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Our field has several pioneers and innovators in family-centered work, whether in clinical practice, education, training, research, or policy specialties. This edition of the Families and Health SIG newsletter wanted to highlight the voices of several well-known individuals in the field and share their words of wisdom to future students and professionals going into work in healthcare and medical settings. Professionals offered their advice below on not only why family-centered work is so critical, but how this lens has shaped the perspectives of their careers.
Janice Bell, RN, Ph.D.
“Global pandemic—those words have taken on new meaning. Family health and healing have taken on new relevance in these extraordinary times. Who is behind the mask? We need to increase our relational care by remembering to introduce ourselves as we practice empathic listening and acknowledge illness suffering.”
Kathryn Fraser, Ph.D.
“Our nation is at an inflection point where it has never been more important to understand the racial/cultural history of the families we treat. Within our social structure in the U.S., privilege and power affords opportunity while discrimination and disenfranchisement detract from success. Family systems theory strives to look at patients in the context of the various systems they inhabit. Only when we understand the intersection between social inequity and health inequity can we maximize our use of family systems theory to improve our patients’ health. We must understand a family’s pathology but also its strength and resiliency, ultimately leveraging the power of families to instill hope and lasting change in its members health status.”
Bill Gunn, Ph.D.
“Here is some advice that I’ve given residents and learners over the years. Know the basic context of your patients: What do they do during the day? Who do they think of as “family”? Who do they live with? What has been their prior experience with health care professionals? Listen carefully to what is not said or said nonverbally. What is it they really want! Involve the “uninvited guest” to a visit in finding out who they are and what they think. Family members can help or hurt following a treatment plan. Finally, patients and families are part of the team. Avoid the need to “fix” and be curious and non-anxious about what they can do for themselves rather than only what we do for them. Chronic conditions with no cure happen a lot.”
Jennifer Hodgson, Ph.D.
“When I started out in this field, family-centered care was something we were fighting to be recognized as equal in importance to many longer standing individually oriented approaches. Since then, empirical support has served to reinforce that family centered care is not only critical to improving health outcomes but should widely be available to all patients. Those coming into the field now are doing amazing things toward (a) advocating for the importance of promoting examination of cultural humility of providers and the socio-cultural context around our patients, (b) moving the needle on how relational data is analyzed, (c) pushing forward policies that make relational sense, (d) designing family centered treatment methods that are adaptable to integrated healthcare workflows and, (e) advocating for reimbursable codes that honor this complex and critical work. For those practicing family centered care, the path less traveled is not easy but the journey is far more rewarding. Those just beginning on this path please continue to take these risks and bold steps toward a system of care that honors where health happens, within the families and communities that our patients live in, and not merely in the exam rooms where they are seen.”
Barry Jacobs, Psy.D.
“People who go into family-centered careers often have their own personal family stories. I grew up in a family in which my father had brain cancer when I was a teenager. The dramatic changes that my family went through at the time informs the work I do now every moment of every day. While we never want to superimpose our histories on our clients, we should always plumb our own experiences for the insights and inspiration to better help families struggling with illness and disability.”
Larry Mauksch, M.Ed.
“Since graduate school a top clinical strategy has been, ” expand my view of the system.” When I joined the UW Department of Family Medicine, the McGoldrick and Gerson book, Genograms and Family Assessment, first ed, was published (1986). My first visit with each patient (over 2000), couple or family over 30 years always included constructing a genogram. I shared the genogram with the patient/family — an intervention itself. Patients saw patterns, dynamics, trauma with me. Each genogram along with my interpretation was dictated into the medical chart for my family physician colleagues to see. In subsequent visits, viewing the genogram information ahead of time brought the patient and family to life and made me a more focused, engaged clinician.”
Susan McDaniel, Ph.D.
“Many problems in our healthcare system relate to ignoring the context–the social determinants– of the patient and their health. Involvement of the family (broadly defined as the most significant relationships of a patient) is a vehicle to understand culture, resources, and beliefs that often have a direct effect on health outcomes.. A focus on the family and community allows an interdisciplinary team to conduct a comprehensive assessment, yielding a treatment plan for a patient, with the support of those most important to the patient. The family therapist, as part of this team, can help to ensure that the patient and family are active members of the healthcare team, ensuring their preferences and realities drive a shared decision-making process. In other words, when appropriate we serve as a bridge between the patient and family, and the rest of the healthcare team and community, ensuring that the needs of the patient (rather than only those of the healthcare system or any of its clinicians) are at the center of the plan. Family therapists are often the missing link in implementing a truly biopsychosocial approach to health and illness. The same processes involved in understanding family process and resilience are applicable to teams and the processes that make them optimally effective, allowing for adaptive reserve.”
Tai Mendenhall, Ph.D.
“Family-centered work serves to connect-the-dots across the biopsychosocial/spiritual worlds that we all (patients and providers, alike) inhabit — from the beginning of our lives to the end. The health behaviors, viewpoints, attitudes, perspectives, belief systems, and ways-of-being in the world that get us into trouble were often first learned within our families-of-origin, and/or are maintained within our own families now. The ones that get us out of trouble (that help us to adapt, to cope, to heal, and to grow), too, evolve and/or are maintained in-connection and in-communion with others. No individual person — no matter how individuated, differentiated, independent, or even socially-disconnected — lives in a vacuum. We are complex creatures. Good care — family centered care — embraces this complexity.”
Keeley Pratt, Ph.D.
“Our association and many of the disciplines represented within CFHA were built upon the core value and centrality of families to our clinical work and scholarship. It is more important now than ever, for providers and scholars across disciplines to be pervasive and creative in our inclusion and assessment of families to ensure representation across diverse family structures, racial/ethnic and economic backgrounds, and nationality. I am encouraged that the next generation was trained during a time in which clear examples of both tragedy and resilience among families and communities were observed, and encourage the next generation to remember that dichotomy in their future family-based work in health care.”
Randall Reitz, Ph.D.
“I became committed to family-centered care when my little brother and my cousin were diagnosed with type 1 diabetes in the same year. With the support of loving parents and a stable homelife, my brother thrived with his health and diabetes management. Unfortunately, my cousin came from a home rocked by alcohol dependence and depression. It took her 20 years to achieve good blood sugar control and to learn to manage her own mental health struggles. I see these same patterns every day in my clinical work. I’m also encouraged each time a family-centered intervention brings stability, focus, and love to a family that is struggling. Family is the heart of family medicine. Family should be the heart of all health care.”
John Rolland, MD, MPH
“During my medical training, serious illness struck in my personal life with my first wife and my mother. I learned firsthand the enormous challenges and unmet needs of couples and families facing a major health condition. These experiences focused my career towards a public health-oriented family systems approach with this population. Chronic conditions inherently draw the patient’s family and community networks into a broader caregiving team. Also, with the rapid expansion of rehabilitation medicine, palliative care (including hospice), and geriatric healthcare, specialty care offers huge opportunities for family-oriented integrated care. The burgeoning field of genomic medicine is by definition family-based. The need for medical family therapists in these areas couldn’t be greater.”
David Seaburn, Ph.D.
“Why Collaborative Family Healthcare? “Collaborative” because we focus on the importance of mental health and healthcare professionals working directly together and whenever possible training side by side. “Family” because family has the greatest influence on the well-being of its members. And “Healthcare” for obvious reasons as the umbrella term for this holistic approach. The point is simple—this is the essence of integrative healthcare; and this is its future.”
Lisa Zak-Hunter, Ph.D.
“Families (however defined) are the epicenter, the core, of what first influenced and continues to sustain a patient’s understanding of themselves, their health, values, and the world around them. It is amazing, once you dig a little, to learn how deeply a patient’s family background and current social connections impact their functioning, well-being, and interactions with the healthcare system. The future of healthcare depends on practitioners who understand and can intervene at this level.”
View the rest of the December 2020 Families and Health Newsletter here.