, family-based intervention in significantly reducing adolescent drug abuse and facilitating adaptive and protective developmental processes.

Asunto(s)

RESUMEN

OBJECTIVES: To identify key demographic, parent, and adolescent characteristics that influence engagement in outpatient drug abuse treatment. METHOD: Youths aged 12 to 17 years (N = 224; 81% male and 72% African American) referred for drug treatment and their parents participated in this study. Marijuana was the primary substance of abuse. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning. RESULTS: A discriminant function analysis revealed that engagement in treatment was related to, in order of weighting, more positive parental expectations for their adolescent's educational achievement (standardized discriminant function coefficient [SDF] = 0.68), higher parental reports of youth externalizing symptoms (SDF = 0.59), and higher levels of family conflict perceived by the youth (SDF = 0.36). Family income, gender, juvenile justice status, minority group status, family structure, parental age and psychopathology, and treatment characteristics did not distinguish treatment-engaged from unengaged adolescents. CONCLUSIONS: The results suggest that both parent and youth perceptions are pivotal to whether or not adolescents are engaged in psychotherapy. These findings lead the authors to recommend adolescent engagement interventions focusing on both the youth and his or her parents and suggest a content focus for adolescent engagement interventions.

Asunto(s)

RESUMEN

Almost two-thirds of African American births are to unmarried mothers, and these single parents are among the most economically vulnerable in the United States. The effects of chronic stressors such as poverty can compromise the ability of these mothers to parent effectively, particularly during the developmental period of adolescence, typically a stressful phase of parenting. This article describes a multidimensional family therapy (MDFT) approach to working with African American adolescents who have drug and/or behavior problems. It is maintained that addressing the intrapersonal functioning of African American single mothers is vital if they are to re-establish the attachment bonds necessary for the maintenance of essential parental influence in the lives of their adolescents. Through systematic attention to the parent as an individual, leading to a balance between self-care and care for others, parental supervision is more easily achieved and relational impasses between parent and adolescent more equitably resolved.

Asunto(s)

RESUMEN

This report describes the development of a new scale designed to establish how therapists intervene and clients respond during effective enactments in family therapy sessions. The Family Therapy Enactment Rating Scale (FTERS) was developed by clinically trained investigators who observed 27 videotaped family therapy sessions and listed therapist interventions and client responses during four phases of enactments: pre-enactment preparation, initiation, facilitation, and closing commentary. Interrater reliabilities for the FTERS were calculated by training 6 undergraduate volunteers to rate independently a sample of 12 enactments. When reliabilities were found to be relatively low, a second study was conducted in which the FTERS was revised and reliabilities were calculated with a different sample of 21 videotaped enactments and a new group of 6 undergraduate raters. Reliability for the FTERS was found to be sufficiently robust to make this measure of therapist interventions and client responses a useful instrument for evaluating what takes place during enactments. Findings on the FTERS were used to offer tentative guidelines for effective initiation and facilitation of enactments in family therapy sessions.

Asunto(s)

RESUMEN

Tremendous advances have been made in our understanding of the intrapersonal, interpersonal, familial, and contextual characteristics and processes that contribute to adaptive as well as maladaptive developmental outcomes with high-risk and clinically referred adolescents. This empirical knowledge base offers clinically rich opportunities for systematic treatment development. An important step in this process is distinguishing which research findings in basic science areas such as developmental psychology and developmental psychopathology might have clinical relevance. Toward this goal, we review relevant but selective research in areas that are central to clinical work with adolescents (parent-adolescent relationship, biological aspects, and affect and cognition), and we offer examples of how basic research in these areas can inform treatment.

Asunto(s)

RESUMEN

Family-based preventive intervention has emerged as a promising modality for preventing antisocial behavior problems in youth. This article introduces an intensive, family-based preventive intervention for high-risk adolescents: Multidimensional Family Prevention. Multidimensional Family Prevention combines the advantages of standard prevention models (curriculum based and protection focused) with those of psychosocial treatment models (assessment based and problem focused). The model's main features are described: theoretical foundations (risk and protection theory, developmental psychopathology, ecological theory), guidelines for constructing a multidomain prevention program (family and peer relationships, school and prosocial activities, drug use and health issues, cultural themes), and strategies for tailoring and implementing five flexible intervention modules (adolescent, parent, interactional, extended family, extrafamilial). Implemented in the family's home, the intervention works to create a resilient family environment that supports the basic adolescent developmental goals of renegotiated attachment bonds within the family and durable connections with prosocial institutions.

Asunto(s)

RESUMEN

This article describes procedures for developing a therapeutic alliance with a parent within the context of family therapy for adolescents. After an overview of the general clinical model, specific themes and interventions are described that provide a map to facilitate this process. Following Bordin's (1979) model, alliance is conceptualized in three parts: bonds, goals, and tasks. The bond phase consists of the therapist showing empathy and understanding toward the parent and the parent developing empathy toward their own life struggles. The goal phase consists of defining parent-child relationship building as a primary focus of treatment. The task phase consists of preparing parents to better communicate with their adolescent. These phases can occur sequentially within a single session with a parent alone. The alliance building session sets the foundation for parent-adolescent conflict resolution leading to reattachment in future sessions.

Asunto(s)

RESUMEN

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate "knowns and unknowns" regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.

Asunto(s)

RESUMEN

Family-based treatments for adolescent drug abuse and related behavior problems have been developed and evaluated with success. Empirical support exists for the efficacy of family-based treatments, and process studies have begun to identify mechanisms by which these treatments may achieve their effects. This article discusses theory and related clinical refinements in a contemporary family-based intervention, multidimensional family therapy. Expansions in the theoretical basis of the model are discussed. I highlight 2 aspects of the theory evolution process, resulting in a sharper clinical focus on intrapersonal development and on adolescents' and families' functioning vis-à-vis influential extrafamilial ecologies of development.

Asunto(s)

RESUMEN

Family-based preventive intervention for substance use and antisocial behavior is introduced as an emerging specialty. Major program parameters are outlined, and intervention techniques endorsed by contemporary models are presented. Recommendations are made for advancing family-based prevention in key areas: targeting high-risk and adolescent populations, customizing interventions for individual families, working with multiple social systems, and integrating knowledge from the fields of prevention and treatment.

Asunto(s)

RESUMEN

This treatment development, process research study focuses on resolving in-session, parent-adolescent conflicts characterized by negative exchanges, emotional disengagement, and poor problem solving. These processes have been empirically linked to poor developmental outcomes, and clinically linked to poor therapeutic progress. Specifically, we examined how a shift of therapeutic focus from behavior management to interpersonal relationship failures could resolve this impasse and resuscitate therapeutic momentum. A task analysis approach was used to verify the presence of the impasse, to illuminate its core features, and to define the therapist and client behaviors associated with resolving it. In Part 1 of this two-part series, we presented the final performance map that represented that family's cognitive, emotional and behavioral interactions necessary to resolve the impasse. This article, Part II, focuses on the theoretical foundation of the intervention strategies, the phenomenology of the impasse, and the therapist's skills needed to facilitate it.

Asunto(s)

RESUMEN

This study explored the process of resolving an in-session impasse between a parent and an adolescent in family therapy. Focusing on altering the content and affective tone of a discussion, the "shift intervention" was used to direct a family's conversation away from trying to solve behavior management problems and toward a discussion of fundamental relationship problems. Task analysis was used to specify problematic family interactions, the intervention strategy, and successful and unsuccessful outcomes. Descriptive analyses of 5 successful and 5 unsuccessful interventions yielded a detailed performance model of therapist and family behaviors involved in breaking the impasse. The Beavers Timberlawn Family Evaluation Scale was used to verify the presence of the shift intervention in the data set and to embellish the performance model. The model suggested that adolescents became more cooperative and engaged in treatment when parents shifted from trying to control them to trying to understand them. A detailed performance map for accomplishing this shift is offered.

Asunto(s)

Asunto(s)

RESUMEN

To assess the potential capability of using artery-specific factors to predict the success of coronary bypass grafting, we classified each graft according to the type of graft (mammary, single vein, or multiple skip vein), the degree of obstruction in the native coronary artery, and the size of the grafted artery. The mean patency rates for each category of graft were determined by performing early postoperative (mean 6.6 months) arteriograms in 354 patients. We found that mammary arteries gave the best results for every graft category. Skip vein grafts had a higher mean patency rate than single vein grafts for arteries with obstructions between 70% and 90% and lumina less than 2.0 mm in diameter. The results for vein and skip grafts were equivalent for the category with arteries greater than 2.0 mm and obstruction greater than 90%. Vein grafts produced better results than skip grafts for the remaining categories. Patients were classified into subgroups according to the number of actually observed graft failures. The probabilities that specific numbers of grafts would fail were calculated for each patient. These probabilities were based upon the observed patency rates for the category appropriate for each graft and the hypothesis that individual grafts within a patient fail independently. We observed an excess number of patients with no failures or multiple failures than would be expected according to the hypothesis of independent failure and category-specific patency rates. Conversely, there were fewer patients than expected who had single failures. Therefore, we postulate that there may also be global factors which influence early graft patency.

Asunto(s)

RESUMEN

For a group of 658 patients who received coronary artery bypass graft surgery, we investigated the correlation between the degree of early (6 months) graft patency and recurrence of anginal symptoms, late myocardial infarction, and postoperative coronary-related death. The patients were grouped according to the number of surgically placed grafts, and each group was further subgrouped on the basis of the number of grafts functioning at the early postsurgical follow-up examination. The patients were observed over a period as long as 13 years. The frequency with which angina returned correlated significantly with the degree of patency within each of the groups (one, two, three, or four grafts); patients with a higher percentage of patent grafts experienced longer periods of freedom from angina. On the average, patients with all of their multiple grafts patent experienced at least 7 more years of symptomatic relief than their counterparts with all grafts occluded. Most surprisingly, the rate of the return of angina for those patients who had all grafts patent and were completely revascularized was independent of the number of diseased vessels or the number of grafts placed. The findings for coronary death and postoperative infarction showed similar trends.

Asunto(s)

RESUMEN

This paper addresses a conceptual and pragmatic gap in the area of family therapy training and supervision. It details an evolving stage-specific set of skills for the conduct of live supervision/consultation, using the previously developed conception of the isomorphic nature of training and therapy as a theoretical backdrop.

Asunto(s)

RESUMEN

Coronary revascularization has been reported to have failed to effectively rehabilitate working-age patients. This study of 565 patients demonstrates that motivation to return to work is strongly influences by age and educational level. Patients under age 55 are more likely to return to work than are patients over that age, but preoperative job classification does not influence rehabilitation. Although preoperative disability was associated with a slightly lower return-to-work rate (90%) than was the case with patients working preoperatively (97%) preoperative retirement was a strongly negative influence on rehabilitation. In this study, 80% of the patients worked to or beyond retirement age, and duration of work was not influenced by preoperative disability. The salary produced by those patients who were rehabilitated by surgery was four and a half times greater than the total cost of care and disability payments for the entire patient population. The factors which seemed to be the most important in effective rehabilitation were the psychological preparation of patients and their families and the attitude toward rehabilitation expressed by physicians and employers.

Asunto(s)

Asunto(s)

RESUMEN

In 405 men under the age of 65 requiring coronary bypass, in whom 6 month postoperative arteriograms were performed, we compared graft patency to postoperative work status and recurrent symptoms. We divided the population into subgroups of patients with varying degrees of patency. When these subgroups were tested, no significant dependence was found between the degree of graft patency and the percentages of patients who were working after operation, unless certain subgroups were removed from the population. When relief of angina was examined in the same manner as the postoperative work, we found a significant dependence between the graft patency and the percentage of patients who reported either short or long-term relief of angina in all groups. Because the rate of rehabilitation was high, even in patients with occluded grafts, and because older patients were less likely to return to work than younger patients despite successful revascularization, we conclude that physician emphasis on work rehabilitation and patient age, as well as graft patency, are all important factors which influence postoperative work status.

Asunto(s)