Effects of family group conferences among high-risk patients of chronic disability and their significant others: study protocol for a multicentre controlled trial

The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning

OBJECTIVE

To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation.

DESIGN

Observational-cross-sectional study.

SETTING

Inpatient stroke rehabilitation.

SUBJECTS

Eighty-seven carers, participating in 48 conferences, were evaluated.

INTERVENTIONS

The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality.

MAIN MEASURES

Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale.

RESULTS

Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework.

CONCLUSIONS

The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.

Practices of Collaborative Decision-Making in Social Work with Families: Methodological Issues in Constructing and Researching Their Results

<p>The article deals with methodological issues in effectiveness research of practices of collaborative decision-making in social work, focused on a family group and its informal social network, exemplified by Family Group Conferences and Network Therapy. The article provides a conceptual review of approaches to constructing the expected results of FGC/NT from the viewpoints of various stakeholders &mdash; professionals, adult family members, and children. It analyses the sensitivity to these results in research projects with various research design types, including randomized controlled trials and their suggested alternatives such as discrete time survival analysis, cohort studies, and case-study. It discusses the factors and mechanisms that influence effectiveness of FGC/NT and should be considered in a &ldquo;theory of change&rdquo; for these practices.</p>

Self-Efficacy Predicts Personal and Family Adjustment Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others: A Dyadic Approach

OBJECTIVES

To investigate whether the combination of self-efficacy levels of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others, measured shortly after the start of inpatient rehabilitation, predict their personal and family adjustment 6 months after inpatient discharge.

DESIGN

Prospective longitudinal study.

SETTING

Twelve Dutch rehabilitation centers.

PARTICIPANTS

Volunteer sample consisting of dyads (N=157) of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-efficacy (General Competence Scale) and personal and family adjustment (Hospital Anxiety and Depression Scale and McMaster Family Assessment Device General Functioning).

RESULTS

In 20 dyads, both individuals with SCI or ABI and their significant others showed low self-efficacy at baseline. In 67 dyads, both showed high self-efficacy. In the low-self-efficacy dyads, 61% of the individuals with SCI or ABI and 50% of the significant others showed symptoms of anxiety 6 months after discharge, vs 23% and 30%, respectively, in the high-self-efficacy dyads. In the low-self-efficacy dyads, 56% of individuals with SCI or ABI and 50% of the significant others reported symptoms of depression, vs 20% and 27%, respectively, in the high-self-efficacy dyads. Problematic family functioning was reported by 53% of the individuals with SCI or ABI and 42% of the significant others in the low-self-efficacy dyads, vs 4% and 12%, respectively, in the high-self-efficacy dyads. Multivariate analysis of variance analyses showed that the combination of levels of self-efficacy of individuals with SCI or ABI and their significant others at the start of inpatient rehabilitation predict personal (V=0.12; F_6,302=2.8; P=.010) and family adjustment (V=0.19; F_6,252=4.3; P<.001) 6 months after discharge.

CONCLUSIONS

Low-self-efficacy dyads appear to be more at risk for personal and family adjustment problems after discharge. Screening for self-efficacy may help healthcare professionals to identify and support families at risk for long-term adjustment problems.

Appraisals and coping mediate the relationship between resilience and distress among significant others of persons with spinal cord injury or acquired brain injury: a cross-sectional study

Background

Many significant others of persons with serious conditions like spinal cord injury (SCI) and acquired brain injury (ABI) report high levels of psychological distress. In line with the stress-coping model, the aim of the present study was to investigate the relationship between personal resource resilience and psychological distress, and whether appraisals of threat and loss, and passive coping mediate this relationship.

Methods

Significant others (n = 228) of persons with SCI or ABI completed questionnaires shortly after admission to first inpatient rehabilitation after onset of the condition. The questionnaire included measures to assess psychological distress (Hospital Anxiety and Depression Scale), resilience (Connor-Davidson Resilience Scale-10), appraisals (Appraisals of Life Events scale, threat and loss) and passive coping (Utrecht Coping List). The PROCESS tool was used to test the presence of mediation. Confounding and differences between SCI and ABI were investigated.

Results

High levels of psychological distress among significant others were found (34–41%). Fifty-five percent of the variance in psychological distress was explained by the relationship between resilience and psychological distress. This relationship was mediated by appraisals of threat and loss, and passive coping. The relationship between resilience and psychological distress was similar in the SCI and ABI groups.

Conclusions

The results of our study indicate that appraisals of threat and loss and passive coping are mediating factors in the relationship between resilience and psychological distress. It seems useful to investigate if interventions focussing on psychological factors like resilience, appraisal and coping are effective to prevent or reduce psychological distress among significant others of persons with SCI or ABI.

Trial registration

Dutch trial register NTR5742. Registered January 9, 2016.

Thought Space Wānanga—A Kaupapa Māori Decolonizing Approach to Research Translation

This paper discusses an indigenous Māori approach, named Thought Space Wānanga, for sharing knowledge and accelerating the translation of research into practical outcomes through transformational practices, policies, and theory development. In contexts such as New Zealand, there is an increasing demand on all publicly funded researchers to demonstrate the impact of their research and to show pathways for achieving social and economic outcomes from single, focused projects. Knowledge translation is the most common term used to describe the link between research and impact and the process of turning research into results. While it is highly debatable whether planning for this at the front end of research will necessarily lead to such high-level outcomes being achieved, many indigenous researchers aim for their research to be translated into real world positive outcomes for indigenous communities. Thought Space Wānanga is a facilitated process framed within Māori cultural protocols, designed to help indigenous Māori researchers meet that aspiration.

Family group decision-making interventions in adult healthcare and welfare: a systematic literature review of its key elements and effectiveness

BACKGROUND

Family group decision-making (FGDM) is a structured decision-making process, aiming to shift the balance of power from professional towards the person in need and their family. It differentiates from other family-centred meetings by the presence of three key elements: (1) plan with actions/goals, (2) family driven, (3) three phases of meetings gradually increasing empowerment. FGDM studies are increasing in different settings in adult healthcare/welfare, although effectiveness is unknown at this date.

OBJECTIVES

(1) to systematically review the presence of the three FGDM key elements in family-centred interventions in adult care and welfare, (2) to evaluate the effectiveness of FGDM interventions.

DESIGN

Systematic review.

DATA SOURCES AND ELIGIBILITY CRITERIA

A total of 14 relevant electronic databases and 1 academic search machine were searched until February 2018. First, family-centred studies were selected with controlled trial designs in adult healthcare/welfare. Second, interventions were categorised as FGDM if all three key elements were present.

DATA EXTRACTION AND SYNTHESIS

Studies were examined concerning their (1) characteristics (2) quality/level of evidence (3) presence of FGDM key elements and (4) results.

RESULTS

Six articles from three studies on family-centred interventions were selected from a total of 1680 articles. All were of low quality. One study (two articles) met all criteria for an FGDM intervention, describing the efficacy of family group conferences among social welfare recipients on mental health outcomes. Although the intervention group showed significantly better outcomes after 16-23 weeks; no differences were seen at the 1-year follow-up.

CONCLUSIONS

Controlled studies of both family-centred interventions and FGDM are still low in quantity and quality. No conclusions on FGDM effectiveness can be drawn. Further high-quality intervention studies are required to evaluate the impact of FGDM on adults in need, including their families; as well as evaluation research detecting possible barriers and facilitators influencing FGDM implementation.

PROSPERO REGISTRATION NUMBER

CRD42017077585.

Evaluating Family Group Conferencing: Towards a meaningful research methodology

There is discussion on the most appropriate research methodology to examine the efficacy of Family Group Conferencing (FGC). Randomised controlled trials (RCTs), despite their pitfalls, are considered by many to be the 'golden standard', but the argument is not compelling. In this paper, the theory on programme evaluation is discussed which offers an alternative methodology to study FGC. It is argued that reaching a comprehensive image of truth in the social sciences is never within reach. A RCT is an abstraction of reality, it only provides a partial image of the complex reality of families and the impact that FGC has on safety issues and the quality of their lives. Moreover, the rigour of a study depends heavily on the researcher's interpretative skills. In studying the efficacy of a complex intervention, such as FGC, it is a challenge to provide a valid and reliable picture of its impact. The context of such a conference, where the lifeworld of families constantly interacts with the system world of professionals, is characterised by multiplicity, polyvalence and interference. The methodology used to examine the efficacy of FGC should meet this 'interplexitiy'.