Working with Families Institute (WWFI)

Permanent URI for this collectionhttps://hdl.handle.net/1807/123823

This collection contains modules designed by the Working with Families Institute for individual learning or small group discussion.

The goal of these modules is to provide a learning resource for physicians dealing with common medical and psychosocial issues that have an impact on families. The modules seek to bridge the gap between current and best practice, and provide opportunities for physicians to enhance or change their approach to a particular clinical problem.

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What to Do When the World Comes to You: Working with Immigrants in Family Practice
(Working With Families Institute, 2014) Rashid, Meb; Inglis, Gabrielle; Lennox, Robin; Munro, Jessica; Yves, Talbot
Over 20% of Canada’s population is foreign born and over one million people are considered new Canadians, having received citizenship within the last five years. 1 Although Canada has always seen large waves of immigrants, in the last 40 years there has been a dramatic increase in immigrants arriving from Asia, Africa, Latin America and the Caribbean. Immigrants may have different risk factor profiles based on genetic risks and different environmental exposures, both pre- and post-migration. Discordance in language and culture may challenge the therapeutic relationship. Given the number of new immigrants in Canada, family physicians become responsible for understanding the nuances of dealing with patients who are foreign-born. The immigrant population is immensely heterogeneous. The majority of immigrants arriving in Canada are accepted as “economic immigrants”. Many have excelled academically, speak multiple languages and may have a job upon arrival. Another 25% of immigrants are sponsored by family members and 10% are refugees.2 The risk factor profile of a university professor from Argentina may differ dramatically from a Burmese woman who has languished in a refugee camp for decades. Despite such heterogeneity, there are some commonalities in health risks based on countries of origin and migration histories. For example, there are higher rates of hemoglobinopathies in people of African descent and refugees often have higher risks for infectious disease. This module identifies approaches to specific issues that challenge family physicians caring for immigrant populations.
Using Community and Family Resources
(Working With Families Institute, 2014) Shuster, Shoel
Two of the four principles of family medicine outlined by the College of Family Physicians of Canada are “the physician is a resource to a practice population” and “family medicine is a community-based discipline”. Family practice is significantly influenced by community factors. As a member of the community, the family physician is able to respond to people’s changing needs, adapt quickly to changing circumstances, and mobilize appropriate resources to address patients’ needs. Family physicians involve families in patient care and use referrals to specialists and community resources judiciously. It is vitally important for family physicians to have knowledge of local community resources that are appropriate for their patients. This module outlines some of the types of resources that may be useful, and how family physicians can utilize those resources to improve their care to their patients.
Working With Families That Have Special Needs
(Working With Families Institute, 2014) Nutik, Melissa; Yolles, Linda
The presence of a family member with special needs has far-reaching effects on the entire family, influencing family identity, structure, roles, and relationships. “Special needs” are any factors affecting a family and/or a person in a way that is out of the norm for the typical life cycle. These factors can be medical conditions or diseases (e.g., diabetes, cancer), developmental delays or disabilities (e.g., Down syndrome, autism), or severe allergies (e.g., peanut allergy). Family physicians should become familiar with family adaptation, psychosocial issues, predictors of coping/family strengths, the family life cycle, marital issues and parenting, and sibling issues. In addition, the clinician who forms effective partnerships with families will be able to provide and coordinate family interventions and therapy effectively.
Solution-Focused Therapy For Patients' Psychosocial Problems
(Working With Families Institute, 2014) Poon, Vincent H.K; Warner, Ronald E.
Ever since the 1980s, the importance of patient-and family-centred care has been recognized in family practice.1-6 Sobel indicated that when patients presented with one of the 14 symptoms most common in outpatient clinics (e.g., headache, chest pain, fatigue), a probable cause was established in less than 16% of cases.7 In this biopsychosocial and cultural context, counselling has become an inevitable component of family practice. Poon describes counselling as the process of helping people overcome obstacles to their personal and interpersonal growth and achieve optimum development of their personal resources and goals in life.8 Among the many approaches to counselling and psychotherapy, solution-focused therapy is most suitable for family physicians for the following reasons: it is brief, usually consisting of fewer than five sessions; it involves an intermediate (15-30 minutes) to advanced (30-60 minutes) level of counselling and thus is adaptable within family practice, and it is relatively easy to learn. This module provides an overview of the essential elements of solution-focused therapy, with an emphasis on working with families. The case examples illustrate how solution-focused therapy is used in the family practice setting.
Working with Sexual Problems: in Family Practice
(Working With Families Institute, 2014) Holzapfel, Stephen; Chertkow, Elizabeth
Sexual health and sexual concerns are common in family medicine. Patients want their family physicians to feel comfortable initiating conversations about sexuality and managing related problems. Over 50% of couples will have significant sexual concerns causing distress and the risk of losing the relationship. 1,2 Many patients wish to discuss sexual concerns with their family doctor but don’t feel comfortable raising the topic themselves. By giving family physicians the tools to initiate conversations about sexuality and manage sexual concerns, we hope to address this gap in care.
Responding to Patients' Unanticipated Emotional Concerns
(Working With Families Institute, 2014) Shuster, Shoel; Watson, William J.
Frequently in family practice, patients present with unanticipated emotions or affect. Patients may mention these issues directly, or reveal them indirectly during a visit for a physical symptom, when the physician asks about a life situation (e.g., a crisis). Patients frequently present with physical symptoms (e.g., tiredness or pain) to legitimize their visit, or are unaware that they have physical symptoms related to emotional issues (e.g., shortness of breath and poor sleep related to anxiety). Anger, fear, worry, a sense of hopelessness, and sadness are some emotions that patients may bring. Because of time constraints or uncertainty about how to respond, patients’ unanticipated emotions can be a challenge for the family physician (FP) in a busy office practice. However, when the FP views such emotions in the context of crisis and change, they provide a great opportunity for helping a patient through a difficult time in his or her life. These emotions also offer a doorway to information that can have an impact on patients’ immediate and long-term health.
Poverty and Health: Key Issues in Health Care
(Working With Families Institute, 2014) Gazeley, Sharon; Ter Kuile, Sonia
Poverty is an important determinant of health and illness, which has profound effects throughout the life cycle. Poverty is strongly linked to many adverse health outcomes and associated with a higher incidence, prevalence, and severity of chronic illness, acute illness, and injuries.1 Physicians can make a difference for individual patients by integrating a “determinants of health” approach into patient-centred care while assisting with access to health care, income supports, and resources. Addressing poverty helps redress inequalities in health—an important ethical concern. An understanding of the facts about poverty in Canada and practical strategies will allow family physicians (FPs) to intervene and care for patients affected by poverty.
Postpartum Mood Disorders: What Family Physicians Should Know
(Working With Families Institute, 2014) Watson, William J.; Stewart, Donna; Vigod, Simone
The postpartum experience can be challenging for mothers and their families because of stress from the birth and delivery, the transition to parenthood, and adjusted schedules and lifestyles. Heterosexual biological parents, same-sex parents, and adoptive parents all face these challenges. A relationship exists between mood disorders and pregnancy and the postnatal period. As well as the longstanding recognition that some women face specific risks in the early postpartum period, there is an increasing understanding of the effects of antenatal and postnatal mood disorders on pregnancy and the developing child. Although not distinctive in their presentation at this time, depressive and anxiety disorders are linked to adverse developmental outcomes for infants and may have profound implications for women and their families. These implications include obstetrical and neonatal complications, impaired mother-infant interactions, childhood developmental delay and subsequent mental health problems, and, in extreme cases, maternal suicide and/or infanticide (Letourneau et al., 2012; Yonkers et al., 2011). Psychosis in the antenatal period may pose particular management challenges and the distinct risk and clinical features associated with postpartum psychosis mean that clinicians must ensure effective and timely risk assessment, detection, and management (SIGN, 2012). Family physicians (FPs) are uniquely positioned in the health care system to help mothers and their families through this critical life transition. How can FPs recognize and improve their treatment of postpartum mood disorders and ultimately help mothers and families cope more effectively with this stage of the life cycle? This module emphasizes preventive, diagnostic, treatment, and communication techniques that can assist FPs in assessing the health of mothers and their families during the postpartum period.
Pets in Families: What Family Physicians Should Know and Do
(Working With Families Institute, 2014) Kim, Florence A.; Hodgson, Kate
Pets are important members of families. They provide emotional support, social capital, and are strong motivators in making positive lifestyle changes that improve human health. Pets also have direct and positive impact on human health–zooeyia. Family physicians can use the Pet Query practice tool to uncover information about a patient’s home life and family structure and to strengthen the patient-physician therapeutic alliance. Managing risks of zoonotic disease and injury is not the primary nor the sole responsibility of family physicians, but rather an opportunity for interprofessional collaboration with veterinarians.
Parenting Strategies in Office Practice: Helping Parents Through The Challenges
(Working With Families Institute, 2014) Watson, William J.; Watson Lindsay
The early years from birth to five are extremely important to a child’s healthy mental and physical development. Emotionally, it is in the first year of life that the child acquires a basic trust or mistrust in the world; the latter may predispose him or her to future behaviour or mental health problems. 1 Poor attachment and parenting practices can have significant long-term consequences on a child’s subsequent mental and physical development. 2,3 Families often consult family physicians for general advice on parenting and childrearing, especially when confronted with their child’s behavioural or developmental issues. This consultation may occur in the context of a regular office visit for well-baby or well-child care, during an assessment for an acute medical illness, or in response to a parent’s request for assessment of a specific behaviour problem. One factor to be considered as a common cause of childhood behaviour problems is parental and family stress; the physician should include an assessment of the family and the couple’s relationship as part of their assessment. During their training, family physicians have no special educational instruction in advising on parenting, except for their own family-of-origin experiences or any personal parenting courses they may have taken. They also have varying degrees of skill and interest in dealing with these problems, which some may consider outside the medical model and therefore not part of the office repertoire. However, the family physician is frequently the only resource available to parents and, because of their long-term relationships and frequency of well-baby visits, is uniquely positioned to provide timely advice and education around parenting issues. The family physician is also well placed to act as the child’s and family’s advocate in liaison with school systems, legal authorities, community agencies, and mental health professionals.
Effective Parenting Strategies in Office Practice
(Working With Families Institute, 2014) Watson, William J.; Watson, Lindsay
A Patient-centred Approach to Obesity: Counselling Health Behaviour Change
(Working With Families Institute, 2014) Watson, William J.; Morris, Melanie; Selby, Peter; Howse, Kelly L.
Family physicians (FPs) commonly deal with patients’ concerns about weight, because of a direct request for advice on losing weight or because a medical assessment leads to concerns about a patient’s overall health risks. As with other chronic conditions such as diabetes or hypertension, some people are predisposed to obesity because of a genetic tendency; the incidence is also influenced by environmental factors. Attempts at weight loss are frustrating for both patients and physicians, because patients have difficulty sustaining long-term weight reduction. An estimated two-thirds of the weight loss achieved by individual patients is regained in the year after the initial loss.1 A patient-centred approach to obesity takes into account such factors as stage of change, level of motivation, health beliefs, support system, family background and other family factors, and psychosocial stress. This approach may improve overall patient care.2,3 Factors beyond diet, exercise, and medications must be considered. FPs need to find ways to avoid frustration and engender optimism in their patients. In addition, we must recognize the role families play in contributing to and perpetuating obesity in patients, especially children.
Motivational Interviewing: Counselling Behaviour Change in Family Practice
(Working With Families Institute, 2014) Yeung, Danny S.C; Greenberg, Gail R.
Physicians are entrepreneurs of change, camouflaged as facilitators, catalysts, and promoters. With each prescription written, diagnostic test ordered, recommendation provided, or treatment advised, physicians foster change in patients’ states of health and well-being. The patient-centred clinical method, the core foundation upon which physician-patient interactions unfold and evolve, includes six components, the third of which is finding common ground.1 Essentially, this component represents a fundamental belief that if a physician is to facilitate change, encounters with patients must include conversations focused on a mutual understanding of the definition of the presenting problems, treatment and management goals, and patient and physician roles.1 To accomplish these goals, physicians need a tool chest that includes knowledge of the change process, accompanied by strategies and techniques to partner with patients as they begin to think about and embark on change. During the 1980s, research in the field of addictions triggered the way health care professionals looked at and thought about change, and laid the groundwork for an understanding of the complexities of change.2 Family physicians (FPs) who routinely incorporate change strategies into patient care understand the stages and processes of change, practise finding common ground, recognize that patient change behaviours include lifestyle modification, adherence to medical regimens, and the reduction or elimination of unhealthy behaviours, and use motivational interviewing techniques.
Menopause: Time for a Change
(Working With Families Institute, 2014) Nathanson, Cynthia; Allan, Scott; Hou Liu, Nana
Menopause is not a disease; it is part of a woman’s natural life cycle. Defined as “the absence of menses for 12 months,” the average age of occurrence is between ages 48 and 52. The process usually begins four to six years earlier and continues for several years after. It is important to understand how each woman experiences menopause. How does she view herself in general and at this specific life stage? What kind of supports are in place within her family, her circle of friends, her physician, her community, and her culture? For some, the transition is easy and uneventful. However, up to 80% of all women will experience some degree of symptoms. 1 In this module, we examine the gaps between current practice and a more comprehensive approach to assisting patients and their families through menopause.
Individual and Family Life Cycles: Predicting Important Transition Points
(Working With Families Institute, 2014) Vincent H.K., Poon; Bader, Ed
Each individual goes through a sequence of stages in life. At each stage, the person must complete some developmental tasks in order to grow and develop. The family life cycle describes developmental trends within a family over time. There are social and cultural variables within each family life cycle. Family members may carry within themselves and in their relationships unresolved tasks from earlier periods of their lives. Because individuals and families interact, individual and family life cycles often juxtapose and intertwine with each other. When patients understand their pasts, they can plan strategies and activities to grow and live more fully in the present, and envision future possibilities more clearly. Through awareness of individual and family life cycles, family physicians (FPs) are better able to understand patients and their families. This is important both during their normal and expected life-stage developments as they become healthy, strong adults and when they encounter difficulties in one or more of the life stages. The FP can play a pivotal role in helping these families.
Grief and Loss: An Approach for Family Physicians
(Working With Families Institute, 2014) Borins, M; Abrahams, P
Grief and loss are commonly encountered in family practice. Patients grieve the loss of loved ones, jobs, marriages, pets and even physical or psychological functioning. Patients may mourn the loss of their good health and seek comfort, understanding, respect, and especially hope. The "work of grief" is a progression through stages of shock, anger, painful dejection, loss of interest in the outside world, inhibition of activity and the temporary interruption of the capacity to love. 1 In addition to a profound sense of sadness, there may be feelings of anxiety, anger, fear, depression, and guilt. Patients, their families, and physicians may underestimate the impact of loss on health, which may cause physical symptoms such as pain, headache, dizziness, fatigue, and disturbances of sleep and digestion, as well as psychological symptoms. Family physicians (FPs) are in a unique position to influence prevention, early detection, and morbidity of these disorders. Psychotherapy can relieve the self-destructive anger and guilt, advance the recovery phase, and stimulate psychological strength and personality growth. How can we identify those individuals who are at risk for grief reactions in our practice? What techniques can FPs utilize to help patients go through the stages of grieving? What supports can the physician provide to families who are experiencing difficulty adapting to loss? How can FPs be aware of their own feelings around loss and how they impact on patient care?
Genograms: Seeing Patients and Families Through A Window - Revised
(Working With Families Institute, 2014) Watson, William J.; Poon, Vincent H.K; Waters, Ian A.
The genogram is a practical, patient-centred tool that permits family physicians (FPs) to gather and record basic family information. The “skeletal” genogram identifies the patient's family members and their medical histories. It offers the physician a quick visual reference for understanding the patient's context, the family’s influence, and the family's role in the patient's illness experience. Specifically, the genogram highlights genetic and family patterns of illness, indicates areas to consider for primary and secondary prevention, identifies the patient's risk for specific health problems and the need for screening, and assists in the development of a differential diagnosis and management plan. The “expanded” genogram builds on the basic genogram information by focusing on the identification of six specific categories: family structure, life-cycle stage, pattern repetition across generations, life events and family functioning, relational patterns and triangles, and family balance and imbalance. The expanded genogram provides the physician with a systemic assessment of the patient’s and the family’s biopsychosocial concerns and level of functioning. It can also be used as a therapeutic tool for both patients and families.
Genograms: Seeing Patients and Families
(Working With Families Institute, 2014) Watson, William J.; Poon, Vincent H.K.; Waters, Ian A.
The genogram is a practical, patient-centred tool that permits family physicians (FPs) to gather and record basic family information. The “skeletal” genogram identifies the patient's family members and their medical histories. It offers the physician a quick visual reference for understanding the patient's context, the family’s influence, and the family's role in the patient's illness experience. Specifically, the genogram highlights genetic and family patterns of illness, indicates areas to consider for primary and secondary prevention, identifies the patient's risk for specific health problems and the need for screening, and assists in the development of a differential diagnosis and management plan. The “expanded” genogram builds on the basic genogram information by focusing on the identification of six specific categories: family structure, life-cycle stage, pattern repetition across generations, life events and family functioning, relational patterns and triangles, and family balance and imbalance. The expanded genogram provides the physician with a systemic assessment of the patient’s and the family’s biopsychosocial concerns and level of functioning. It can also be used as a therapeutic tool for both patients and families.
The Family Meeting: An Opportunity to Provide Family-Oriented Care
(Working With Families Institute, 2014) Waters, Ian; Stone, Sue
Family doctors face many situations where their management plans for their patients would be greatly enhanced by a discussion with the whole family. There may be medical information that the family needs to understand; there may be differences of opinion as to the method of dealing with a situation, or there may be conflict among family members because of the situation. Interviewing a family is not the same as interviewing an individual patient: first the patient has to understand and acknowledge the need for a family meeting, then the family members need to understand why they have been invited. Family members’ concerns and ideas about possible solutions should be taken into account when developing a management plan to assist the patient and family cope with the presenting illness or concern. This module emphasizes the necessary tasks in planning and facilitating a family meeting.
Working With Dying Patients and Their Families: A Task-Oriented Approach
(Working With Families Institute, 2014) Gantois Chaban, Michèle; Librach, Larry
The family physician is often involved in the care of patients who are dying. The demands on the family physician often increase after acute care has failed and the person needs palliative care, or when coordinating community resources during therapy, or for pain and symptom management. The complexities of this care are increasing. A task-oriented, interdisciplinary approach will help to ensure a dignified death without unnecessary suffering and help families cope with the loss of a loved one.

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