Rolland, J. (1994). Families, illness, and disability: An integrative treatment model. New York: Basic Books.
This book, though somewhat dated by contemporary standards, remains available in either new or used editions. Although it is not specifically focused on the aged, both Rolland’s multigenerational framework and the dynamics of chronic disease he illuminates are highly relevant to social work practice with the aged and their families. Rolland applies an ecosystem perspective to the family assessment process that is skillfully integrated with a readily interpretable typology of chronic disease. His book provides remarkably coherent syntheses of the literatures on the family and on the nature of chronic illness from medical anthropology, medical sociology, behavioral medicine, psychology, and social work, and then weaves it all into an incredibly pragmatic framework for clinical practice.As alternatives to acquiring Rolland’s book, the following two articles by Rolland precede the book and explicate Rolland’s conceptual framework of chronic disease and family processes:
Fisher, L., & Weihs, K. (2000). Can addressing family relationships improve outcomes in chronic disease. Journal of Family Practice, 49, 561-566.
This article is a highly informative review written by researchers affiliated with the National Working Group on Family-Based Interventions on Chronic Disease. The authors identify important mechanisms through which the family’s relational context affects disease management, then describe how particular characteristics of family relationships can function as risk or protective factors for disease management. In addition, major forms of family-based interventions are provided, linked to a review of the findings from selected clinical trials, which in turn are extended to applications for clinical practice. The authors first note two principal mechanisms through which the family context influences the course of chronic disease. The first mechanism is broadly described as the emotional climate, in essence the quality of attachments in the family and the degree of hostility and conflict present and their effect on the physiological disease and stress-response processes in the identified patient. The second mechanism is the family’s capacity to organize itself around the adaptive demands of the disease: e.g., accommodating numerous clinic appointments, dietary restriction, losses in functional capacity, and the difficult role changes for family members that might result. The review of the literature is divided into two segments. The first segment pertains to the identification of family characteristics that function as risk and protective factors in the management of chronic disease. The second segment examines the findings from selected clinical trials of family centered interventions in the context of chronic disease management, specifically psychoeducational approaches, relationship-focused interventions, and more intensive couples or family psychotherapy. Although most of the intervention studies reviewed involved the families of nonelderly patients, many of the findings appear to be relevant to diagnosis and intervention with families at all stages of the life course. Moreover, consistent with Rolland’s framework (1984, 1987, 1994, it appears that the typology of disease is as relevant as the stage of aging or the family life cycle under consideration.
Glasgow, R., Strycker, L., Toobert, D, & Eakin, E. (2000). A social–ecologic approach to assessing support for disease self-management: The chronic illness resources survey. Journal of Behavioral Medicine, 23, 559-583.
In research supported by the Robert Wood Johnson Foundation, Glasgow et al. described the structure, application, and psychometric properties of a social support survey based on a multilevel social-ecological model that was tested on a sample of adults with an array of chronic diseases (mean age, 63; range, 40 to 88 years). Because it interrogates eight distinct levels of psychosocial environmental support (physician and health care team, family and friends, personal actions, neighborhood, community, media and policy, community organizations, and workplace), the survey instrument offers a highly comprehensive approach to the person-environment psychosocial assessment essential to the management of chronic disease. The Chronic Illness Resources Survey (CIRS) has two versions: a 64-item full instrument and 29-item Brief CIRS. The authors described a prospective evaluation with the 123 patients having heart disease, arthritis, diabetes, and/or chronic obstructive pulmonary disease and revealed that the overall instrument and its subscales all met at least acceptable standards for internal consistency, test-retest reliability, and construct validity. Even more impressive, the authors assessed the predictive validity of the subscales in a 4-month prospective evaluation of chronic disease management and uncovered promising results suggesting various ways the scales might be directly applied to patients and families struggling with the management of chronic disease. The CIRS can be reasonably useful as a baseline diagnostic tool to determine whether, and in what areas, family level intervention is indicated, then be used later at different time points to assess whether intervention efforts are being effective in promoting positive change. Both the full and brief versions of the CIRS are provided in an appendix.
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