Objective-To examine the role of patient, family, and treatment variables on self-reported engagement for physicians and nurses working with pediatric complex care patients.Methods-Sixty-eight physicians and 85 registered nurses at a children's hospital reviewed eight case scenarios that varied by the patient and patient's family (each cooperative vs. difficult) and the length of hospitalization (<30 vs. >30 days). Participants rated their engagement from highly engaged/responsive to distancing/disconnected behaviors.Results-Nurses were more likely than physicians to engage in situations with a difficult patient/ cooperative family but less likely to engage in situations with a cooperative patient/difficult family. Nurses were more likely to consult a colleague regarding the care of a difficult patient/difficult family, while physicians were more likely to refer a difficult patient/difficult family to a psychosocial professional.Conclusions-Differences were found for engagement with "difficult" patients/families, with physicians more likely to distance themselves or refer to a psychosocial professional, while nurses were more likely to consult with a colleague.Practice Implications-Communication between health care team members is essential for optimal family centered health care. Thus, interventions are needed that focus on communication and support for health care teams working with pediatric complex care patients and their families.
The 2020 COVID-19 pandemic and resulting stay at home orders halted face-to-face in-home therapy for youth at risk of out-ofhome placement in Pennsylvania and Delaware. Three family therapy training centers collaborated with state officials managed care organizations, and supervisors to create a two-step process for orchestrating an abrupt, unwanted shift to technology-assisted intensive in-home family therapy. The first step encouraged supervisors to set the stage for this change through an ethics-based lens. The central tenet was to tenaciously advance the wellbeing of the child and their family. The second step encouraged supervisors to remain grounded in the basic principles of treatment and supervision that they followed before telehealth, but with a few adaptations. Three principles are emphasized. Principle one focused on securing clinician commitment to a adapting a family therapy model to a telehealth format. Principle two focused on an unremitting adherence to a preferred family therapy model by using a checklist adapted for technology-based challenges. Finally, principle three focused on fostering professional competence through attending to case conceptualization, supervision-based practice, person-of-the-self challenges, and family-cliniciansupervisor isomorphic patterns. Two case examples illustrate the beginning and ending phases of technology-assisted intensive in-home family therapy. Based on feedback from in-home agencies, implementation of these two-steps helped supervisors effectively lead pandemic-induced, practice-based change to a telehealth format with intentionality, conviction, and selfefficacy. KEYWORDS Pandemic-induced; practicebased change; technologyassisted intensive in-home family therapy; family systems approach; clinical supervision Hardship, tragedy, and trauma are ruthlessly rearing their ugly heads through a new conduit, COVID-19, and relying on an ancient forum, worldwide pandemic, to afflict, once again, their menacing presence in the lives of children and their families. This disease's ultimate impact on child development, family life, and our social world is yet to be determined. Mental health professionals using intensive in-home family therapy to thwart out-of-home placement of children at risk from neglect and abuse very recently experienced CONTACT
This paper uses a case study to illustrate a framework for identifying and then resolving therapeutic impasses in medical settings. A pediatric case study involving a 12-year-old girl with Acute Lymphoblastic Leukemia who is unable to swallow the required oral medications is used to illustrate the framework. Impasses can be identified through a two-part ABC cycle: Affect which is negative; Behavior that binds the patient and therapist; and Consequences such as isolation, distance, and fragmentation in relationships. The solution to the impasse lies in the second half of the ABC cycle: Accessing relationships, B_alancing the intervention between resolving the identified symptom and building relationships, and focusing on the Competencies of all involved parties.
A pilot evaluation study of the implementation of the Rapid Response Program, a program utilizing the ecosystemic structural family therapy model, in a rural area of Pennsylvania was conducted. This approach was implemented in children's mental health to supplant a costly model of care that had not proven to break the cycle of dependency for children with severe behavioral problems and their families. Initial results show that the Rapid Response Program appears to improve problematic family patterns and children's behavioral problems. The study results are limited by small sample size; however, the outcomes suggest that the program warrants further study using a more rigorous research design with a larger sample.
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