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This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.

Purpose: The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors. Design and Methods: One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health project participated in this study. We assessed sociodemographics, burden, depression, anxiety, and perceived health for each caregiver. We measured family functioning by using a multidimensional and observational instrument. We used structural equation modeling to assess the fit of the model for the overall sample and for different caregiver subgroups and to examine whether demographic variables affected the relationships in the model. Results: The results of the study indicated that family functioning significantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. We also found that the stress-process model was adequately fit by the hypothesized relationships between objective burden, family functioning, and distress for the overall sample and all of the subsamples, except for wives. Implications: This study provides support for the structural family approach as an explanatory model for the influence of family functioning on dementia caregivers. Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress. (Contains 5 tables and 1 figure.)

Purpose: This study adapted the Structural Family Systems Ratings (SFSR), an observational measure of family interactions, for dementia caregivers. This article presents the development of the SFSR-Dementia Caregiver adaptation (SFSR-DC) and examines relationships between specific family-interaction patterns and caregiver distress. Design and Methods: The families of 177 Cuban American and White non-Hispanic American caregivers of dementia patients were assessed at baseline, 6, 12, and 18 months. Structural family theory and clinical experience were used to identify family interaction patterns believed to be related to caregiver emotional functioning. Factor analysis was used to refine subscales and develop a multiscale measure. Results: Six reliable subscales were related to caregiver distress and included in the SFSR-DC. There were two second-order factors. The SFSR-DC was provisionally cross-validated and showed invariance across the two ethnic groups. Implications: The SFSR-DC provides a method for examining specific and multiple interaction patterns in caregiver families and thus can advance knowledge regarding the role of the family in the stress processes of caregiving. These findings support the relevance of family interactions in caregiver distress and suggest that a treatment approach aimed at supporting family closeness and conflict resolution and reducing negativity might enhance caregiver well-being.

This study tests the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention, in improving psychosocial functioning when compared with an attention-comparison person-centered condition and a community control condition. A sample of 209 HIV-seropositive, urban, low-income, African American women was randomized into 1 of the 3 conditions. Results of growth curve analyses over 5 time points revealed that SET was more efficacious than either of the control conditions in reducing psychological distress and family-related hassles. However, contrary to hypotheses, SET was not more efficacious in increasing family support. Latent growth mixture modeling analyses indicated that SET was most efficacious for women who, on average, were at or near the clinical threshold for psychological distress and for women with high levels of family hassles. Implications for further intervention development are discussed.

Purpose: The majority of persons with Alzheimer's disease (AD) are cared for at home by a family member such as a spouse or daughter. Caregiving places enormous demands on these caregivers, and the negative consequences associated with caregiving are well documented. This paper reports results from the Miami site of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms (according to the Center for Epidemiological Studies Depression scale) among family caregivers of AD patients at 6 months and 18 months follow-up. Design and Methods: There were 225 White American and Cuban American caregivers that were randomized into a structural ecosystems therapy, structural ecosystems therapy + computer-telephone integrated system, or minimal support control condition. Results: Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months. The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husband and daughter caregivers. Implications: The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers. The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship.

Changes in within-session family interaction patterns were examined over the course of Brief Strategic Family Therapy with four Hispanic adolescents referred for behavior problems and drug or alcohol use. Adolescents' successful outcomes were related to improvements in family style of conflict resolution and other measures of family functioning. (Contains 27 references.) (Author/SV)

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1545-5300.2010.01337.x Byline: AHNALEE M. BRINCKS (*), DANIEL J. FEASTER (*), VICTORIA B. MITRANI ([dagger]) Keywords: Stress; Coping; HIV; Family; Multilevel Mediation Abstract: All abstracts are available in Spanish and Mandarin Chinese on Wiley Online Library (http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1545-5300). Please pass this information on to your international colleagues and students. Families are influential systems and may be an important context in which to consider the stress and coping process. To date, many studies have focused on modeling the stress and coping process for the individual, isolated from the family. The purpose of this secondary analysis was to investigate a cross-sectional stress and coping model for HIV-positive African-American mothers recruited from HIV service facilities in South Florida (n=214) and their family members (n=294). Avoidance coping was hypothesized to mediate the relationship between stress and psychological distress. In addition, the family average of individual stress was hypothesized to moderate the relationship between avoidance coping and psychological distress. For all constructs, individuals reported on themselves and multilevel modeling techniques were used to account for similarities between members of the same family. The estimated mediation effect was significant. Aggregated family stress significantly moderated the relationship between avoidance coping and psychological distress. This study suggests that individuals exhibit different relationships between avoidance coping and psychological outcomes and that average stress reported by members of a family moderates the relationship between avoidance coping and psychological distress. Abstract (French) RESUMEN Las familias son sistemas influyentes y pueden ser un contexto importante en el cual considerar el estres y el proceso de afrontamiento. Hasta la fecha, muchos estudios se han centrado en modelar el estres y el proceso de afrontamiento para el individuo, aislado de la familia. El proposito de este analisis secundario fue investigar un modelo transversal de estres y afrontamiento para madres afroamericanas con VIH positivo convocadas en centros de salud especializados en VIH de South Florida (n=214) y sus familiares (n=294). Se planteo la hipotesis de afrontamiento evasivo para mediar la relacion entre estres y angustia psicologica. Tambien se planteo la hipotesis del promedio familiar de estres individual para moderar la relacion entre afrontamiento evasivo y angustia psicologica. Para todos los constructos, las personas informaron sobre si mismas y se utilizaron tecnicas de modelo multinivel para explicar las similitudes entre miembros de la misma familia. El efecto estimado de mediacion fue importante. El estres familiar en conjunto modero considerablemente la relacion entre el afrontamiento evasivo y la angustia psicologica. Este estudio sugiere que las personas muestran relaciones diferentes entre el afrontamiento evasivo y los resultados psicologicos, y que el estres promedio informado por los miembros de la familia modera la relacion entre el afrontamiento evasivo y la angustia psicologica. Palabras clave: estres, afrontamiento, VIH, familia, mediacion multinivel Author Affiliation: (*)Leonard M. Miller School of Medicine, Epidemiology & Public Health, University of Miami, Miami, FL. ([dagger])Center of Excellence for Health Disparities Research, El Centro, School of Nursing and Health Studies, University of Miami, Miami, FL. Article note: Correspondence concerning this article should be addressed to Ahnalee M. Brincks, Leonard M. Miller School of Medicine, Epidemiology & Public Health, University of Miami, 1425 NW 10 Ave., Miami, FL 33136. E-mail: Abrincks@med.miami.edu

HIV/AIDS is recognized as affecting and being affected by the family. HIV+ women in drug recovery and their families are particularly at risk due to family disruption and stigma. Yet [...]

A study to establish whether ecological interventions contribute to the impact of family therapy above and beyond contributions of family process-only interventions is conducted. Comparison between structural ecosystem therapy with family process-only condition and community services control approaches suggest the importance of investigating changes in adolescent drug use as a result of treatment condition across more than 1 racial group.

Recruitment is one of the most significant challenges in conducting research with ethnic minority populations. Establishing relationships with organizations that serve ethnic minority communities can facilitate recruitment. To create a successful recruitment process, a strategic plan of action is necessary prior to implementing community outreach efforts. For this study population of women who were HIV+ and recovering from substance abuse disorder, the authors found that establishing trust with community organizations that serve these women allows for a productive referral relationship. Although the majority of women in this study are African American, the authors were particularly challenged in recruiting Hispanic women. This article presents a recruitment process model that has facilitated our recruitment efforts and has helped the authors to organize, document, and evaluate their community outreach strategies. This model can be adopted and adapted by nurses and other health researchers to enhance engagement of minority populations. Keywords: recruitment; minorities; community; engagement; outreach

This article presents specialized family therapy intervention strategies for Hispanic families with behavior-problem adolescents who have experienced an immigration-related separation. Such specialized interventions correspond to a philosophy of customized treatment delivery for Hispanic families. Interactional and cognitive/affective features are presented, and guidelines for building therapeutic alliances, identifying core family processes/themes, and transforming interactions are offered.

This study tests the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention, in improving psychosocial functioning when compared with an attention-comparison person-centered condition and a community control condition. A sample of 209 HIV-seropositive, urban, low-income, African American women was randomized into 1 of the 3 conditions. Results of growth curve analyses over 5 time points revealed that SET was more efficacious than either of the control conditions in reducing psychological distress and family-related hassles. However, contrary to hypotheses, SET was not more efficacious in increasing family support. Latent growth mixture modeling analyses indicated that SET was most efficacious for women who, on average, were at or near the clinical threshold for psychological distress and for women with high levels of family hassles. Implications for further intervention development are discussed.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1744-6155.2008.00134.x Byline: Maite P. Mena (1), Victoria B. Mitrani (2), Joan A. Muir (3), Daniel A. Santisteban (4) Keywords: Adolescent behavior; Hispanics; immigrants; immigration; mother-child relations; mother-child separations; substance abuse Author Affiliation: (1)Research Assistant Professor Center for Family Studies University of Miami Miller School of Medicine Miami, FL (2)Professor School of Nursing and Health Studies University of Miami Coral Gables, FL (3)Associate Training Director Brief Strategic Family Therapy Training Institute Center for Family Studies University of Miami Miller School of Medicine Miami, FL (4)Research Professor Center for Family Studies University of Miami Miller School of Medicine Miami, FL Article note: Author contact: mmena@med.miami.edu, with a copy to the Editor: roxie.foster @uchsc.edu

Accessible summary: What is known on the subject?: Mothers with mental health problems are at risk of well‐being and experience lack of support.There is little research focusing on the effect of household composition on health of Hispanic mothers with mental illness.As the family is a central feature in Hispanic lives and there is a high dependence on the family for help, it is crucial to understand how household composition and family functioning influences Hispanic mothers' health and well‐being. What does the paper adds to existing knowledge?: Living with at least one other adult in the household are related to better Hispanic mothers' physical and psychological health.Mothers living with a greater number of adult in the house are more likely to have fatigue and depression.More family hassles are associated with worse health outcomes in Hispanic mothers with mental health problems What are the implications for practice?: There is a need to assess family members who are supportive to Hispanic mothers and to address families' basic needs in the intervention.Interventions for Hispanic mothers with mental health problems should be grounded in supporting the strengths of the Hispanic familial networks.A family‐centred approach for mothers with mental health problems requires integrated assessments and interventions including the families as units. Introduction: Household composition is seen as a critical factor for recovery of Hispanic mothers with mental illness, but little research has examined the relationship of household composition and health. Aim: This study examined how household composition and family functioning impact on both physical and psychological health of Hispanic mothers receiving outpatient mental health services. Method: The study analysed baseline data of 137 Hispanic mothers participating in a randomized trial of "Healthy Home," a family‐strengthening home health intervention. A bilingual (English/Spanish) research assessor interviewed participants regarding household composition, family hassles, family cohesion and mother's physical and psychological health. Results: Mothers living with at least one other adult and having fewer family hassles had better health outcomes. Mothers living with a greater number of adult in the house were more likely to have fatigue and depression. Discussion: Hispanic mothers having no adults to help them in the house are less able to maintain their physical and psychological health. A family‐centred approach for mothers requires integrated assessments and interventions including the families as units. Implication for practice: Interventions for Hispanic mothers with mental health problems should be grounded in supporting the values and strengths of the Hispanic familial networks. [ABSTRACT FROM AUTHOR]

Barriers in advanced practice nurses' work environment impede effective use in acute care settings, reduce job satisfaction, and increase intent to leave. Fostering psychological ownership for work through improved work design has increased satisfaction, motivation, and productivity, and lowered turnover in other fields, and may have similar effects for advanced practice nurses. This multilevel cross-sectional survey study examined the relationship between advanced practice nurse work environment and psychological ownership using data from a survey of advanced practice nurses and nurse executives in Florida hospitals. Barriers in scope of practice and exclusion from hospital governance were common. Advanced practice nurses reported good relations with physicians and moderate organizational climate but poor relations with administrators and limited control over work. Organizational climate had a strong positive relationship with psychological ownership. Fostering advanced practice nurse psychological ownership could improve job satisfaction and decrease turnover leading to increased effectiveness in acute care settings. [ABSTRACT FROM AUTHOR]