FAMILY SYSTEMS IN HEALTHCARE

Don Bloch and John Rolland

The recognition of the importance of family for healthcare issues has a long history. The public health movement and public health nursing, for example, recognized early on that the physical and emotional context of the family, and its economic status in particular, were critical physical health variables. Medical social work, as an established discipline, had much the same orientation and a technology for intervening - usually from a hospital base. There has been a substantial history of interdisciplinary collaboration among the breadth of health and mental health professionals who work in the healthcare sector. A few of the more significant efforts, closer to the orientation of family therapy, that existed before the founding of the journal Family Systems Medicine in 1983 should be mentioned:

The Peckham experiment in England (1926) explored a grand vision much ahead of its time. The Pioneer Health Center established a family oriented community center in London that provided a wide range of health related, and healthful, activities.

Henry B. Richardson, an internist, was the project director of a large collaborative research effort: "The Study of the Family in Sickness and Health Care." The classic report, Patients Have Families was published in 1944.

Michael Balint, a British psychoanalyst, in 1957, summarized his views on the importance for medical practice of the personality of the physician. The eponymous Balint groups still provide a venue for physicians' work on personal issues in practice.

Edgar Auerswald was a young American psychiatrist and family therapist in 1965-69 when he undertook the work at an experimental health center on New York's lower East Side on which his article is based. He describes the creation of a family based, ecologically oriented, community health program. The paper is subtitled An Experiment in Ecosystemic Community Health Care Delivery.

George L. Engel is Professor Emeritus of Medicine and of Psychiatry at the University of Rochester, New York. His original article was published in 1977 and provided us with the concept of the biopsychosocial paradigm, emphasizing a general systems-oriented foundation for medicine.

In the late 1970s and early 1980s activities in the area of family therapy and medicine increased in frequency. The journal, Family Systems Medicine was first published in 1983 and has been in continuous publication since then, more recently as Families, Systems & Health. While we will emphasize this sector of the field, it is important to recognize that many psychosocial practitioners and social scientists have labored productively in the healthcare area, both in the US and elsewhere. The Society of Teachers of Family Medicine and its Task Force on the Family particularly need to be mentioned.

In March of 1993, at the annual meeting in Amelia Island, the Task Force on the Family of the Society of Teachers of Family Medicine (STFM), a group of 15 colleagues drawn from the fields of family therapy and family medicine, met. The meeting was convened by the journal Family Systems Medicine in order to discuss the possibility of developing a new and more appropriate health?care paradigm. Since its first issue, in 1983, the Journal had undertaken to explore the relation between "Family Therapy, Systems Theory, and Modern Medicine." This exploration was informed by an ecosystemic orientation and driven by an awareness that gathering clouds of clinical impasse and rising costs necessitated new models of care delivery. The meeting addressed the question: Could a new vision of healthcare delivery be developed that was practical, that took into account the urgency of cost containment, the realities of provider capabilities, and that preserved an ethical and humane stance? At this meeting, and at a subsequent planning meeting held in January of 1994, a new paradigm, dubbed the collaborative family healthcare model, was defined, and the Collaborative Family Healthcare Coalition (CFHcC) was formed to explore the many aspects of the paradigm.

The journal Families, Systems & Health (formerly Family Systems Medicine) publishes a growing body of collaborative family healthcare research and clinical innovation. There is a growing periodical literature in the field as well as several important books, mostly published by Basic Books under the umbrella of the Family and Health Series. CFHcC has organized 3 conferences so far and is presenting the fourth Collaborative Family Healthcare Conference in Washington DC in January 2000. (For information about this conference contact <staff@cfhcc.org> . A web site, <http:www.cfhcc.org> , Newsletter, and Directory are available to members).

Numerous training programs with a collaborative family healthcare orientation are underway, including those at the University of Rochester and University of Chicago. While training efforts were initially post?degree, recently some master's and doctoral programs have begun offering clinical specializations in family systems approaches in healthcare. These programs teach specific skills in collaborative models of consultation and therapy that address the needs of families facing a range of health problems.

Nationally and internationally, there are a number of institutions with clinical services that are utilizing systemic, family?centered, collaborative models of care, both in primary care and tertiary care settings (e.g. cancer centers, programs for various chronic illnesses or disabilities, hospice/end?of?life care). Increasingly, we are being asked to provide consultation regarding service delivery and clinical training to frontline healthcare professionals across a number of health/mental health disciplines.

International networks are being created, taking into account the leadership that many other countries can provide to the US in this area.

As we all know, the healthcare system is evolving at a furious rate. Family therapy has continued to be relevant to these developments.

References:

• Richardson, Henry B. (1948). Patients Have Families. New York; The Commonwealth Fund.
• Balint, M. (1957). The Doctor, His Patient, and the Illness. New York; International Universities Press.
• Auerswald, Edgar. H. (1983). The Gouvereneur Health Services Program: An Experiment in Ecosystemic Community Healthcare Delivery. Family Systems Medicine, Fall (1), 3.
• Engel, George L. (Unknown year). The need for a new medical model: A challenge for biomedicine, Science, 129-136.