FAMILY COPING STRATEGIES WHEN A PARENT HAS A SEVERE OR MEDIUM CRANIO-CEREBRAL TRAUMATISM AS A STARTING POINT IN PSYCHO-PROPHILACTICAL INTERVENTION

Knowledge of the family coping strategies when a parent suddenly became ill constitutes a basic factor of preventive therapeutic intervention. They can be evaluated by specific instruments and the data can represent a starting point for psycho-prophilactical intervention. The articol presents the statisticaly data about the family coping strategies (F-COPES and FAD questionaires) and the larger conclusions of this research. This data could be extinguishing to the other illness category wich starts suddenly.Key words: coping strategies, psycho-trauma, psycho-prophilaxy, distress, resilience, psychological counseling.

Since the response modalities in the case of sudden illness by prin severe or medium cranio-cerebral trauma of one of the parents over tha family as a system and especially over the children is rarely approached in the specialist documentation in the world, and in out country it is a novelty, I have endeavoured through this research to identify and to follow for 6 months the psychological reactions which occur in the situation described above. I evaluated these highly complex internal psychological processes in children and in the support parents with the help of the following instruments: KIDCOPE (Checklist for Coping Strategies), F-COPES (Family Crises Oriented Personal Scales), FAD (Family Assessment Device), BADO-C (Documentation of Socio-Demographic and Socio-Economical Status), the Karnofsky Index.

The questionnaires were applied in two moments:

• The initial moment (T0): the first iteration was performed in hospital both to the healthy parent and to the child (on the occasion of a visit to the ill parent). They were completed in the presence of the psychologist in order to allow the clarification of any misunderstanding and in order to increase the accuracy of the data.
• The final moment (T2): re-evaluation was made six months after the moment T0 in the family’s home. The second iteration was also performed in the psychologist’s presence, both to the supporting parent and to the child.

In this articol I propose data analyses of the 2 folowing scales refering to the evaluation of family functioning as a whole during the exposure period to the psychotrauma: F-COPES and FAD.

F-COPES (Family Crisis Oriented Personal Scales, Hamilton, 2000) evaluates the family’s coping style. The “Family Crisis Oriented Personal Evaluation” scales are conceived to record the actual “problem-solving”attitudes and behaviours which families adopt as a response to problems and difficulties.

The questionnaire contains thirty items, each of which evaluates the intensity of description on a five-step Lickert scale: 1=”strongly disagree”, and 5=”strongly agree”. The total score, as well as the score of each inpidual scale, shows the degree to which the family uses a specific coping strategy. The questionnaire was completed by the healthy parent, and the data thus obtained refer to the following scales: Looking for support, Restructuring, reorganization, Orientation towards  spiritual support, Mobilising the family towards seeking and accepting help, Passive evaluation.

FAD (Family Assessment Device by Epstein, Baldwin and Bishop, 1983) is a questionnaire for the  evaluation of the functioning of the family as a whole. It contains sixty items, and the choice is made on a four-step Likert scale: “strongly agree”, “agree”, “disagree”, “ strongly disagree”. High scores indicate a high degree of family disfunctionality. The dimensions are: General functioning, Problem solving, Communication, Roles, Affective receptivity, Involvement, Behaviour control.

The lot of the research comprises a number of 58 legally constituted families, with children aged between 6-17, families in which one of the parents suffered a severe or medium cranio-cerebral or medular trauma.

The study’s organisers randomly pided the group under research into two subgroups approximately equal in point of volume and offered the first subgroup (the probationary group) four sessions of psychological counseling throughout the six months during which research took place, whereas the second subgroup (the witness group) was offered an informative pamphlet at the initial moment of the research performed(t0).

Chart 1. Characteristics of the analysed lot of subjects (common T0 … T2)

This paper’s hyotheses aim at an investigation with descriptive value of the phenomena, but also a transversal and longitudinal comparative analysis according to natural variables (gender, the child’s age, the ill parent’s gender), as well as an experimental variable (offering counseling to the probatory lot). The statistic investigation focuses on doubting the null hypothesis, namely that there is no difference among the categories of subjects generated by the variables under analysis.

F-COPES ANALYSIS

30 initial items. Medium values. In decreasing order of averages.

Evolution t0…t2

N=52 cases (common cases t0 & t2)

significant difference   significant difference

Longitudinal comparative analysis: T0 vs T2

To begin with, let us study the way in which coping strategies in the family have evolved from the inițial moment to the final one in the entire lot of children, irrespective of their characteristics, on the level of the six synthetic indices that resulted from the aggregation of the 30 indicators of the FCOPES questionnaire: general adaptation (labeled “Total” in the charts) and the five dimensions postulated by the authors of the FCOPES test: social support, reframing the situation, spiritual support, the family’s  mobilisation and passive evaluation.

Fig. 1. Evolution of coping strategies in the family (FCOPES) from the inițial moment T0 to the final one T2 of the research.

FAD ANALYSIS

Longitudinal comparative analysis: T0 vs T2

We shall move on therefore to the comparative study of the way in which the functioning strategies in the family set forth by the FAD test evolved in the entire analysed lot, irrespective of their characteristics, on the level of the 7 indices of the FAD questionnaire: general functioning (labeled “Total” in the charts) and the six și distinct dimensions: problem solving, communication, roles within the family, affective receptivity, affective involvement and behaviour control.

Chart 2. Evolution of the a coping strategies in the family (FCOPES) from the initial moment T0 to the  final one T2 of the research. Standardised synthetic indicators. Medium values (percent)

After the statistic analysis of the data obtained from the lot under study we can formulate the following  statistically significant conclusions:

Chart 3. Evolution of the functioning dimensions within the family (FAD) from the initial moment T0 to the final one T2 of the research. Synthetic indicators. Standardised average scores

1. The categories for which the psycho-trauma threat is greater, identified as a result of comparative statistic analysis of various sublots are as follows: “being an only child”, “being a small child” and “having the mother ill”. The dimension of coping strategies is correlated with the one of risk factors.
2. The lot of support parents with more children senses that it has fewer emotional resources to cope with the situation (the coping strategy “family mobilisation”, 59% at T0 for the parents with a single child, 42% at T0 for the parents with several children), yet, on the contrary, the children in those families are much better adapted.
3. The lot of support parents with a single child believes it manages to cope with the situation in the  family (“family mobilisation” 59% at T0 as compared to 42% in the case of parents with several children), yet the single child perceives himself as being more vulnerable, with more responsabilities and much less capable to cope. Fact which is important for the counseling  services, in order to bear in mind the greater vulnerability of the single child.
4. The response to psycho-trauma is significantly different, from a statistical point of view, in the lot of girls and boys. The girls in the lot from the very beginning have a better awareness of the situation, are more preoccupied with solving the family problems and live through the situation at a higher level of intensity (from the differences in incidences presented previously). Conversely, the boys in the lot at the beginning are “farther away” from what is going on in the family and get involved into the new situation in the family later on, which shows that they are more vulnerable and that they have stronger defences.
5. The small variations from the initial moment of the research to the final one, the fact that the incidences of the coping stategies stay high even six months after the trauma show that the response to psycho-trauma has a larger extent in tima and that the environment continues to be perceived as being threatening. Which may constitute another long-term risk factor.
6. Another identified risk factor is the ill parent’s gender, the intensity of the disfunctionality in the family being more increased in the families with ill mothers (pct.5,d), which goes to show that the mother represents the nucleus of relation-building and of emotional support for the children in the family.
7. The evaluation of statistical data from those with counseling against thedata from those who only received the pamphlet shows that, following the counseling, on the level of coping strategies, statistically, there was a significant improvement of the capacity to evaluate and to re-evaluate  the situations that occur and there increased the flexibility of taking into account the newly-emerged information in the probatory lot (from 83% at T0 to 96% at T2), whereas in the witness lot it stayed at the same values (69% at T0 and 69% at T2), which, in the case of the probatory lor, shows an increase of the capacity for adaptation to the ever-changing present, whereas other strategies remained at similar incidences.
8. There became apparent over the 6 months processes of convergence (phenomena that varied at  T0, and at T2 reduce or eliminate their variation), pergence (phenomena that did not vary at T0, and at T2 featured a significant variation) and equality of the coping strategies according to their statistically significant variation between T0 and T2 over the 5 categories of variables. The intensity of changes appears in categories of variables as follows: “children’s age” (70% changes for the ten coping strategies), “the ill parent’s gender”(60%), “children’s gender”(40%), “single child/with siblings”(40%), “psychological counseling”(30%). Among them, there are 32% pergence processes and 12% convergence ones. Among the coping strategies, the most intense variations are at: “wishful thinking” (3 pergences, 1 convergence and a continuing difference), “distraction” (2 pergences, 1 convergence), “ emotional regulation” (3 pergences), “problem solving” (1 convergence, 1 pergence, 1 continuing difference), “ cognitive restructuring” (2 pergences). In a nutshell, we can state that it is a process which unfolds in time, that there is an inertia of the occurrence of psychological processes generated by the trauma which necessitate long-term monitoring, not only punctual monitoring in the interval of exposure to trauma.
9. These children strive to cope with the life situation they go through and need external support: people from the close social circle with whom they can feel they “share” the sufferance, as well as a specialised intervention which should address the psychological phenomena which occur in this traumatic situation, and which were described in detail until now.

BIBLIOGRAPHY

1. Akister J., Stevenson-Hinde J. (1991). Identifying families at risk: exploring the potential of the McMaster Family Assessment Device, Journal of Family Therapy, 13: 411-421
2. Armsden G. & Lewis F.M. (1993). The child’s adaptation to parental medical illness: Theory and clinical aplications. Patient Education and Counseling, 22 (3): 153-165.
3. Babbie E., (2010). Practica cercetării sociale. Iaşi: Editura Polirom.
4. Briere, J.N.(1992). Child abuse trauma: Theory and treatement of the lasting effects. Newbury Park, CA: Sage Publications.
5. Helping your children coping with trauma. (n.d.). Accesat din www.redcross.org
6. Herman J.L. (1992). Trauma and recovery. New York: Basic.
7. Horowitz M.J. (2003). Treatment of Stress Response Syndroms. American Psychiatric Publishing, Washington.
8. Kleber, R. J. and Brom, D. (1992). Coping With Trauma: Theory, prevention and treatment. Amsterdam/Lisse: Swets and Zeitlinger.
9. Malchiodi, C. (2008). Creative Interventions with Traumatized Children. New York: The Guilford Press.
10. Masten, A (2001). Ordinary magic: Resilience processes in development, American Psychologist, 56 (3): 227-238.
11. McCubbin Hi., Joy CB, Cauble si altii (1980). Family stress and coping: a decade review. Journal of family 42: 855-871.
12. Milea, Ş.(2006). Profilaxia primară a tulburărilor psihice la copil și adolescent, vol. I, Bucureşti: Editura Ştiinţelor medicale.
13. Milea, Ş.(2009). Profilaxia primară a tulburărilor psihice la copil și adolescent- Categorii de copii cu risc crescut, vol. II, Editura Ama Best Art, Bucureşti.
14. Satir V. (1991). Satir model: Family therapy and beyond. New York: Science and Behavior Books.
15. Terr, L. C. (1991). Childhood traumas: An outline and overview.American Journal of Psychiatry, 148, 10–20.
16. Van Eijk, J.T. (1987). Life events and family dynamics. International Journal of Family Psychiatry, 8(3): 243-257.

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