goes beyond psychoeducation alone to a relationship-focused intervention targeting the parents’ interaction with the child.

The use of multifamily groups is an efficient way to provide psychoeducation and family-relationship-functioning interventions, although some families might not work optimally in a multifamily setting (Gonzalez et al., 1989). A randomized study of 32 families compared six weekly multifamily group sessions with usual care for children with insulin-dependent diabetes (Satin et al., 1989). The intervention focused on metabolic control and psychosocial function of the child and on family function. The children in the intervention group had better hemoglobin A1C, attitudes, and self-care behavior than did those in the control group.

Wamboldt and Levin (1995) reported the results of a multifamily group intervention delivered to 72 children with asthma and their families. The intervention lasted 5 hours, and was delivered on 2 consecutive days for 17 groups of families. It included education, support, and group discussion. Preintervention and postintervention assessments revealed an increase in family members’ reports of feeling understood by others, feeling open to help with the illness, and having a stronger belief that it is helpful for family members to share their feeling about the illness with each other. No medical outcomes or long-term follow-up were reported. However, increased sense of support and increased belief that communication is useful are associated with improved disease outcomes in descriptive studies, so this intervention potentially could improve asthma management and outcome.

Another multifamily group intervention pilot project included 19 families of survivors of childhood cancer (Kazak et al., 1999). A combination of cognitive/behavioral approaches and manualized family therapy was used during four sessions delivered on 1 day. Success in decreasing symptoms of posttraumatic stress and anxiety in parents, siblings, and survivors was documented with preintervention and postintervention assessment.

Family Therapy

Family therapy has been used for secondary prevention, but it might be most appropriate for tertiary prevention. Screening programs can detect families in which serious psychological dysfunction predates the disease or complications of the chronic disease already constitute disorders to target for more intensive intervention.

A randomized trial of family therapy (n=25) in the setting of poorly



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