What's Working in Family-Based Services--or, What's Left to Believe in During a Time of Such Doubt?

This article is a qualitative, personal report from the field, designed to highlight current developments in family-based theory and practice that bring hopefulness to workers and clients. The author, an experienced human services consultant and family therapist, draws from his recent experience in a number of states to identify exemplars of practice in the following areas: integrative theory building, functional family assessment, systems change in regard to inter-agency coordination and foster care, community building in low income neighborhoods, developing humility as helpers, and addressing issues of hope and spirituality with clients and with co-workers. Given the turbulent and hostile political environment for family-based services, this article challenges us to remember that effectiveness in helping others is directly related to our feelings of hopefulness about ourselves and our world.

Why is asthma mortality higher in Puerto Ricans?

Asthma is a significant public health issue and the most common chronic disease in children. The disease burden of asthma is rising around the world and especially in certain populations. In the United States Puerto Rican Americans have the highest rates of mortality due to asthma, while Mexico Americans have the lowest asthma mortality in the U.S. The reasons for this have been the cause of much speculation in the past; however, no clear cause for these differences has been recognized. The present work reviews the literature bearing on this question to show that there are good reasons to believe that individuals with unusually responsive innate immune responses may be predisposed to the development of asthma. Also reviewed is the molecular basis for this connection. The evidence shows that the history and anthropology of the Puerto Rican people is quite different from that of any other surviving North American or Caribbean population, as it was a relatively isolated island population for 400 years with an environment that tended to eliminate individuals with weak innate immune systems. The Puerto Rican population successfully survived the Columbian exchange of microbes but may be poorly adapted to the modern pro-inflammatory diet coupled with exposure to cigarette smoke as well as cockroach and house dust mite feces.^

The care to share HIV disclosure study - the attitudes toward and beliefs about HIV disclosure among perinatally-infected HIV-positive youth and their caregivers

HIV incidence has not changed since the introduction of the pandemic. Daily 14,000 persons are infected with HIV and 25 to 50% of the HIV-infected population and subgroups respectively are estimated to be unaware of their HIV diagnosis. Perinatally-infected HIV-positive youth, aged 13-24 years, have survived unexpectedly into adulthood, have had unique HIV disclosure experiences and now face HIV disclosure issues of adulthood and perhaps parenthood. Despite new effective HIV therapies, no HIV prevention plan exists that has diminished the rate of new HIV infections. HIV stigma and lack of universal HIV reporting laws dissuade timely HIV disclosure. Missed HIV disclosure perpetuates HIV transmission and infection. Understanding the attitudes and beliefs of HIV disclosure among perinatally-infected HIV-positive youth and their caregivers may uncover reasons to HIV disclosure delays, avoidance and intentions. The Care to Share HIV Disclosure study was designed to identify the attitudes and beliefs of HIV disclosure among HIV-positve youth (aged 13-24 years), who were infected from birth and who knew their HIV diagnosis, along with their caregivers. Twenty-six participants (15 youth and 11 caregivers) completed the theory-based questionnaires of a 21-item multiple choice survey on HIV disclosure framed in the Theory of Reasoned Action and Theory of Planned Behavior and included an additional open-ended survey that applied the Transactional Model of Stress and Coping to address youth's and caregivers' HIV disclosure experiences. Youth were found to have a selective unfavorable HIV disclosure outcome when among referents of close friends. However youth did believe in HIV partner notification. For caregivers, it mattered who disclosed the HIV illness to the youth. HIV stigma was of concern based on the youths' tendency to believe in keeping HIV a secret and their caregivers' ambivalence to HIV secrecy. However, favorable HIV disclosure outcomes were identified for both youth and caregivers the potential for HIV disclosure: when seeking HIV knowledge, when around caregivers and close family and in situations of perceived controllability as when helping others learn about HIV. These findings unveil HIV disclosure attitudes and beliefs within this population and may reveal the attributes that may inhibit or promote HIV disclosure behaviors. HIV disclosure studies that address attitudes and beliefs among larger populations of youth and HIV-infected persons are necessary to identify effective individual, group and society approaches that would promote timely, responsible and meaningful HIV disclosure methods that promote a healthy identity and interrupt HIV transmission.^

RELATIONSHIP OF ANTISOCIAL PERSONALITY SYNDROME IN BOYS TO PARENTAL ALCOHOL/DRUG DEPENDENCY

The study focused on the relationship between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency. The population studied was case records of 101 boys coming to a private psychiatrist from 1966 through 1979. The boys were predominantly white and from middle to upper income families.^ A boy was determined to have antisocial personality syndrome if he exhibited antisocial behaviors in four or five major categories, did not exhibit a brain syndrome, and did not exhibit a thought disorder. The five major behavior categories were: (1) self-control (i.e., temper tantrums or hyperactivity), (2) behavior at home (i.e., disobedience or lying), (3) behavior at school (i.e., truancy or cheating), (4) behavior toward peers (i.e., bullying, fighting, or tattling), and (5) behavior against property (i.e., destructiveness or stealing). A boy was determined to be a control if he exhibited antisocial behaviors in two or less behavior categories.^ A parent was determined to have alcohol/drug dependency if s/he exhibited a score above the established threshold (1) for the MacAndrew Alcoholism Scale (28 or above), and (2) for the Holmes Alcoholism Scale (35 or above) which are used with the MMPI. A parent was classified not alcohol/drug dependent if s/he had scores below set thresholds (22 on the MacAndrew Alcoholism Scale and 28 on the Holmes Alcoholism Scale).^ For the final sample (N = 10), there was no reason to believe a relationship exists between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency (Fisher's Exact Test {FET} P = 1.0). The small sample size primarily occurred as a result of 88.12% of the parents being classified in a questionable category in terms of alcohol/drug dependency.^ The sample was suggestive of a relationship between the fathers' Psychopathic Deviate (Pd) Scale scores as a measure of antisocial tendencies and the boy having antisocial personality syndrome (N = 75; P = .12). There was no evidence of such a relationship for mothers (N = 75; P = .97). ^

Family Preservation Journal, 1997, Volume 2, Issue 1. (Entire issue)

Entire issue (large pdf file) Articles include: What's Working in Family-Based Services?--or, What's Left to Believe in During a Time of Such Doubt? Roger Friedman The Family Preservation Philosophy and Therapy With Lesbian Clients. Pamela de Santa Parenting Pioneers and Parenting Teams: Strengthening Extended Family Ties in Family Support Programs. Susan Whitelaw Downs Conceptual Bases of the Planning Process in Family Preservation/Family Support State Plans. June Lloyd

Chipping Away at the Monolith: Dispelling the Myth of Father Noninvolvement in Children's Early Literacy Development

Current research stresses the importance of parent involvement in their children 's academic development. Parents reading and writing with their young children is shown to prepare them for the benefits of for ma I education. Studies completed on parent participation in early literacy activities have tended to look at mothers ' role. Few researchers have investigated the contributions fathers have made. The results of a study completed on father-child early literacy practices are presented. Fathers reported engaging in reading and writing activities with their children for three reasons: To prepare their children for school, to bond with their children, and to assist their children in language skill development. Recommendations are provided on how to encourage fathers to participate in early literacy practices

Knowledge, beliefs, risk behaviors, and social skills for HIV/STD prevention in junior college students (grades 11--12) in Bombay, India

1230 year 11 and 12 college students, modal age 16 and 17, in three colleges in Bombay, India, were studied on sexual behaviors or risk of sexual behaviors, beliefs about sex, HIV/STD knowledge, perceived norms regarding sexual behaviors, and the relationships between social skills/anxieties in HIV/STD prevention and actual and anticipated sexual behaviors. A quantitative questionnaire examining HIV/STD risk behaviors, knowledge, attitudes and beliefs, and the AIDS Social Assertiveness Scale (ASAS) were administered to these 1230 college students. Data indicated that 8% of males and 1% of females had had sexual experience, but over one third were not sure at all of being able to abstain from sexual activity with either steady or casual partners. Perceived norms were slanted toward sexual abstinence for the majority of the sample. Knowledge of protective effects of condoms was high, although half of those who had had sex did not use condoms. Logistic regression showed knowledge was higher among males, those who believed it was OK to have sex with a steady partner and that they should not wait until they were older, those who believed that condoms should be used even if the partner is known, and those who believed it was acceptable to have multiple partners. Gender differences in sexual activity and beliefs about sexual activity showed males were less likely to believe in abstaining from sexual activity. The 5 scales of the ASAS were scored and compared on ANOVA on: those who had had sexual experience (HS), those who anticipated being unable to refuse sex (AS), and those who did not anticipate problems in refusing sex (DS). Those in the AS group had greater anxieties about refusing sexual or other risk behaviors than HS and DS groups. There were greater anxieties about dealing with condoms in the AS and DS groups compared with the HS group. Confiding sexual or HIV/STD-related problems to significant others was more anxiety-provoking for the AS group compared with the HS group, and the AS group were more anxious about interactions with people with HIV. Factor analysis produced the same 5 factors as those found in previous studies. Of these, condom interactions and confiding in significant others were most anxiety provoking, and condom interactions most variable based on demographic and attitudinal factors.^ This age group is appropriate for HIV/STD reduction education given the low rate of sexual activity but despite knowledge of the importance of condom use, social skills to apply this knowledge are lacking. Social skills training in sexual negotiations, condom negotiations, and confiding HIV/STD-related concerns to significant others should reduce the risks of Indian college students having unwanted or unprotected sex. ^

Assessing perceptions of environmental risk and environmental justice and their impacts on neighborhood attachment in a predominately Hispanic community

This study examines and relates concepts from environmental risk perception and environmental justice and focuses on the perception of environmental problems, their consequent health risks and their impact on neighborhood attachment in a predominately Hispanic community along the U.S.-Mexico border. The findings indicate that the perception of environmental problems in the immediate area varies by problem and demographic subgroup. Ethnicity and income have the highest number of statistically significant associations across ten environmental problems. This result lies in the fact that Hispanics in El Paso County and those with low annual incomes live in neighborhoods that are faced with more severe environmental problems. Thus the findings lend support to the environmental justice claim that the poor and minorities bear the brunt of environmental degradation. ^ The findings also provide evidence that public perception of health risks from an environmental problem is influenced by the perceived severity of an environmental problem in the immediate area. Those who believe the problem is serious on a local level are the ones who are most likely to believe that they could become ill or injured from that problem and that the illness/injury will be serious. ^ The findings of this study also indicate that the young, Hispanics, those who perceive considerable environmental problems in their neighborhood, those who believe that their neighborhood has more environmental problems than others, and those who are angry about those problems are most likely to want to move from their neighborhood. ^ Efforts need to be made to enact policies and programs designed to reduce the environmental hazards in disadvantaged Hispanic communities along the U.S.-Mexico border. Future environmental education campaigns need to complement community-based projects with the media. Programs that involve and empower the community, particularly the youth, in improving the neighborhood could provide a sense of control and pride within their community in solving these problems. These neighborhood improvement efforts could also lead to the development and strengthening of social ties within the community, as well as enhanced community cohesiveness in tackling these problems. ^

A simulation study using the hybrid statistic and the meta-analysis t-test for data with matched and unmatched subjects in the interim analysis of clinical trials

An interim analysis is usually applied in later phase II or phase III trials to find convincing evidence of a significant treatment difference that may lead to trial termination at an earlier point than planned at the beginning. This can result in the saving of patient resources and shortening of drug development and approval time. In addition, ethics and economics are also the reasons to stop a trial earlier. In clinical trials of eyes, ears, knees, arms, kidneys, lungs, and other clustered treatments, data may include distribution-free random variables with matched and unmatched subjects in one study. It is important to properly include both subjects in the interim and the final analyses so that the maximum efficiency of statistical and clinical inferences can be obtained at different stages of the trials. So far, no publication has applied a statistical method for distribution-free data with matched and unmatched subjects in the interim analysis of clinical trials. In this simulation study, the hybrid statistic was used to estimate the empirical powers and the empirical type I errors among the simulated datasets with different sample sizes, different effect sizes, different correlation coefficients for matched pairs, and different data distributions, respectively, in the interim and final analysis with 4 different group sequential methods. Empirical powers and empirical type I errors were also compared to those estimated by using the meta-analysis t-test among the same simulated datasets. Results from this simulation study show that, compared to the meta-analysis t-test commonly used for data with normally distributed observations, the hybrid statistic has a greater power for data observed from normally, log-normally, and multinomially distributed random variables with matched and unmatched subjects and with outliers. Powers rose with the increase in sample size, effect size, and correlation coefficient for the matched pairs. In addition, lower type I errors were observed estimated by using the hybrid statistic, which indicates that this test is also conservative for data with outliers in the interim analysis of clinical trials.^