Calgary Family Intervention Model

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Calgary Family Intervention Model

• (CFIM)

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Purpose

• To promote, improve, and/or sustain effective
  family functioning in three domains
• Affective
• Behavioral
• Cognitive

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• A change in one domain will have an impact on
  another domain
• The most profound and sustaining change will be
  that which occurs in the familys beliefs
  (cognition).
  

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Indications for Family Intervention

• Illness of one family member causing detrimental
  effect on another
• Behavior of family member contributes to problems
  of another
• One family members improved situation results in
  symptoms on another
• Development of emotional, behavioral, or physical
  problem within the context of an already existing
  illness

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• 5. Illness newly diagnosed.
• 6. Marked deterioration of a family members
  condition.
• 7. Chronically ill family member moves home
• 8. Individual or family milestone missed or
  delayed
• 9. Chronically ill family member dies.

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Contraindications

• All family members decline pursuing help as a
  family
• Family desires assistance, but from another
  professional.

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Types of Interventions

• A myriad of interventions nurses can choose from
  to promote or facilitate change in a family
  system
• Interventions must be tailored to fit each family
  and the chosen domain of functioning

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Interventions Should Be

• Related to the issue or problem
• Derived from a hypothesis
• Match the familys style of relating
• Linked to the familys strength
• Consistent with the familys ethnicity/religious
  beliefs
• Consider whether they will be useful or effective
  rather than "right

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Interventive Questions

• Intended to actively effect change in any or all
  three domains
• Circular questions not just assessment questions
  they are family interventions as well

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Circular Questions

• Reveal understanding explanations of problems
• Seek out differences between people, events,
  ideas or beliefs
• Provide new information to the family about
  itself
• Intended to facilitate behavioral change

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Examples of Circular Questions

• Who in your family is managing the situation
  best?
• What is most helpful to your mother in relieving
  her anxiety?

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Types of Circular Question

• Difference explores differences between people,
  between relationships and times.
• Hypothetical useful to help family consider
  alternate actions or meanings
• Behavioral Effect explore connections between
  the effect of one persons behavior on another
• Triadic a questions addressed to a third person
  about the relationships between two other people

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Difference Questions

• Explores differences between people,
  relationships, time, ideas and beliefs

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Sample Difference Questions

• CognitiveWhat information would be most helpful
  to you in order to manage your sons diabetes?
• Affective
• Who is most worried about the heredity
  aspects of diabetes?
• Behavioral
• Who is the best person in getting your son to
  take his insulin?

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Sample Hypothetical or Future Oriented Questions

• Cognitive
• What do you think will happen when you take
  your wife home?
• Affective
• If your wifes illness doesnt improve, who
  will be most affected?
• Behavioral
• If your wife isnt able to come home, what do
  you think your children will do?

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Sample Behavioral Effect Questions

• Cognitive
• How do you make sense of your daughters
  illness?
• Affective
• How do you feel when your daughter cries
  after her injections
• Behavioral
• What do you do when your husband tells you
  that hes afraid to visit your daughter?

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Sample Triadic Questions

• Cognitive
• If your brother were not dealing drugs, what
  would your mother think about his going out with
  his friends?
• Affective
• How does your mother feel when your father
  goes out to the bar with his friends?
• Behavioral
• If your mother were willing to consider
  solutions to her drinking problem what would she
  say to your father?

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Other Interventions

• Cognitive Domain
• Offering information or opinions
• Reframing

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Other Interventions

• Affective Domain
• Validating or normalizing emotional responses
• Drawing forth family supports
• Commendations

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Other Interventions

• Behavioral Domain
• Encouraging family members as caregivers
• Encouraging respite

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Case Study 1

• Jackson family called re their sons impending
  admission to ICU following head injury
  unconsciousness from skiing accident
• Wayne, age 26 years, slid 900 meters down
  mountain
• Family lived about 9 hours drive away from this
  hospital

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Case Study 1

• During the long drive to hospital, Waynes
  71-year-old father developed urinary retention
• Family stopped at a small hospital along the way
  and an indwelling catheter was inserted
• Family arrived at 3 AM, saw Wayne briefly and
  went to find a hotel
• Father required prostate surgery while Wayne in
  hospital