A. Understand the evolving nature of the concept of family, and its organizational diversity

• historical and modern views of family
• diverse contexts (culture, religion, socio-economic, etc.)
• varied organizational structures

Class construct examples of the family patterns according to Olson: chaotic, flexible, structured, and rigid; disengaged, separated, connected, emeshed. List complaints or other descriptive evidence a teenager might give to indicate his family’s pattern of functioning. Class members determine from own experience or practice how adolescent development appears to be impacted by the differing types of functioning.

Optional activity: Analyse family functioning shown in a film.

Case study
A late maturing 17 year-old boy, Tanner stage G3P3, comes to consultation for depression. From a very early age he showed socialization difficulties. He had always been infantilised by his father with whom he feels weakly linked. He has a strong bond with his mother. During the first 5 years of life, he spent much time with his mother’s elderly parents. His father’s parents died when the father was young. Discuss: What is the probable family functioning pattern? How might this adolescent give clues about his family functioning? What questions could the professional ask to gain evidence about the pattern and its influence on the boy?

Refs 3, 4

Film suggestion:
Robert Redford’s
“Ordinary People”

Lecture review the four styles: authoritative,authoritarian, permissive, and unconcerned, explaining the corresponding parental quality of emotional involvement and method of setting limits.
Class discussion: Specify which styles of parenting will likely promote well-being of adolescents, or provoke problem behavior. Consider the developmental tasks of adolescence.

Case study:
Describe how an authoritative family would handle the situation of a 13 year-old girl, a 15 year-old boy, and a 17 year-old girl staying overnight with friends unsupervised in a countryside cabin.
Describe the reactions of a permissive family towards the same situation.

Refs 5, 6

Appendix 1

Class considers problems such as chronic illness (including mental disease and mental retardation), or drug misuse starting during adolescence. List effects on well functioning families and on dysfunctional families.

Case study:
In a happy and busy highly professional family with four children, the second child gets acute leukaemia at age 14. Discuss how the providers can help the family to cope with this situation for the best of everyone involved.

Prepare a speech on what is known about the effects of parenting styles on the well-being of adolescents, to be given to parents of 12 to 14 year-old students at a school.

Case study
A 14 year-old girl with asthma is having many crises because she is unable to cope with her daily preventive therapy. Her parents do not want to allow her to camp with her scout group, as they are not sure she will be able to comply with the medication routine without their help. They also complain that their daughter recently began rejecting family rules.

Role play and discuss:
What are the different perspectives of the adolescent and of the parents?
How do you renegotiate roles and rules within this family?  What and how do you explain your understanding of the situation to those involved using the parenting styles according to Steinberg?

Refs 12, 13

Appendix 1

A. Understand the provider’s role regarding problematic family dynamics

• Provider as communications facilitator
• Appropriate use of the professional competencies of different care team members.
• Criteria for referral

Small groups debate the limits of the role of the health practitioner as a ‘communication facilitator’ for the different elements of the family system, as well as for the different professionals working on the case. Which communication skills are especially needed? Discuss how to use different professional team members in a family intervention. Identify potential sources of problems and suggest solutions.

At what point should a provider seek other help with a case?

Participants role play  (or trainer provides) an example of effective facilitation.

Refs
7, 8, 9, 10,11

Module A3

B. Demonstrate facility in family assessment, including obtaining relevant information and evaluating the impact of family functioning on the adolescent’s development

• Olson’s circumplex model

Case study
A 13 year-old girl complains of headaches. Her parents divorced two months ago. She is living half of the week with her mother and the other half with her father. She mentions she feels like she is living in ‘no man’s land’. A fight for the ‘possession’ of the girl is taking place.

Question:
How has family dysfunction probably affected the health of this girl? Analyze the situation; refer to Olson’s circumplex model:

1. Cohesion (disengaged, separated, connected, enmeshed). Evaluate emotional bonding, family involvement, parent-adolescent relationship, and internal and external boundaries.
2. Change (chaotic, flexible, structured, rigid). Evaluate leadership, discipline, negotiation, roles and rules.
3. Communication =listener’s skills, speaker’s skills, self-disclosure, clarity, continuity, respect and regard.

Ref 4

Website 1

Case study
A 16 year-old adolescent boy with phenilketonuria (PKU) lives in a family characterised by lack of leadership, erratic discipline, recent dramatic role shifts, too much change in the recent years (parental divorce, boy living first with his mother, then with his father against his wishes); father had never been able to understand what having PKU meant. His phenilalanine blood levels are becoming excessively high; father and boy have not been able to communicate with each other for several weeks. At the consultation, the father complains of not being respected and the boy complains of not being understood by his father.

What would you like to change in the family dynamics of the case study?

Skills to be practiced: Questioning in a non-judgmental way, balancing empathy and distance between the individual adolescent and the parents, facilitating communication among the different members of the family, supporting and balancing everyone’s issues and concerns

Ref 14

Appendix 2