[Solved] Reaction4

Assignment Prompt & Instructions

See attachments

– a month ago

**files (2)**

– ## Help1Instructions.docx

– ## PDF.pdf

**## Help1Instructions.docx**

Instructions: Compose a reaction paper to the attached. This reaction paper must consist of graduate level spelling, grammar, and style.
**This is a reaction paper, not a summary of what the author wrote but rather your analysis and critique of the presented topic.**

· Word document, typed in Times New Roman

· 12 point font

· Single spaced

· One inch margins

· Must be One-two pages in length

· APA 6th edition formatting using the following two references

· Attached article

· Smith-Acuna (2011) Systems Theory in Action: Applications to Individual, Couples, and Family Therapy.

100% NO PLAGIARISM or use of AI

**## PDF.pdf**

Commentary: Reflecting on the History of

Family Systems Work Within the Field of

Pediatric Psychology

Kimberly S. Canter, PHD

Nemours Center for Healthcare Deliver Science, Nemours Children’s Health System

All correspondence concerning this article should be addressed to Kimberly Canter, PhD., Nemours Center for

Healthcare, Deliver Science, 1600 Rockland Road, Wilmington, DE 19081. Email: Kimberly.canter@nemours.org

Received February 9, 2019; revisions received April 22, 2019; accepted April 24, 2019

As a junior investigator committed to advancing the
science surrounding family focused psychosocial inter-
ventions within pediatric psychology, it is both excit-
ing and daunting to take a step back and reflect on the
history of this important topic. The “take away” mes-
sage of Friedrich’s (1977) paper rings loud and clear
today, over four decades after its initial publication—
chronic illness and disability do not exist in a bubble,
but rather have wide-reaching implications for the
whole family unit. The language we use today has
changed and our explorations of family functioning
have become both more explicit and more nuanced;
however, it is not difficult to imagine an investigator
today drawing similar conclusions to Freidrich about
the important role of the entire family within pediatric
psychology.

A recent historical analysis found that the content
code “family system” was the most popular overall
content in the history of The Journal of Pediatric
Psychology, comprising 11% of articles published
since the journal’s inception. The “family system”
code was also the most popular content code in every
decade since the 1970s, with the exception of the
1980s (Canter, Amaro, Noser, & Roberts, 2018). It is
quite clear that our field agrees that the social and
emotional ramifications of having a child with a
chronic illness are just as important to consider for the
whole family system as the illness itself, and this belief
is deeply engrained in many of our research studies.

The widespread recognition of the importance of
the family is also apparent in the hospitals where
many of us work, from the design of patient rooms
with parent sleeping areas, to family advisory coun-
cils, to support programs for siblings. The historical
context in which Freidrich’s review was written is

important to consider, as much that we may take for
granted today (e.g., parents as medical decision mak-
ers for their children) actually represents a seismic
shift away from institutionalization and past schools
of thought about approaches to childhood disease and
disability (Wells, 2011). While Friedrich was making
the case for considering the family and the impact of
disease on the family in his article, today we inherently
recognize the critical and universal importance of
thinking of the child as part of a larger ecological sys-
tem. The field has expanded to consider the various
ways that the child, family, and broader social context
impact and interact with one another in a multidirec-
tional manner. Having “grown up” professionally in
this environment, it was interesting to reflect on a time
when pediatric psychologists were tasked with consid-
ering the role of families.

In many ways, the field has evolved considerably
since the publication of Friedrich’s article in 1977.
While the Friedrich paper acknowledges that some
families are resilient when faced with an illness or dis-
ability, I found the overall tone of the commentary to
be fairly pessimistic with regard to the impact of ill-
ness. In part, this may relate to the unique historical
context from which Freidrich was writing, where
parents were expected to care for their medically com-
plex children without the resources and supports that,
while far from perfect, exist for many families today.
Today, our field’s understanding of the impact of
chronic illness is far more nuanced, with more explicit
models and theories specific to the role of families in
promoting adjustment and adaptation to chronic dis-
eases over time. There is also a more widespread focus
on the idea that many families are resilient (e.g.,
Hilliard, McQuaid, Nabors, & Hood, 2015). While

VC The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 774

Journal of Pediatric Psychology, 44(7), 2019, 774–776

doi: 10.1093/jpepsy/jsz038

Advance Access Publication Date: 17 May 2019

Commentary

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20-)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

we recognize that subgroups of families will experi-
ence significant hardship, we also know that many
families will do well overall following the diagnosis of
a pediatric chronic illness (Kazak, Schneider,
Didonato, & Pai, 2015). Although our understanding
of family trajectories and outcomes is in no way com-
plete, we recognize the importance of adopting resil-
ience and strength-based approaches when providing
clinical care to families and developing research stud-
ies. We also increasingly recognize the importance of
delivering customized, tailored care to families, in-
formed by their specific needs and strengths.

The importance of psychosocial screening has
grown within our field as well, allowing us to identify
the specific needs for a particular family (e.g., through
use of an instrument like the Psychosocial Assessment
Tool) and provide clinical care consistent with those
needs (Kazak et al., 2015). Critically, psychosocial
screening also allows us to recognize the shifting and
evolving needs of families at various time points on an
illness trajectory. When I think about the future of our
field, ongoing work to “match” families to psychoso-
cial interventions that meet their specific needs at a
specific time is an exciting area for future growth.

The explicit focus on the marital relationship and sib-
ling functioning also jumped out to me as I read
Friedrich’s paper. Friedrich commented on the “neglect”
of the healthy siblings in the literature, and identified the
needs of siblings as an important area of focus for our
field. Importantly, and perhaps a bit depressingly, sib-
lings remain understudied and under-supported within
our field. Important research has identified critical needs,
and working to develop interventions for siblings
remains an area for future growth (Long et al., 2018).
The explicit needs of siblings (Gerhardt, Lehmann,
Long, & Alderfer, 2015) and parents/caregivers
(Kearney, Salley, & Muriel, 2015) are highlighted in the
Standards of Psychosocial Care for Parents of Children
with Cancer (Wiener, Kazak, Noll, Patenaude, & Kupst,
2015), and these standards may serve as models for
“calls to action” in other populations as well.

The specific mention of financial strain associated
with pediatric chronic illness was also striking to me,
as this is an area where progress has been more stag-
nant in the sense that financial toxicity remains a sa-
lient and often debilitating concern for families
managing a childhood chronic disease (e.g., Pelletier
& Bona, 2015). Studies focused on cost reduction and
cost savings for both families and the healthcare sys-
tem will remain an important future direction for our
field (e.g., McGrady, Echman, O’Brien, & Pai, 2018),
and resources such as financial counseling and guid-
ance are important to consider clinically. Challenges
related to representation in family focused interven-
tion research also remain true today. Although our
attributions may be different than those described by

the author, we continue to struggle with overrepresen-
tation of mothers in research compared to fathers and
other caregivers. Working to expand our research to
include the perspectives and experiences of more di-
verse families—including diversity in terms of race,
ethnicity, and family structure—will only strengthen
the impact we have on the understanding and improv-
ing the care of children with chronic illnesses and their
families (Alderfer, 2017).

As I look to the future of our field after reflecting
on the past, I am excited by all of the opportunities to
build on the foundation introduced by Friedrich.
Advanced statistical methods and new approaches to
data analysis hold great promise for developing more
sensitive and nuanced understandings of the experien-
ces of families. Novel intervention delivery modalities
(e.g., eHealth interventions) and multisite collabora-
tive studies afford us the opportunity to expand the
reach of evidence-based interventions. A movement
toward patient-engaged research also provides the op-
portunity to partner with families to set research agen-
das that truly meet their needs at different time points,
and implementation science and other approaches to
more rapidly disseminate quality care are particularly
exciting to me as I think about the future. I recognize
that, in many ways, these ideas are just the tip of the
iceberg—and I look forward to seeing where the field
moves in the years to come.

References

Alderfer, M. (2017). Commentary: Family processes and out-
comes: research advances and future directions. Journal of
Pediatric Psychology, 42, 125–129.

Canter, K., Amaro, C., Noser, A., & Roberts, M. (2018).
Historical analysis: The Journal of Pediatric Psychology
from 1976 to 2015. Journal of Pediatric Psychology, 43,
21–30.

Friedrich, W. (1977). Ameliorating the psychological impact
of chronic physical disease on the child and family. Journal
of Pediatric Psychology, 2, 26–31.

Gerhardt, C. A., Lehmann, V., Long, K. A., & Alderfer, M.
A. (2015). Supporting siblings as a standard of care in pe-
diatric oncology. Pediatric Blood & Cancer, 62,
S750–S804.

Hilliard, M., McQuaid, E., Nabors, L., & Hood, K. (2015).
Resilience in youth and families living with pediatric
health and developmental conditions: introduction to the
special issue on resilience. Journal of Pediatric Psychology,
40, 835–839.

Kazak, A., Schneider, S., Didonato, S., & Pai, A. (2015).
Family psychosocial risk screening guided by the Pediatric
Psychosocial Preventative Health Model (PPPHM) using
the Psychosocial Assessment Tool (PAT). Acta
Oncologica, 54, 574–580.

Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015).
Standards of psychosocial care for parents of children with
cancer. Pediatric Blood & Cancer, 62, S632–S683.

Reflecting on the History of Family Systems 775

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20-)

[Deleted Text: ,](https://www.sweetstudy.com/questions/Deleted%20Text:%20,)

[Deleted Text: s](https://www.sweetstudy.com/questions/Deleted%20Text:%20s)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

Long, K., Lehmann, V., Gerhardt, C., Carpenter, A.,
Marsland, A., & Alderfer, M. (2018). Psychosocial func-
tioning and risk factors among siblings of children with
cancer: an updated systematic review. Psychooncology,
27, 1467–1479.

McGrady, M. E., Eckman, M. H., O’Brien, M. M., & Pai, A.
L. H. (2018). Cost-effectiveness analysis of an adherence-
promotion intervention for children with leukemia: a
Markov model-based simulation. Journal of Pediatric
Psychology, 43, 758–768.

Pelletier, W., & Bona, K. (2015). Assessment of financial
burden as a standard of care in pediatric oncology.
Pediatric Blood & Cancer, 62, S619–S631.

Wiener, L., Kazak, A. E., Noll, R. B., Farkas Patenaude, A.,
& Kupst, M. J. (2015). Standards for the psychosocial care
of children with cancer and their families: an introduction
to the special issue. Pediatric Blood & Cancer, 62,
S419–S424.

Wells, N. (2011). Historical perspective on family-centered
care. Academic Pediatrics, 11, 100–102.

776 Canter

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

**## PDF.pdf**

Commentary: Reflecting on the History of

Family Systems Work Within the Field of

Pediatric Psychology

Kimberly S. Canter, PHD

Nemours Center for Healthcare Deliver Science, Nemours Children’s Health System

All correspondence concerning this article should be addressed to Kimberly Canter, PhD., Nemours Center for

Healthcare, Deliver Science, 1600 Rockland Road, Wilmington, DE 19081. Email: Kimberly.canter@nemours.org

Received February 9, 2019; revisions received April 22, 2019; accepted April 24, 2019

As a junior investigator committed to advancing the
science surrounding family focused psychosocial inter-
ventions within pediatric psychology, it is both excit-
ing and daunting to take a step back and reflect on the
history of this important topic. The “take away” mes-
sage of Friedrich’s (1977) paper rings loud and clear
today, over four decades after its initial publication—
chronic illness and disability do not exist in a bubble,
but rather have wide-reaching implications for the
whole family unit. The language we use today has
changed and our explorations of family functioning
have become both more explicit and more nuanced;
however, it is not difficult to imagine an investigator
today drawing similar conclusions to Freidrich about
the important role of the entire family within pediatric
psychology.

A recent historical analysis found that the content
code “family system” was the most popular overall
content in the history of The Journal of Pediatric
Psychology, comprising 11% of articles published
since the journal’s inception. The “family system”
code was also the most popular content code in every
decade since the 1970s, with the exception of the
1980s (Canter, Amaro, Noser, & Roberts, 2018). It is
quite clear that our field agrees that the social and
emotional ramifications of having a child with a
chronic illness are just as important to consider for the
whole family system as the illness itself, and this belief
is deeply engrained in many of our research studies.

The widespread recognition of the importance of
the family is also apparent in the hospitals where
many of us work, from the design of patient rooms
with parent sleeping areas, to family advisory coun-
cils, to support programs for siblings. The historical
context in which Freidrich’s review was written is

important to consider, as much that we may take for
granted today (e.g., parents as medical decision mak-
ers for their children) actually represents a seismic
shift away from institutionalization and past schools
of thought about approaches to childhood disease and
disability (Wells, 2011). While Friedrich was making
the case for considering the family and the impact of
disease on the family in his article, today we inherently
recognize the critical and universal importance of
thinking of the child as part of a larger ecological sys-
tem. The field has expanded to consider the various
ways that the child, family, and broader social context
impact and interact with one another in a multidirec-
tional manner. Having “grown up” professionally in
this environment, it was interesting to reflect on a time
when pediatric psychologists were tasked with consid-
ering the role of families.

In many ways, the field has evolved considerably
since the publication of Friedrich’s article in 1977.
While the Friedrich paper acknowledges that some
families are resilient when faced with an illness or dis-
ability, I found the overall tone of the commentary to
be fairly pessimistic with regard to the impact of ill-
ness. In part, this may relate to the unique historical
context from which Freidrich was writing, where
parents were expected to care for their medically com-
plex children without the resources and supports that,
while far from perfect, exist for many families today.
Today, our field’s understanding of the impact of
chronic illness is far more nuanced, with more explicit
models and theories specific to the role of families in
promoting adjustment and adaptation to chronic dis-
eases over time. There is also a more widespread focus
on the idea that many families are resilient (e.g.,
Hilliard, McQuaid, Nabors, & Hood, 2015). While

VC The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 774

Journal of Pediatric Psychology, 44(7), 2019, 774–776

doi: 10.1093/jpepsy/jsz038

Advance Access Publication Date: 17 May 2019

Commentary

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20-)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

we recognize that subgroups of families will experi-
ence significant hardship, we also know that many
families will do well overall following the diagnosis of
a pediatric chronic illness (Kazak, Schneider,
Didonato, & Pai, 2015). Although our understanding
of family trajectories and outcomes is in no way com-
plete, we recognize the importance of adopting resil-
ience and strength-based approaches when providing
clinical care to families and developing research stud-
ies. We also increasingly recognize the importance of
delivering customized, tailored care to families, in-
formed by their specific needs and strengths.

The importance of psychosocial screening has
grown within our field as well, allowing us to identify
the specific needs for a particular family (e.g., through
use of an instrument like the Psychosocial Assessment
Tool) and provide clinical care consistent with those
needs (Kazak et al., 2015). Critically, psychosocial
screening also allows us to recognize the shifting and
evolving needs of families at various time points on an
illness trajectory. When I think about the future of our
field, ongoing work to “match” families to psychoso-
cial interventions that meet their specific needs at a
specific time is an exciting area for future growth.

The explicit focus on the marital relationship and sib-
ling functioning also jumped out to me as I read
Friedrich’s paper. Friedrich commented on the “neglect”
of the healthy siblings in the literature, and identified the
needs of siblings as an important area of focus for our
field. Importantly, and perhaps a bit depressingly, sib-
lings remain understudied and under-supported within
our field. Important research has identified critical needs,
and working to develop interventions for siblings
remains an area for future growth (Long et al., 2018).
The explicit needs of siblings (Gerhardt, Lehmann,
Long, & Alderfer, 2015) and parents/caregivers
(Kearney, Salley, & Muriel, 2015) are highlighted in the
Standards of Psychosocial Care for Parents of Children
with Cancer (Wiener, Kazak, Noll, Patenaude, & Kupst,
2015), and these standards may serve as models for
“calls to action” in other populations as well.

The specific mention of financial strain associated
with pediatric chronic illness was also striking to me,
as this is an area where progress has been more stag-
nant in the sense that financial toxicity remains a sa-
lient and often debilitating concern for families
managing a childhood chronic disease (e.g., Pelletier
& Bona, 2015). Studies focused on cost reduction and
cost savings for both families and the healthcare sys-
tem will remain an important future direction for our
field (e.g., McGrady, Echman, O’Brien, & Pai, 2018),
and resources such as financial counseling and guid-
ance are important to consider clinically. Challenges
related to representation in family focused interven-
tion research also remain true today. Although our
attributions may be different than those described by

the author, we continue to struggle with overrepresen-
tation of mothers in research compared to fathers and
other caregivers. Working to expand our research to
include the perspectives and experiences of more di-
verse families—including diversity in terms of race,
ethnicity, and family structure—will only strengthen
the impact we have on the understanding and improv-
ing the care of children with chronic illnesses and their
families (Alderfer, 2017).

As I look to the future of our field after reflecting
on the past, I am excited by all of the opportunities to
build on the foundation introduced by Friedrich.
Advanced statistical methods and new approaches to
data analysis hold great promise for developing more
sensitive and nuanced understandings of the experien-
ces of families. Novel intervention delivery modalities
(e.g., eHealth interventions) and multisite collabora-
tive studies afford us the opportunity to expand the
reach of evidence-based interventions. A movement
toward patient-engaged research also provides the op-
portunity to partner with families to set research agen-
das that truly meet their needs at different time points,
and implementation science and other approaches to
more rapidly disseminate quality care are particularly
exciting to me as I think about the future. I recognize
that, in many ways, these ideas are just the tip of the
iceberg—and I look forward to seeing where the field
moves in the years to come.

References

Alderfer, M. (2017). Commentary: Family processes and out-
comes: research advances and future directions. Journal of
Pediatric Psychology, 42, 125–129.

Canter, K., Amaro, C., Noser, A., & Roberts, M. (2018).
Historical analysis: The Journal of Pediatric Psychology
from 1976 to 2015. Journal of Pediatric Psychology, 43,
21–30.

Friedrich, W. (1977). Ameliorating the psychological impact
of chronic physical disease on the child and family. Journal
of Pediatric Psychology, 2, 26–31.

Gerhardt, C. A., Lehmann, V., Long, K. A., & Alderfer, M.
A. (2015). Supporting siblings as a standard of care in pe-
diatric oncology. Pediatric Blood & Cancer, 62,
S750–S804.

Hilliard, M., McQuaid, E., Nabors, L., & Hood, K. (2015).
Resilience in youth and families living with pediatric
health and developmental conditions: introduction to the
special issue on resilience. Journal of Pediatric Psychology,
40, 835–839.

Kazak, A., Schneider, S., Didonato, S., & Pai, A. (2015).
Family psychosocial risk screening guided by the Pediatric
Psychosocial Preventative Health Model (PPPHM) using
the Psychosocial Assessment Tool (PAT). Acta
Oncologica, 54, 574–580.

Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015).
Standards of psychosocial care for parents of children with
cancer. Pediatric Blood & Cancer, 62, S632–S683.

Reflecting on the History of Family Systems 775

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20-)

[Deleted Text: ,](https://www.sweetstudy.com/questions/Deleted%20Text:%20,)

[Deleted Text: s](https://www.sweetstudy.com/questions/Deleted%20Text:%20s)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

Long, K., Lehmann, V., Gerhardt, C., Carpenter, A.,
Marsland, A., & Alderfer, M. (2018). Psychosocial func-
tioning and risk factors among siblings of children with
cancer: an updated systematic review. Psychooncology,
27, 1467–1479.

McGrady, M. E., Eckman, M. H., O’Brien, M. M., & Pai, A.
L. H. (2018). Cost-effectiveness analysis of an adherence-
promotion intervention for children with leukemia: a
Markov model-based simulation. Journal of Pediatric
Psychology, 43, 758–768.

Pelletier, W., & Bona, K. (2015). Assessment of financial
burden as a standard of care in pediatric oncology.
Pediatric Blood & Cancer, 62, S619–S631.

Wiener, L., Kazak, A. E., Noll, R. B., Farkas Patenaude, A.,
& Kupst, M. J. (2015). Standards for the psychosocial care
of children with cancer and their families: an introduction
to the special issue. Pediatric Blood & Cancer, 62,
S419–S424.

Wells, N. (2011). Historical perspective on family-centered
care. Academic Pediatrics, 11, 100–102.

776 Canter

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

**## Help1Instructions.docx**

Instructions: Compose a reaction paper to the attached. This reaction paper must consist of graduate level spelling, grammar, and style.
**This is a reaction paper, not a summary of what the author wrote but rather your analysis and critique of the presented topic.**

· Word document, typed in Times New Roman

· 12 point font

· Single spaced

· One inch margins

· Must be One-two pages in length

· APA 6th edition formatting using the following two references

· Attached article

· Smith-Acuna (2011) Systems Theory in Action: Applications to Individual, Couples, and Family Therapy.

100% NO PLAGIARISM or use of AI

**## PDF.pdf**

Commentary: Reflecting on the History of

Family Systems Work Within the Field of

Pediatric Psychology

Kimberly S. Canter, PHD

Nemours Center for Healthcare Deliver Science, Nemours Children’s Health System

All correspondence concerning this article should be addressed to Kimberly Canter, PhD., Nemours Center for

Healthcare, Deliver Science, 1600 Rockland Road, Wilmington, DE 19081. Email: Kimberly.canter@nemours.org

Received February 9, 2019; revisions received April 22, 2019; accepted April 24, 2019

As a junior investigator committed to advancing the
science surrounding family focused psychosocial inter-
ventions within pediatric psychology, it is both excit-
ing and daunting to take a step back and reflect on the
history of this important topic. The “take away” mes-
sage of Friedrich’s (1977) paper rings loud and clear
today, over four decades after its initial publication—
chronic illness and disability do not exist in a bubble,
but rather have wide-reaching implications for the
whole family unit. The language we use today has
changed and our explorations of family functioning
have become both more explicit and more nuanced;
however, it is not difficult to imagine an investigator
today drawing similar conclusions to Freidrich about
the important role of the entire family within pediatric
psychology.

A recent historical analysis found that the content
code “family system” was the most popular overall
content in the history of The Journal of Pediatric
Psychology, comprising 11% of articles published
since the journal’s inception. The “family system”
code was also the most popular content code in every
decade since the 1970s, with the exception of the
1980s (Canter, Amaro, Noser, & Roberts, 2018). It is
quite clear that our field agrees that the social and
emotional ramifications of having a child with a
chronic illness are just as important to consider for the
whole family system as the illness itself, and this belief
is deeply engrained in many of our research studies.

The widespread recognition of the importance of
the family is also apparent in the hospitals where
many of us work, from the design of patient rooms
with parent sleeping areas, to family advisory coun-
cils, to support programs for siblings. The historical
context in which Freidrich’s review was written is

important to consider, as much that we may take for
granted today (e.g., parents as medical decision mak-
ers for their children) actually represents a seismic
shift away from institutionalization and past schools
of thought about approaches to childhood disease and
disability (Wells, 2011). While Friedrich was making
the case for considering the family and the impact of
disease on the family in his article, today we inherently
recognize the critical and universal importance of
thinking of the child as part of a larger ecological sys-
tem. The field has expanded to consider the various
ways that the child, family, and broader social context
impact and interact with one another in a multidirec-
tional manner. Having “grown up” professionally in
this environment, it was interesting to reflect on a time
when pediatric psychologists were tasked with consid-
ering the role of families.

In many ways, the field has evolved considerably
since the publication of Friedrich’s article in 1977.
While the Friedrich paper acknowledges that some
families are resilient when faced with an illness or dis-
ability, I found the overall tone of the commentary to
be fairly pessimistic with regard to the impact of ill-
ness. In part, this may relate to the unique historical
context from which Freidrich was writing, where
parents were expected to care for their medically com-
plex children without the resources and supports that,
while far from perfect, exist for many families today.
Today, our field’s understanding of the impact of
chronic illness is far more nuanced, with more explicit
models and theories specific to the role of families in
promoting adjustment and adaptation to chronic dis-
eases over time. There is also a more widespread focus
on the idea that many families are resilient (e.g.,
Hilliard, McQuaid, Nabors, & Hood, 2015). While

VC The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 774

Journal of Pediatric Psychology, 44(7), 2019, 774–776

doi: 10.1093/jpepsy/jsz038

Advance Access Publication Date: 17 May 2019

Commentary

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20-)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

we recognize that subgroups of families will experi-
ence significant hardship, we also know that many
families will do well overall following the diagnosis of
a pediatric chronic illness (Kazak, Schneider,
Didonato, & Pai, 2015). Although our understanding
of family trajectories and outcomes is in no way com-
plete, we recognize the importance of adopting resil-
ience and strength-based approaches when providing
clinical care to families and developing research stud-
ies. We also increasingly recognize the importance of
delivering customized, tailored care to families, in-
formed by their specific needs and strengths.

The importance of psychosocial screening has
grown within our field as well, allowing us to identify
the specific needs for a particular family (e.g., through
use of an instrument like the Psychosocial Assessment
Tool) and provide clinical care consistent with those
needs (Kazak et al., 2015). Critically, psychosocial
screening also allows us to recognize the shifting and
evolving needs of families at various time points on an
illness trajectory. When I think about the future of our
field, ongoing work to “match” families to psychoso-
cial interventions that meet their specific needs at a
specific time is an exciting area for future growth.

The explicit focus on the marital relationship and sib-
ling functioning also jumped out to me as I read
Friedrich’s paper. Friedrich commented on the “neglect”
of the healthy siblings in the literature, and identified the
needs of siblings as an important area of focus for our
field. Importantly, and perhaps a bit depressingly, sib-
lings remain understudied and under-supported within
our field. Important research has identified critical needs,
and working to develop interventions for siblings
remains an area for future growth (Long et al., 2018).
The explicit needs of siblings (Gerhardt, Lehmann,
Long, & Alderfer, 2015) and parents/caregivers
(Kearney, Salley, & Muriel, 2015) are highlighted in the
Standards of Psychosocial Care for Parents of Children
with Cancer (Wiener, Kazak, Noll, Patenaude, & Kupst,
2015), and these standards may serve as models for
“calls to action” in other populations as well.

The specific mention of financial strain associated
with pediatric chronic illness was also striking to me,
as this is an area where progress has been more stag-
nant in the sense that financial toxicity remains a sa-
lient and often debilitating concern for families
managing a childhood chronic disease (e.g., Pelletier
& Bona, 2015). Studies focused on cost reduction and
cost savings for both families and the healthcare sys-
tem will remain an important future direction for our
field (e.g., McGrady, Echman, O’Brien, & Pai, 2018),
and resources such as financial counseling and guid-
ance are important to consider clinically. Challenges
related to representation in family focused interven-
tion research also remain true today. Although our
attributions may be different than those described by

the author, we continue to struggle with overrepresen-
tation of mothers in research compared to fathers and
other caregivers. Working to expand our research to
include the perspectives and experiences of more di-
verse families—including diversity in terms of race,
ethnicity, and family structure—will only strengthen
the impact we have on the understanding and improv-
ing the care of children with chronic illnesses and their
families (Alderfer, 2017).

As I look to the future of our field after reflecting
on the past, I am excited by all of the opportunities to
build on the foundation introduced by Friedrich.
Advanced statistical methods and new approaches to
data analysis hold great promise for developing more
sensitive and nuanced understandings of the experien-
ces of families. Novel intervention delivery modalities
(e.g., eHealth interventions) and multisite collabora-
tive studies afford us the opportunity to expand the
reach of evidence-based interventions. A movement
toward patient-engaged research also provides the op-
portunity to partner with families to set research agen-
das that truly meet their needs at different time points,
and implementation science and other approaches to
more rapidly disseminate quality care are particularly
exciting to me as I think about the future. I recognize
that, in many ways, these ideas are just the tip of the
iceberg—and I look forward to seeing where the field
moves in the years to come.

References

Alderfer, M. (2017). Commentary: Family processes and out-
comes: research advances and future directions. Journal of
Pediatric Psychology, 42, 125–129.

Canter, K., Amaro, C., Noser, A., & Roberts, M. (2018).
Historical analysis: The Journal of Pediatric Psychology
from 1976 to 2015. Journal of Pediatric Psychology, 43,
21–30.

Friedrich, W. (1977). Ameliorating the psychological impact
of chronic physical disease on the child and family. Journal
of Pediatric Psychology, 2, 26–31.

Gerhardt, C. A., Lehmann, V., Long, K. A., & Alderfer, M.
A. (2015). Supporting siblings as a standard of care in pe-
diatric oncology. Pediatric Blood & Cancer, 62,
S750–S804.

Hilliard, M., McQuaid, E., Nabors, L., & Hood, K. (2015).
Resilience in youth and families living with pediatric
health and developmental conditions: introduction to the
special issue on resilience. Journal of Pediatric Psychology,
40, 835–839.

Kazak, A., Schneider, S., Didonato, S., & Pai, A. (2015).
Family psychosocial risk screening guided by the Pediatric
Psychosocial Preventative Health Model (PPPHM) using
the Psychosocial Assessment Tool (PAT). Acta
Oncologica, 54, 574–580.

Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015).
Standards of psychosocial care for parents of children with
cancer. Pediatric Blood & Cancer, 62, S632–S683.

Reflecting on the History of Family Systems 775

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20-)

[Deleted Text: ,](https://www.sweetstudy.com/questions/Deleted%20Text:%20,)

[Deleted Text: s](https://www.sweetstudy.com/questions/Deleted%20Text:%20s)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

Long, K., Lehmann, V., Gerhardt, C., Carpenter, A.,
Marsland, A., & Alderfer, M. (2018). Psychosocial func-
tioning and risk factors among siblings of children with
cancer: an updated systematic review. Psychooncology,
27, 1467–1479.

McGrady, M. E., Eckman, M. H., O’Brien, M. M., & Pai, A.
L. H. (2018). Cost-effectiveness analysis of an adherence-
promotion intervention for children with leukemia: a
Markov model-based simulation. Journal of Pediatric
Psychology, 43, 758–768.

Pelletier, W., & Bona, K. (2015). Assessment of financial
burden as a standard of care in pediatric oncology.
Pediatric Blood & Cancer, 62, S619–S631.

Wiener, L., Kazak, A. E., Noll, R. B., Farkas Patenaude, A.,
& Kupst, M. J. (2015). Standards for the psychosocial care
of children with cancer and their families: an introduction
to the special issue. Pediatric Blood & Cancer, 62,
S419–S424.

Wells, N. (2011). Historical perspective on family-centered
care. Academic Pediatrics, 11, 100–102.

776 Canter

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

**## Help1Instructions.docx**

Instructions: Compose a reaction paper to the attached. This reaction paper must consist of graduate level spelling, grammar, and style.
**This is a reaction paper, not a summary of what the author wrote but rather your analysis and critique of the presented topic.**

· Word document, typed in Times New Roman

· 12 point font

· Single spaced

· One inch margins

· Must be One-two pages in length

· APA 6th edition formatting using the following two references

· Attached article

· Smith-Acuna (2011) Systems Theory in Action: Applications to Individual, Couples, and Family Therapy.

100% NO PLAGIARISM or use of AI

**## PDF.pdf**

Commentary: Reflecting on the History of

Family Systems Work Within the Field of

Pediatric Psychology

Kimberly S. Canter, PHD

Nemours Center for Healthcare Deliver Science, Nemours Children’s Health System

All correspondence concerning this article should be addressed to Kimberly Canter, PhD., Nemours Center for

Healthcare, Deliver Science, 1600 Rockland Road, Wilmington, DE 19081. Email: Kimberly.canter@nemours.org

Received February 9, 2019; revisions received April 22, 2019; accepted April 24, 2019

As a junior investigator committed to advancing the
science surrounding family focused psychosocial inter-
ventions within pediatric psychology, it is both excit-
ing and daunting to take a step back and reflect on the
history of this important topic. The “take away” mes-
sage of Friedrich’s (1977) paper rings loud and clear
today, over four decades after its initial publication—
chronic illness and disability do not exist in a bubble,
but rather have wide-reaching implications for the
whole family unit. The language we use today has
changed and our explorations of family functioning
have become both more explicit and more nuanced;
however, it is not difficult to imagine an investigator
today drawing similar conclusions to Freidrich about
the important role of the entire family within pediatric
psychology.

A recent historical analysis found that the content
code “family system” was the most popular overall
content in the history of The Journal of Pediatric
Psychology, comprising 11% of articles published
since the journal’s inception. The “family system”
code was also the most popular content code in every
decade since the 1970s, with the exception of the
1980s (Canter, Amaro, Noser, & Roberts, 2018). It is
quite clear that our field agrees that the social and
emotional ramifications of having a child with a
chronic illness are just as important to consider for the
whole family system as the illness itself, and this belief
is deeply engrained in many of our research studies.

The widespread recognition of the importance of
the family is also apparent in the hospitals where
many of us work, from the design of patient rooms
with parent sleeping areas, to family advisory coun-
cils, to support programs for siblings. The historical
context in which Freidrich’s review was written is

important to consider, as much that we may take for
granted today (e.g., parents as medical decision mak-
ers for their children) actually represents a seismic
shift away from institutionalization and past schools
of thought about approaches to childhood disease and
disability (Wells, 2011). While Friedrich was making
the case for considering the family and the impact of
disease on the family in his article, today we inherently
recognize the critical and universal importance of
thinking of the child as part of a larger ecological sys-
tem. The field has expanded to consider the various
ways that the child, family, and broader social context
impact and interact with one another in a multidirec-
tional manner. Having “grown up” professionally in
this environment, it was interesting to reflect on a time
when pediatric psychologists were tasked with consid-
ering the role of families.

In many ways, the field has evolved considerably
since the publication of Friedrich’s article in 1977.
While the Friedrich paper acknowledges that some
families are resilient when faced with an illness or dis-
ability, I found the overall tone of the commentary to
be fairly pessimistic with regard to the impact of ill-
ness. In part, this may relate to the unique historical
context from which Freidrich was writing, where
parents were expected to care for their medically com-
plex children without the resources and supports that,
while far from perfect, exist for many families today.
Today, our field’s understanding of the impact of
chronic illness is far more nuanced, with more explicit
models and theories specific to the role of families in
promoting adjustment and adaptation to chronic dis-
eases over time. There is also a more widespread focus
on the idea that many families are resilient (e.g.,
Hilliard, McQuaid, Nabors, & Hood, 2015). While

VC The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 774

Journal of Pediatric Psychology, 44(7), 2019, 774–776

doi: 10.1093/jpepsy/jsz038

Advance Access Publication Date: 17 May 2019

Commentary

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20-)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

we recognize that subgroups of families will experi-
ence significant hardship, we also know that many
families will do well overall following the diagnosis of
a pediatric chronic illness (Kazak, Schneider,
Didonato, & Pai, 2015). Although our understanding
of family trajectories and outcomes is in no way com-
plete, we recognize the importance of adopting resil-
ience and strength-based approaches when providing
clinical care to families and developing research stud-
ies. We also increasingly recognize the importance of
delivering customized, tailored care to families, in-
formed by their specific needs and strengths.

The importance of psychosocial screening has
grown within our field as well, allowing us to identify
the specific needs for a particular family (e.g., through
use of an instrument like the Psychosocial Assessment
Tool) and provide clinical care consistent with those
needs (Kazak et al., 2015). Critically, psychosocial
screening also allows us to recognize the shifting and
evolving needs of families at various time points on an
illness trajectory. When I think about the future of our
field, ongoing work to “match” families to psychoso-
cial interventions that meet their specific needs at a
specific time is an exciting area for future growth.

The explicit focus on the marital relationship and sib-
ling functioning also jumped out to me as I read
Friedrich’s paper. Friedrich commented on the “neglect”
of the healthy siblings in the literature, and identified the
needs of siblings as an important area of focus for our
field. Importantly, and perhaps a bit depressingly, sib-
lings remain understudied and under-supported within
our field. Important research has identified critical needs,
and working to develop interventions for siblings
remains an area for future growth (Long et al., 2018).
The explicit needs of siblings (Gerhardt, Lehmann,
Long, & Alderfer, 2015) and parents/caregivers
(Kearney, Salley, & Muriel, 2015) are highlighted in the
Standards of Psychosocial Care for Parents of Children
with Cancer (Wiener, Kazak, Noll, Patenaude, & Kupst,
2015), and these standards may serve as models for
“calls to action” in other populations as well.

The specific mention of financial strain associated
with pediatric chronic illness was also striking to me,
as this is an area where progress has been more stag-
nant in the sense that financial toxicity remains a sa-
lient and often debilitating concern for families
managing a childhood chronic disease (e.g., Pelletier
& Bona, 2015). Studies focused on cost reduction and
cost savings for both families and the healthcare sys-
tem will remain an important future direction for our
field (e.g., McGrady, Echman, O’Brien, & Pai, 2018),
and resources such as financial counseling and guid-
ance are important to consider clinically. Challenges
related to representation in family focused interven-
tion research also remain true today. Although our
attributions may be different than those described by

the author, we continue to struggle with overrepresen-
tation of mothers in research compared to fathers and
other caregivers. Working to expand our research to
include the perspectives and experiences of more di-
verse families—including diversity in terms of race,
ethnicity, and family structure—will only strengthen
the impact we have on the understanding and improv-
ing the care of children with chronic illnesses and their
families (Alderfer, 2017).

As I look to the future of our field after reflecting
on the past, I am excited by all of the opportunities to
build on the foundation introduced by Friedrich.
Advanced statistical methods and new approaches to
data analysis hold great promise for developing more
sensitive and nuanced understandings of the experien-
ces of families. Novel intervention delivery modalities
(e.g., eHealth interventions) and multisite collabora-
tive studies afford us the opportunity to expand the
reach of evidence-based interventions. A movement
toward patient-engaged research also provides the op-
portunity to partner with families to set research agen-
das that truly meet their needs at different time points,
and implementation science and other approaches to
more rapidly disseminate quality care are particularly
exciting to me as I think about the future. I recognize
that, in many ways, these ideas are just the tip of the
iceberg—and I look forward to seeing where the field
moves in the years to come.

References

Alderfer, M. (2017). Commentary: Family processes and out-
comes: research advances and future directions. Journal of
Pediatric Psychology, 42, 125–129.

Canter, K., Amaro, C., Noser, A., & Roberts, M. (2018).
Historical analysis: The Journal of Pediatric Psychology
from 1976 to 2015. Journal of Pediatric Psychology, 43,
21–30.

Friedrich, W. (1977). Ameliorating the psychological impact
of chronic physical disease on the child and family. Journal
of Pediatric Psychology, 2, 26–31.

Gerhardt, C. A., Lehmann, V., Long, K. A., & Alderfer, M.
A. (2015). Supporting siblings as a standard of care in pe-
diatric oncology. Pediatric Blood & Cancer, 62,
S750–S804.

Hilliard, M., McQuaid, E., Nabors, L., & Hood, K. (2015).
Resilience in youth and families living with pediatric
health and developmental conditions: introduction to the
special issue on resilience. Journal of Pediatric Psychology,
40, 835–839.

Kazak, A., Schneider, S., Didonato, S., & Pai, A. (2015).
Family psychosocial risk screening guided by the Pediatric
Psychosocial Preventative Health Model (PPPHM) using
the Psychosocial Assessment Tool (PAT). Acta
Oncologica, 54, 574–580.

Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015).
Standards of psychosocial care for parents of children with
cancer. Pediatric Blood & Cancer, 62, S632–S683.

Reflecting on the History of Family Systems 775

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

[Deleted Text: -](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20-)

[Deleted Text: ,](https://www.sweetstudy.com/questions/Deleted%20Text:%20,)

[Deleted Text: s](https://www.sweetstudy.com/questions/Deleted%20Text:%20s)

[Deleted Text: –](https://www.sweetstudy.com/questions/Deleted%20Text:%20%20–)

Long, K., Lehmann, V., Gerhardt, C., Carpenter, A.,
Marsland, A., & Alderfer, M. (2018). Psychosocial func-
tioning and risk factors among siblings of children with
cancer: an updated systematic review. Psychooncology,
27, 1467–1479.

McGrady, M. E., Eckman, M. H., O’Brien, M. M., & Pai, A.
L. H. (2018). Cost-effectiveness analysis of an adherence-
promotion intervention for children with leukemia: a
Markov model-based simulation. Journal of Pediatric
Psychology, 43, 758–768.

Pelletier, W., & Bona, K. (2015). Assessment of financial
burden as a standard of care in pediatric oncology.
Pediatric Blood & Cancer, 62, S619–S631.

Wiener, L., Kazak, A. E., Noll, R. B., Farkas Patenaude, A.,
& Kupst, M. J. (2015). Standards for the psychosocial care
of children with cancer and their families: an introduction
to the special issue. Pediatric Blood & Cancer, 62,
S419–S424.

Wells, N. (2011). Historical perspective on family-centered
care. Academic Pediatrics, 11, 100–102.

776 Canter

D
ow

nloaded from
academ

ic.oup.com
/jpepsy/article/44/7/774/5491108 by Alabam

a D
epartm

ent of Public H
ealth user on 16 Septem

ber 2026