1. Session # C3a
October 14, 2016
Spanning Systems, Bridging Relationships: Collaborative Family Healthcare in Primary and Specialty Settings for Complex Chronic Illnesses Part I: Collaborative Family Healthcare with Children: Childhood and Parental Illness
Please insert the assigned session number (track letter, period number), i.e., A2a
Please insert the assigned DAY and DATE of your presentation, i.e., Friday, October 16, 2015 or Saturday, October 17, 2015
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List each PRESENTER who will attend the CFHA Conference to make this presentation. You may acknowledge other authors in subsequent slides.
Collaborative Family Healthcare Association 18th Annual Conference
October Charlotte, North Carolina U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. John Rolland, MD, MPH Professor of Psychiatry & Behavioral Sciences Northwestern University Feinberg School of Medicine Executive Co-Director, Chicago Center for Family Health Jackie Williams-Reade, Ph.D., LMFT Associate Professor School of Behavioral Health Loma Linda University

3. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

4. Learning Objectives At the conclusion of this session, the participant will be able to:
Identify the unique clinical needs of parents and children when a family member has a chronic, complex illness, specifically childhood cancer.
Learn how to help engage and intervene with family members through frameworks and evidence-based assessments and interventions.
Understand differences in care at the primary and specialty care levels and the importance of collaboration between settings
Include the behavioral learning objectives for this session
Collaborative Family Healthcare Association 12th Annual Conference

5. The Number of Americans with Chronic Conditions is Expected to Rise

6. The Shrinking Pool of Potential Caregivers

7. Illness and Disability in Family Context
Family, broadly defined, as the psychological and caregiving focal point
Family as a key resource & partner in care
Illness and related stresses affect family life, all members and relationships
Mutual influence between illness & family
Family organization and processes can influence treatment adherence & disease course

8. Need for Family Psychosocial Map
Family functioning:
Beliefs, organization, communication
Psychosocial understanding of illness
Understanding developmental processes

9. Family Systems – Illness Model

10. Time Line & Phases of Illness

11. Key Initial Crisis Phase Issues
-Define Challenge of Illness in shared “WE” Terms -Establish Functional Collaborative Relationship with Health Care Providers

12. Communication Who will be included or excluded and why?
parents
parent-child
patient/family –healthcare team
What topics are off-limits and why?
Communication with Children & Adolescents
No evidence kids hurt by age-appropriate info.
Gradual approach associated with less problems in Adolescents.
Blocked communication associated with isolation, anxiety, depression for all members.

13. Multigenerational Developmental Perspective
Multigenerational experiences with illness & loss, including stories of resilience
Current timing and possible impact on future individual and family life cycle planning

14. Family Consultations Prevention-oriented At crucial transitions
Psychosocial Check-ups
Individual, Family & Couple

15. Specialty Care Team Members
Specialty Physician
Nurse
Behavioral Health Consultant (BHC)
Child life specialists (pediatric)
Pharmacists
Physical and occupational therapists
Psychiatrists
Other
multi-disciplinary specialties which heavily depend on collaboration due to the complexity of illnesses and the attunement to the patient’s overall quality of life.
Collaborative Family Healthcare Association 12th Annual Conference

16. Primary and Specialty Coordination
Serious gaps in medical care can occur when a number of medical providers are involved in a child’s care acting in an uncoordinated fashion.
Pediatric subspecialty teams providing disease-specific care may not be focused on the primary care needs of children under their care, or some services that might be provided by either generalists or specialists may be done by neither physician.
There is lack of consensus about whether the PCP or the specialty pediatrician is best suited to be the preferred provider, highlighting the need for closer communication and dialogue

17. Childhood Cancer: Facts, Family Impact, and Primary Care Collaboration
Jackie Williams-Reade

18. Childhood Cancer Facts
Cancer is the 2nd leading cause of death (following accidents) in children aged 5 to 14 years.
Annual incidence rate in children and adolescents is per 1 million children aged birth to 19 years.
1 in 285 children will be diagnosed with cancer before age 20 years
Collaborative Family Healthcare Association 12th Annual Conference

19. Diagnosis Phase
Meeting with unfamiliar multidisciplinary professionals and receiving an immense load of information about the illness may overwhelm parents and increase their anxiety (Alderfer & Kazak, 2006).
Families experience is “frightening” as they are immediately plunged into this new, unfamiliar world due to the immediate need for intervention (Madeo, O’Brien, Bernhardt, & Biesecker, 2012).
At diagnosis, the world they had known has been shattered (Björk et al., 2009; Schweitzer et al., 2012; Woodgate, 2006).
Metaphor of “new trip”
Thus, although most researchers share the argument of definite negative impacts of childhood cancer experiences during the diagnostic phase, divergent family functioning outcomes after this phase were found in different studies.
Because common childhood cancer symptoms, such as fatigue and joint pain, are often overlooked in the diagnosis phase, parents often wait days or weeks before taking their children to a hospital. This delay may increase a sense of guilt in the parents.
When parents do visit physicians, they often see their children undergo painful, invasive diagnostic procedures.
, as they worry about the survival and health of their ill brother or sister. At the same time, the siblings may be, or feel, somewhat excluded by their families because parents’ attention tends to focus on the ill children and those siblings may not receive sufficient information about the illness from their parents, preventing them from having a complete and accurate understanding of the experiences of their ill brother or sister. This may be a scary feeling for those children
Collaborative Family Healthcare Association 12th Annual Conference

20. Chronic State Treatment Phase
The family must adapt to new routines such as medication administration, protection from infection, and a myriad of doctor’s appointments and tests (Flury, Caflisch, Ullmann-Bremi, & Spichiger,
Siblings may also feel that their lives are disrupted due to the illness (Havermans & Eiser, 1994).
Patient continues treatments that can be painful and experiences side effects (nausea, rashes, poor appetite).
Anxiety and guilt as family members watch the pediatric patient suffer (Enskar, Carlsson, Golsater, Hamrin, & Kreuger, 1997).
Childhood cancer is a rare and unexpected event in the life of a family.
Families’ daily lives may begin to revolve around treatment.
The ill child and treatment become the central organizing force in family life.
Parents are often in shock, unable to comprehend the full implications of the diagnosis.
Throws families into a state of chaos, uncertainty, and broken routines. Families must work together in a way that incorporates caring for the child and dealing with an unknown future (Björk et al., 2005).
During the two years following diagnosis, Sawyer, Antoniou, Toogood, Rice, and Baghurst (2000) identified the successful adaptation of families. According to them, the psychological adjustment and function of families with childhood cancer gradually improved and became closer to the level of control groups in four years. On the other hand, some researchers identified both good and poor adaptations by families. Over the course of 5 years following diagnosis, Wijnberg-Williams, Kamps, Klip, and Hoekstra-Weebers (2006) found that while the distress in most parents was alleviated, some parents who experienced the repeated deterioration of their child’s condition exhibited elevated distress levels. Moreover, Kazak (1989) suggests that families that were low-functioning prior to diagnosis may adjust poorly to the illness after the end of treatment. Similarly, Maurice-Stam, Oort, Last, and Grootenhuis (2008) found that although parental psychological distress tends to return to a normal level, families with a passive reaction pattern tend to have higher distress levels than families with an optimistic reaction pattern. Thus, while the passage of time seems to attenuate disorganizing effects on family functioning, some families still experience detrimental impact on their function.
Collaborative Family Healthcare Association 12th Annual Conference

21. Myriad of Losses
Normal life is replaced by a “rollercoaster ride” of tests, treatments, and decisions (Fletcher, Schneider, & Harry, 2010).
A loss of normalcy occurs as families transition to a life that centers on the ill child (Long, Marsland, Wright, & Hinds, 2015).
They experience multiple losses related to the security and safety in life that they had taken for granted prior to diagnosis (Björk, Wiebe, & Hallström, 2005; Moreira & Ângelo, 2008; Schweitzer et al., 2012; Woodgate, 2006).
The lives of family members are placed on hold, suspended in time (Björk et al., 2005; Earle, Clarke, Eiser, & Sheppard, 2007; Fletcher, 2010; Woodgate, 2006); (Patterson et al., 2004)
Medical world sees patient-centered care as a good thing – in family therapy, we begin to wonder how patient centered care can create alliances, triangles, and varying troubles
Knowledge that a child has a life-threating or life-limiting disease radically changes family dynamics and family function.
Svavarsdottir (2005) found within the first 20 months of diagnosis, the greatest stressor is caring for the child who is ill alongside meeting the needs of the rest of the family.
Similarly, Bjork and colleagues (2005) interviewed the family members of 17 children with newly diagnosed cancer. Two themes emerged from this study: “a broken life world” and “striving to survive” (p.272).
Slowly, parents began to realize that the child’s disease and the unknown future would have an impact on them for the rest of their lives (Flury et al., 2011).
Collaborative Family Healthcare Association 12th Annual Conference

22. End of Treatment Phase
Families’ overall burden may decrease, but also include mixed feelings such as anxiety and joy (Katz & Jay, 1984).
Can bring anxiety due to loss of security and protection due to being under constant care (Alderfer & Kazak, 2006; Katz & Jay, 1984).
Families have to recreate their everyday life patterns which can be challenging (Ostroff, Ross, & Steinglass, 2000).
Fear of death, relapse, and lasting negative side effects can persist in the minds of families (Byrne et al., 1987; Hutchinson, Willard, Hardy, & Bonner, 2009; Ostroff et al., 2000; Vannatta, Salley, & Gerhardt, 2009).
“Life is never the same” (Woodgate, 2006).
months or years post-diagnosis when intense treatment is replaced by periodical follow-up visits.
Through the course of treatment, families may increase their dependency on medical care and staff, preventing them from facing the fear of relapse.
. Since families may have by this point successfully incorporated treatment regimens into their lives, including diet restrictions and limited physical activities,
Thus, families’ experiences may change dramatically during the course of treatment because each phase of childhood cancer treatment has a different and significant impact on their functioning.
Collaborative Family Healthcare Association 12th Annual Conference

23. Positive effects
Family cohesion and marital relationships can be strengthened (Barbarin et al., 1985; Delden, & Grypdonck, 2008; Kars, Duijnstee, Pool, & Quin, 2008).
Fathers report engaging in more family activities, feeling closer to their families, and communicating more openly (Neil-Urban and Jones 2002)
Mothers and fathers of children who have completed treatment indicate increased closeness with patient (Norberg and Steneby 2009), and more likely to ‘live in the present’ Quin (2008)
Parents experience positive changes in self-esteem and assigning meaning to the illness by observing their children’s emotional growth Gannoni and Shute (2010)
Siblings feel closer to their families only if they assume an active role in supporting others through treatment (Woodgate 2006b).
Hosoda, T. (2014). The Impact of Childhood Cancer on Family Functioning: A Review.
Families showed resiliency by maintaining functional integrity during the treatment phases McCubbin et al. (2002)
In spite of family changes and strains, a body of longitudinal and cross-sectional qualitative work suggests that relationships are often strengthened as a result of the cancer experience, and family closeness is prioritized over time (Brody and Simmons 2007; Clarke-Steffen 1997; McGrath et al. 2005; Neil-Urban and Jones 2002; Norberg and Steneby 2009; Woodgate 2006a, b; Woodgate and Degner 2003).
Contrary to the quantitative studies, evidence of potential positive effects as well as non-impairing impacts of childhood cancer on family functioning was found among the qualitative studies.
most qualitative studies under review found a change of existential meaning due to childhood cancer experiences.
Thus, the difficult circumstances of childhood cancer did not always have negative impacts on family functioning. In many cases, parents found a way to maintain their families, both by developing positive perceptions of their child’s illness and by adjusting the assignment of roles within the family. For example, parents may have intimate conversations and help each other to overcome the difficulty, which could improve their relationship and self-esteem.
While some quantitative studies show impairing effects on family functioning due to childhood cancer, others show non-impairing effects. Acknowledging the impairing effects on family functioning, by contrast, some qualitative studies found that childhood cancer actually has positive effects on family functioning, including the change of existential meaning. In other words, while quantitative studies tend to focus on disorganizing or non-disorganizing effects, qualitative studies tend to focus on organizing effects on family functioning.
Collaborative Family Healthcare Association 12th Annual Conference

24. Assessments and Interventions

25. Assessing Family Functioning
Family functioning may influence current and later psychological adjustment of ill children and their treatment in both direct and indirect ways. (Drotar, 1997; Katz & Jay, 1984, Kazak et al., 2011; Pelcovitz et al., 1998; Pless, Roghmann, & Haggerty, 1972, Trask et al., 2003; Wallander & Varni, 1998).
When the family is cooperative and has open communication concerning the illness, the child might be better able to acknowledge the situation (DiMatteo, 2004; Sobo, 2004).
If psychosocial problems in the family (e.g., neglectful childcare, parental depression) deter the parents from regularly attending hospital visits and seeking medical consultation, it may impede treatment (Sobo, 2004).
It is important for health care providers to appropriately consider
Collaborative Family Healthcare Association 12th Annual Conference

26. Assessments
Psychosocial Assessment Tool, a brief screening tool based on obtained parental reports. This tool aims to detect families at psychosocial risk at the point of diagnosis.
Time-frame to complete is 10 minutes
Purpose: to assess psychosocial risk in families of children newly diagnosed with cancer
Item example: “Who can you count on to provide the following: childcare/parenting, emotional support, financial support, information, help with everyday tasks?”
(Kazak, 2011)
Since there are many intervention options, the identification of the characteristics of a family and what they actually need at a practical level and/or existential level in the pre-diagnosis and treatment phases might allow mental health professionals to facilitate appropriate interventions corresponding to each family.
To obtain the instrument: Stephen DiDonato, MS, Center for Pediatric Traumatic Stress, Nemours/AI DuPont Hospital for
References
Pai, A.L., Patino-Fernandez, A.M., McSherry, M., Beele, D., Alderfer, M.A., Reilly, A.T., Hwang, W-T., & Kazak, A.E. (2008). The psychosocial assessment tool (PAT2.0): Psychometric properties of a screener for psychosocial distress in families of children newly-diagnosed with cancer.Journal of Pediatric Psychology, 33,
Alderfer, M.A., Mougianis, I., Barakat, L.P., Beele, D., DiTaranto, S., Hwang, W-T., Rielly, A.T. & Kazak, A.E. (2009). Family psychosocial risk, distress, and service utilization in pediatric cancer: predictive validity of the Psychosocial Assessment Tool (PAT). Cancer, 115(8), S
Collaborative Family Healthcare Association 12th Annual Conference

27. Evidence-based Interventions
Findings from review of RCTs in childhood cancer: Shields (2012)
Caregivers participating in a cognitive behavioral intervention, reported significant decreases in trait anxiety (Stehl et al., 2009)
Mothers who participated in a problem-solving intervention, reported improved problem-solving skills, decreased anxiety, and negative mood. (Sahler et al., 2005).
Parents and siblings participated in a cognitive behavioral intervention reported significant reductions in posttraumatic stress symptoms. Adolescent survivors reported reductions in hyperarousal symptoms. (Kazak et al., 2004).
Recent review Shields, C. G., Finley, M. A., Chawla, N. and Meadors, w. P. (2012), Couple and Family Interventions in Health Problems. Journal of Marital and Family Therapy, 38: 265–280. doi: /j x
Interventions with children have focused on the family relationships and employed cognitive behavioral and coping skills training (CST) to reduce parental anxiety and post-traumatic stress symptoms hypothesizing that less distressed parents would be able to care for their children more effectively.
Future studies of family interventions for childhood or adolescent cancer survivors need to develop recruitment and retention strategies for more distressed parents and families. Future intervention delivery strategies may be able to take advantage of advances in technology to provide interventions to families in the midst of early treatment in non-intrusive ways that will not add to the burdens they are already experiencing.
Collaborative Family Healthcare Association 12th Annual Conference

28. Narrative Approach
Elicit each family member’s illness story (through their language and behaviors)
Deconstruction of illness meanings (“I’m a burden to my family, my child is broken”)
Externalization – help separate their identity from the illness (“Cancer has caused some problems”)
Mapping the effects of the illness or illness-related problem on the patient and family members (“Cancer tries to take away my strength” “Cancer keeps me from school”)
Re-authoring - developing a preferred illness narrative that puts “illness in its’ place”; create new meanings
Williams-Reade, J., Freitas, C., & Lawson, L. (2014). Narrative-informed medical family therapy: Using narrative therapy practices in brief medical encounters. Families, Systems, & Health, 32(4), 416.
Collaborative Family Healthcare Association 12th Annual Conference

29. Posttraumatic growth
Family members may lose their unconscious belief in immortality… and may establish beliefs more applicable to their situation, thereby beginning to regain their control and original capabilities. Björk et al. (2005)
Rebuilding schemas through thought and reflection was essential, but there was also the opportunity to construct a stronger and more resilient assumptive world.
Barakat, L. P., Alderfer, M. A., & Kazak, A. E. (2006). Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers.Journal of pediatric psychology, 31(4),
Posttraumatic growth has been shown to be present in these families but needs more examination
that health care professionals need not only to help families stay hopeful but also to support them in living with both hope and fear.
Collaborative Family Healthcare Association 12th Annual Conference

30. Collaboration with Primary Care

31. Childhood and adolescent cancer statistics, 2014
ONS indicates other nervous system. Note: Lines represent joinpoint fitted trends. The average annual percent change for cancers with significant trends during the most recent period: acute lymphocytic leukemia (−3.1* during 1988‐2010), brain (−1.1* during 1975‐2010), non‐Hodgkin lymphoma (−4.1* during 1975‐2010), soft tissue (−1.0* during 1979‐2010), kidney (−1.2* during 1992‐2010), and Hodgkin lymphoma (−4.9* during 1975‐2010). Source: National Center for Health Statistics, Centers for Disease Control and Prevention
CA: A Cancer Journal for Clinicians Volume 64, Issue 2, pages , 31 JAN 2014 DOI: /caac

32. Survivorship Overall 5-year survival rate is approximately 80%
1 in 530 young adults between the ages of 20 and 39 is a childhood cancer survivor.
Increased risk of recurrence and development of subsequent cancers, chronic diseases, and functional impairments
neurocognitive and neurosensory impairment, vision or hearing impairment, hypothyroidism, infertility, obesity and metabolic syndrome, dental problems, cardiac-related health problems
counseling about behaviors such as smoking, diet, and physical activity
assessment of psychosocial adjustment and QOL
Howlader N, Noone AM,Krapcho M, et al, eds. SEER Cancer Statistics Review,  Bethesda, MD: National Cancer Institute;2013.
Armstrong GT, Liu Q, Yasui Y, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol.
In comparison to adult cancers, pediatric cancers are exceeding rare and children have a much better survival rate.
Treatment for childhood and adolescent cancer takes place at medical centers that specialize in childhood cancer
However, since pediatric cancer treatments can result in long-term and late effects for these patients, it is important that survivors receive appropriate follow-up care after treatment has ended.
The diagnosis of cancer in children and adolescents is a life-altering event for them as well as their families.
Wasilewski-Masker K, Liu Q,Yasui Y, et al. Late recurrence in pediatric cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst.2009;101:
Meadows AT, Friedman DL,Neglia JP, et al. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:
After oncology treatment, long-term care is still needed and should include:
Pediatric oncology patients often maintain their relationship with their primary care pediatrician for preventive care, health maintenance, and acute care.
After cancer treatment, patients may be monitored by their oncologist for 3 years or more.
The availability and duration of follow-up and specialized survivorship care by the pediatric oncologist and/or survivorship center will influence the roles and responsibilities of the primary care clinician.
Young adults who are transitioning from pediatric to adult primary care receive information regarding their cancer experience, including diagnosis and treatment, as well as subsequent follow-up recommendations, especially if they are not participating in specialized survivorship care programs.
Henderson TO, Friedman DL, Meadows AT.Childhood cancer survivors: transition to adult-focused risk-based care. Pediatrics.2010;126:
Survivors of Hodgkin’s Lymphoma who are treated with chest radiation have an increased risk of developing lung cancer, and tobacco use increases this risk.
**Successful smoking prevention and cessation strategies, screening for lung and breast cancer
Increased risk of obesity
increased risks of cardiovascular disease
**screening and behavioral and medical interventions to modify cardiovascular risk factors, such as hypertension, can potentially reduce these risks.
Green DM, Cox CL, Zhu L, et al. Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol.2012;30:
Nathan PC, Ford JS,Henderson TO, et al. Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:
Armstrong GT, Oeffinger KC, Chen Y, et al.Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. J ClinOncol. 2013;31:
Primary care clinician should.
Research is currently underway to define optimal models for survivorship care.
National Cancer Policy Board, Institute of Medicine, National Research Council of the National Academies; Hewitt M, Weiner SL, Simone JV, eds. Childhood Cancer Survivorship: Improving Care and Quality of Life.Washington, DC: National Academies Press; 2003.
Singer S, Gianinazzi ME,Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer.2013;60:
Collaborative Family Healthcare Association 12th Annual Conference

33. Primary Care Role in Bereavement
Partner with pediatric oncology centers and hospice professionals to provide care to terminally ill children to manage pain and symptoms and help families to make informed decisions about the child's care.
Health care providers may play an important role in helping families through the grieving process by supporting them and providing referrals for counseling and community-based support services.
Wolfe J, Tournay A, Zeltzer L. Palliative care for children with advanced cancer. In: Kreitler S, Ben Arush MW, eds.Psychosocial Aspects of Pediatric Oncology.Chichester, UK: John Wiley and Sons, Ltd; 2004:45-70.
Postovsky S, Ben Arush MW. Care of a child dying of cancer. In: Kreitler S, Ben Arush MW, eds.Psychosocial Aspects of Pediatric Oncology.Chichester, UK: John Wiley and Sons, Ltd; 2004:
Despite advances in treatment and survival, some children with cancer will not survive the disease.
Collaborative Family Healthcare Association 12th Annual Conference

34. Discussion
Questions?
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

35. Bibliography / Reference
Davey, M., Kissil, K., Lynch, L., Harmon, LR., & Hodgson, N. (2012). Lessons learned in developing a culturally adapted intervention for African American families coping with parental cancer. Journal of Cancer Education, 27,
Barakat, L., Alderfer, M., & Kazak, A. (2005). Posttraumatic growth in adolescent survivors of cancer and their families. Journal of Pediatric Psychology. Davey, M., Kissil, K., Lynch, L., Harmon, LR., & Hodgson, N. (2013). A culturally adapted family intervention for African American families coping with parental cancer: Outcomes of a pilot study. Psycho-Oncology, 22,
Deshields, T., Zebrack, B., & Kennedy, V. (2013). The state of psychosocial services in cancer care in the United States. Psycho‐oncology, 22(3),
Lewis, F. M., Casey, S. M., Brandt, P. A., Shands, M. E., & Zahlis, E. H. (2006). The enhancing connections program: Pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer. Psycho-Oncology, 15(6),
Long, K. & Marsland, L., (2011). Family adjustment to childhood cancer: A systematic review. Clinical Child and Family Psychology Review, 14(1),
Continuing education approval now requires that each presentation include five references within the last 5 years.
Please list at least FIVE (5) references for this presentation that are no older than 5 years.
Without these references, your session may NOT be approved for CE credit.
Collaborative Family Healthcare Association 12th Annual Conference

36. Rolland, J.S. (2012). Mastering family challenges with serious illness and disability. In F. Walsh (Ed.) Normal Family Processes. 4th Ed, pp New York: Guilford.
Rolland, J.S. (in press, 2017). Mastering family challenges with illness and disability: An integrative practice model. New York: Guilford Press
Rolland, J.S. & Walsh, F. (2006) Facilitating family resilience with childhood illness
and disability. Current Opinion in Pediatrics, 18:
Williams-Reade, J., Lamson, A, White, M.B., Knight, S., Ballard, S., and Desai, P.P. (2015). “Paediatric Palliative Care: A Review of Needs, Obstacles, and the Future.” Journal of Nursing Management, 23(1), doi: /jonm PMID: .

37. Session Evaluation
Please complete and return the evaluation form to the classroom monitor before leaving this session.
Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference