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## Complete Summary

#### GUIDELINE TITLE

Practice parameter for the assessment of the family.

#### BIBLIOGRAPHIC SOURCE(S)

Josephson AM, AACAP Work Group on Quality Issues. Practice parameter for
the assessment of the family. J Am Acad Child Adolesc Psychiatry 2007
Jul;46(7):922-37. \[50 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17581454)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Psychiatric disorders

#### GUIDELINE CATEGORY

Evaluation

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics\
Psychiatry

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To assist clinicians in gathering enough family data to develop a
rational treatment plan

#### TARGET POPULATION

Children and adolescents with psychiatric disorders and their families

#### INTERVENTIONS AND PRACTICES CONSIDERED

Assessment of the patient\'s family including:

1.  Gathering historical and current information about the family and
    basic elements of family functioning

2.  Observation of the patient\'s interaction with caretakers

3.  Interviews with family members including questions regarding family
    risk factors for specific disorders

4.  Use of ancillary techniques if indicated, such as genogram and
    family timeline

5.  Assessment of family\'s cultural background

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The literature review included bibliographies of book chapters, review
articles, source materials from the Committee on the Family of the
American Academy of Child and Adolescent Psychiatry, and consultations
with clinicians and researchers with specific expertise in this area. A
review of Medline psychiatry abstracts from 1985 to 2005 and PsycInfo
from 1990 to 2005 was conducted with the search phrase \"family
assessment,\" which yielded about 160 articles.

#### NUMBER OF SOURCE DOCUMENTS

160 articles

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The American Academy of Child and Adolescent Psychiatry (AACAP) develops
both patient-oriented and clinician-oriented practice parameters.
Patient-oriented parameters provide recommendations to guide clinicians
toward the best treatment practices. Treatment recommendations are based
both on empirical evidence and clinical consensus and are graded
according to the strength of the empirical and clinical support.
Clinician-oriented parameters provide clinicians with the information
(stated as principles) needed to develop practice-based skills. Although
empirical evidence may be available to support certain principles,
principles are primarily based on expert opinion and clinical
experience.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This parameter was reviewed at the Member Forum at the Annual Meeting of
the American Academy of Child and Adolescent Psychiatry (AACAP) in
October 2005. From July 2006 through September 2006, this parameter was
reviewed by a Consensus Group convened by the Work Group on Quality
Issues.

This practice parameter was approved by the AACAP Council on October 11,
2006.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Principle 1**. The Psychiatric Assessment of a Child or Adolescent
Must Include Both Historical and Current Information about the Family
and Its Functioning, Typically Gathered from the Child and Primary
Caretaker(s).

**Structured Guide to Eliciting Family History**

Demographic data should document family moves, changes in family
composition, socioeconomic circumstances, family illness, legal
difficulties, and altered family structure.

The family\'s historical report should be supplemented by ancillary
sources of data. These sources can include history from other
professionals who have evaluated or treated family members, as well as
information from schools, local social service agencies, the courts, and
child welfare agencies. These sources often provide a broader
perspective of family functioning by providing information that the
family either sees as unimportant or is unable or unwilling to
communicate clearly to the clinician. Parents must give their consent
for clinicians to gather history from these sources, with an
adolescent\'s assent also prudent practice.

Gathering family history by interviewing ex-spouses, common-law
partners, and stepparents also raises legal issues. The clinician may
receive history from any individual regarding a child but should divulge
information about the child only to those who have a legal right or
permission to receive it.

The following is a guide to the areas that should be covered in
gathering a detailed family history. These are questions the clinician
should consider and may, in some cases, directly ask the family or
family members.

1.  Family Demographics

    -   This information should include names and ages of parents and
        siblings, parents\' occupations, current composition of
        family/household (including nonbiological members), health and
        psychiatric status of family members, and custody status.

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2.  Clinical Symptomatology of the Child

    -   What is the interactional context of the symptomatic behavior
        (e.g., oppositional behavior)? What are the typical sequences of
        family interaction associated with the problem?

    -   Is there a characteristic family profile associated with the
        clinical problem being assessed (e.g., coercive, inconsistent
        parenting practices in conduct-disordered children)? If so,
        questions related to this profile should be pursued.

    -   Is one particular person blamed for the problem? Does the family
        feel responsible for the clinical problem (e.g., a child\'s
        dependency), or do they perceive themselves as responding to
        something deviant within the child (e.g., a child\'s difficulty
        sustaining attention)?

    -   Are there family interactions that precipitated the current
        problem, predisposed to the current problem, or maintain the
        current problem?

    -   Do individual symptoms appear to maintain a family\'s preferred
        interactional pattern? What are the mechanisms?

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3.  Individual Parent History

    -   How did each parent negotiate his or her formative developmental
        years? Are there specific events in the parent\'s family of
        origin that appear to have had particular impact (e.g., sexual
        abuse)? Has cumulative developmental experience (e.g., having
        experienced harsh, punitive parenting) had an enduring effect on
        the parents\' current parenting behaviors?

    -   Does the parent have a diagnosed mental disorder or a medical
        disorder that affects parenting? How does it affect parenting?

    -   What is the style of the parents\' pervasive personality
        functioning? How does it affect parenting?

        -   Are there identifiable patterns in occupational or marital
            functioning that suggest personality strengths or
            weaknesses?

        -   Is there a particular developmental stage of child
            development that is problematic for the parent?

        -   How does each parent respond to siblings of the identified
            patient?

        -   What is the parents\' level of insight and self-observation?

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4.  Parent Relationship History

    -   What attracted the mother and father to each other? What is the
        chronological history of their relationship?

    -   What were the couple\'s early relationship (e.g., premarital)
        expectations of each other? How have these been modified?

    -   Were there previous marriages or relationships? Were children
        the result of the relationships? What were the factors in
        termination of these relationships? Do such factors affect the
        current marriage? In what way do ex-spouses affect the current
        marriages?

    -   What are the current areas of satisfaction and dissatisfaction
        with respect to vocation, finances, sexual relationship, and
        parenting?

    -   What is the legal status of the parents\' relationship?

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5.  History of Family as a Unit

    -   How has the family negotiated the anticipated events of each
        family developmental stage: birth of first child, young
        children, adolescents, and launching young adults?

    -   What are the unanticipated or unique challenges that this family
        has faced (e.g., unemployment, family illness)? Has the family
        responded in an adaptive or maladaptive manner?

    -   How has the family\'s socioeconomic status affected their
        children? Is it related to clinical presentation?

    -   How has the family\'s cultural and religious perspective
        affected their children? Is it related to clinical presentation?

    -   Are there specific events of significance (e.g., family moves,
        remarriages)?

    -   Is the family isolated from the larger community or is it
        interrelated to other groups?

    -   Is there a current theme or challenge that dominates the
        family\'s attention? How is this related to the symptomatic
        child

**Principle 2**. The Family Assessment of a Child or Adolescent Must
Include an Observation of the Child\'s Interaction with Caretaker(s).

History taking occurs simultaneously with ongoing observation of
parent-child interaction.

Clinicians should be attuned to any interactive process that contravenes
known principles of healthy child development.

**Structured Guide to Assessment of Basic Elements of Family
Functioning**

The following is a guide to four elements of basic family functioning,
areas that should be covered in a comprehensive family assessment. It is
structured in the format of questions the clinician should consider and,
in some cases, may ask the family. The following data are gathered
through family members\' historical report and clinician observation of
family interaction.

1.  Family Structure: Family structure refers to the typical
    organizational and transactional patterns and hierarchies that exist
    between the individuals or subsystems within the family. Important
    components of the family structure are its adaptability or
    flexibility, its level of cohesiveness, and the nature of its
    subsystems (e.g., spousal, parental and sibling) and the boundaries
    between them.

    -   Adaptability: Healthy family function denotes a flexible
        structure in which transactional patterns are stable but can
        shift when circumstances dictate that change is needed. Clinical
        families may be too chaotic, with patterns and individual family
        roles constantly changing, or too rigid, where the family is
        unable to change typical ways of interacting as life\'s
        circumstances demand change. (Here, and in subsequent text, the
        term clinical family denotes families whose problems in a
        specific area of functioning are associated with a clinical
        disorder in one of their children.)

    -   Cohesion: Healthy family functioning is indicated by a balance
        between connectedness and separateness. Clinical families may be
        either too emotionally close (enmeshment) or too emotionally
        distant (disengaged).

    -   Boundaries and subsystems: Healthy family functioning is
        indicated by emotional boundaries between individuals and
        subsystems that are permeable but clear, whereas in clinical
        families, boundaries may be rigid, diffuse, or misaligned.

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2.  Family Communication: Family communication refers to the verbal and
    behavioral interactions by which family members impart information
    to each other about their individual needs and their perceptions of,
    and feelings about, others in the family. Components of family
    communication to be considered are clarity, directness, emotional
    expression, and problem solving.

    -   Clarity: Healthy family functioning is indicated by
        communication that is clear, direct, and consistent, with
        affective responses congruent to the message conveyed. Clinical
        families tend to communicate ambiguously and indirectly about
        both minor transactions and those with major importance, with
        affective expression that is muted, inappropriate, or
        incongruent.

    -   Emotional expression: Healthy family communication is
        characterized by affect that is congruent with the message
        conveyed. Clinical families may block the expression of feelings
        and do not express affect congruent with life experiences.

    -   Problem solving: Healthy family functioning identifies that
        problems exist, negotiates differences or conflicts, emphasizes
        positive reciprocal interactions among members, and uses new
        information in modifying behavior and/or perspective. Clinical
        families tend to have multiple individual perceptions of the
        problem, are unable to sacrifice toward common family goals, and
        are unable to perform the tasks necessary to assist family
        coping. Clinical families may be ineffective at problem solving
        and may have parent(s) who are poorly communicating,
        authoritarian, or indecisive.

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3.  Family Belief: The third area of observation, perhaps the most
    difficult to assess in initial interviews, is of family belief
    systems or shared constructions of reality. This refers to the
    observation that families have a type of memory function that goes
    beyond that of the beliefs and memories of each of its members.
    Clinical observations should attempt to ascertain beliefs termed
    \"family myths\" and \"family legacies.\" This concept refers to
    ideas that guide decisions and actions in the family and help
    contribute to repetitive patterns of interaction that families
    demonstrate across generations. Healthy family beliefs empower
    family continuity and adaptation (e.g., a family tradition of
    heroism and bravery). Clinical families may have beliefs that foster
    maladaptation (e.g., men always leave their partners; adolescents
    are rebellious).

    -   What are the recurring themes in family life? Are there clusters
        of related problems such as alcohol-related problems, legal
        difficulties, or unquestioned beliefs or perceptions (e.g., men
        will abuse you and leave you; adolescent girls will be
        promiscuous).

    -   Are family roles rooted in family beliefs?

    -   Are there puzzling patterns of family interaction? Did they
        exist in previous generations?

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4.  Family Regulation of Child Development: In family health the
    developmental needs of children are met and their developmental
    tasks are mastered in the context of *family regulation*. The family
    must regulate the child\'s negotiation of these inevitable
    developmental tasks. Such regulation implies an equilibrium between
    inhibiting and facilitating interactions between caretaker and
    child. The parents are attuned to their child\'s developmental needs
    and facilitate the emergence of the child\'s autonomous regulatory
    capacities. Family assessment should observe behaviors and gather
    history, which allows the clinician to clarify the nature and impact
    of regulatory processes. The following questions guide the
    clinician\'s task:

    -   Does the family have a balanced, empathic response to
        developmental needs of its children? This can be evaluated by
        the following review of basic developmental issues.

        -   How does the family nurture and support?

        -   How does the family set limits and teach internal
            self-control?

        -   How does the family foster early socialization efforts?

        -   How does the family facilitate achievement and success,
            including academic success?

        -   How does the family facilitate independence/selfhood and
            individuation?

    -   Do parents regulate development in a coordinated pattern or is
        there a contrast in their efforts (e.g., one parent overinvolved
        with children and one parent underinvolved)?

    -   Is the family pattern of regulating developmental need
        characterized by overregulation (an excessive response to a
        child\'s developmental need that usurps the child\'s autonomous
        regulatory capacities), underregulation (a deficient response to
        a child\'s developmental need, which thus fails to support and
        nurture the child\'s emerging regulatory capacities),
        inappropriate (the family\'s responses are appropriate for an
        earlier developmental stage but are inappropriately applied to a
        child\'s developmental need in the current stage), irregular
        (the family that is consistent in one domain of function \[e.g.,
        feeding\] but inconsistent in another \[e.g., monitoring
        socialization\]), or chaotic (no discernible pattern of family
        response to a child\'s developmental need) regulation?

Refer to Appendix B in the original guideline document for additional
details on assessment of basic elements of family functioning.

**Principle 3**. The Family Interview Can Comprise Interviews with
Individual Family Members, Groups of Members, or the Entire Family.

The family interview is the cornerstone of family assessment. In
addition to members of the immediate family, the interview should
include those who interact with the child on a regular, sustained basis,
in a manner that the clinician judges to be influential. This could
include, for example, grandparents, other family members, or live-in
partners.

It is important to keep legal issues in mind when planning interviews.
Parents with legal custody should provide information to the clinician
and can receive information about their child. However, the caregiver(s)
with primary physical custody and children who have regular contact with
the identified patient are usually those who attend interviews. A parent
without primary physical custody should provide information and when the
child visits this parent on a regular basis, a separate interview with
that parent and child will provide a more comprehensive database.

Valuable information is obtained when data obtained from a family
subunit interview are contrasted with data obtained from a whole family
interview. The clinician must determine whether and in what sequence
other family members should be interviewed and observed in interaction
with the symptomatic child or adolescent. An individual interview with a
child may supplement information gathered from an initial family
interview, with its importance increasing coincident with a child\'s
increasing age. An interview with a very young child is optional, and an
interview with an adolescent is essential. Interviewing parents alone
may provide an opportunity for the parents to freely discuss their
relationship and provide differing views on their symptomatic child.
Interviewing the child alone may allow the child to freely discuss
conflicts that may not be easily divulged with parents present. This is
particularly true with adolescents. Discrepant views of clinical
problems often emerge more sharply in individual interviews and, once
identified, may suggest family treatment as part of the treatment plan.

It is not uncommon for some family members to fail to attend, even when
their presence has been requested. In this instance the clinician should
interview all who actually attend but should be attentive to the absence
of certain members and its meaning for the family. The absence of a
member, most often a reluctant parent or adolescent, powerfully affects
what happens in the session and is often an opportunity to understand
some of the family difficulties associated with the child\'s presenting
complaint.

The child or adolescent is invariably the identified patient, and
interviewing other individuals regarding the child or adolescent\'s
functioning raises the issue of confidentiality. Parents should be made
aware of issues that are of concern to the younger child. As the child
becomes an adolescent, this issue becomes more complicated and the
adolescent\'s desire for confidence is respected unless an issue of
dangerousness precludes maintaining confidentiality. Although
interviewing individuals separately often helps them share their history
more freely, confidentiality is maintained wherever possible.

The family interview is best conducted in a comfortable room large
enough to accommodate the expected number of individuals. Furniture or
objects potentially harmful to younger children should be removed. Games
or activities for younger children should be present to facilitate
rapport with them and decrease the likelihood of their behavioral
disruption. It is important for the clinician to manage flexibly the
simultaneous tasks of history taking and observing family interaction.
At times, acute problems such as suicidal ideation or intense
disagreement about an issue can prevent systematic gathering of
background family history, effectively terminating some content data
gathering while providing powerful experiential process data.

In the beginning of a family interview, each member is addressed in an
informal manner that is consistent with his or her developmental level,
with a goal of establishing rapport. One way that this is accomplished
is by the clinician identifying family strengths and resources at the
outset, best achieved through an informal interview style. The clinician
then defines the problem by gathering relevant current and past history.
While this is taking place, the clinician observes family interactions
and facilitates the interactional stage with the use of probing
questions. By asking family members about their individual responses,
behaviors, and feelings, the clinician begins to understand how events
have acquired specific meanings for each member and how these meanings
differ.

It is not uncommon for conflict to emerge in the session while the
clinician gathers history. At such points the antecedents and
consequences of behavioral problems are not merely reported but
demonstrated. A history of successful problem resolution should be
reviewed, as well as discussing situations in which problems remain
unresolved. A completion of the family interview includes the summation
stage, in which the clinician formulates what he or she has observed,
its relevance to the identified patient\'s problems, and the role, if
any, family members may play in subsequent treatments. All of the family
members should feel that they have been understood, and, whenever
possible, the clinician should convey a sense of hope with respect to
future family adjustment.

**Principle 4**. When the Clinical History Suggests Interactional
Problems, the Family Members in Daily Contact with the Child Should Be
Interviewed, with the Goal of Establishing An Understanding of the
Family Context of Symptomatic Behaviors.

Because most families present to the clinic with a symptomatic child, it
is prudent to begin a family assessment with a review of the child\'s
symptomatology. Some problems present with an interactive focus:
oppositional behavior, a child running away from home, a self-harm
gesture after a family argument, or a child\'s refusal to eat. In these
instances it is important to obtain a history of the sequence of events,
behaviors, and family interactions associated with the clinical problem.
The assessment goal is not only to describe the problematic behavior but
also to understand the meaning and function of the behavior in
relationship to the child\'s family. A given symptom, such as a temper
tantrum, may have different meanings in different children and different
families. To draw such distinctions, the family assessment must include
a review of family circumstances and consequences of the problematic
behavior. Questions should include a review of the family\'s past
attempts at solving problems. In this sense, history taking, diagnostic
formulation, and observation of the family occur concomitantly. During
the assessment process the clinician must keep in mind the reciprocal
nature of family influences. Although family interaction may be
associated with symptoms in the child, the child\'s symptoms may provoke
family responses.

**Principle 5**. The Family Interview Should Include Questioning
Regarding Family Risk Factors for Specific Disorders.

The clinician should recognize that some disorders are associated with
typical family or parenting styles, and this knowledge should inform
history taking (e.g., coercive and inconsistent discipline in
conduct-disordered youths, parental illness, and vulnerability in
children with separation anxiety). A history of clinical symptomatology
must include a review of which behavior management techniques parents
have tried, either successfully or unsuccessfully. The clinician must
always keep in mind that patterns of interaction may be primarily a
response to a child with a biological vulnerability.

**Principle 6**. The Family Evaluation Should Provide Enough Data for a
Clinician to Characterize Adequately the Family\'s Structure, Level of
Communication, Belief System, and Regulatory Functioning.

Perhaps the most challenging aspect of family assessment is the
systematic observation and categorization of the basic elements of
family functioning. Four elements are described most frequently and
subsume the most clinically relevant aspects of family function:
structure, communication, belief systems, and regulatory processes. (See
Principle 2 of this summary and Appendix B in the original guideline
document for a full description of the elements.)

**Principle 7**. The Family Assessment Is Enhanced by a Family
Developmental History, a Marital/Relationship History, and Individual
Parent History, Including a History of Psychiatric Disorders in Family
Members.

A history of both parents should identify psychiatric and/or medical
disorders that may be transmitted to their children, whether through
experiential or genetic mechanisms. It is important to assess the
parents\' level of knowledge of child development and of the child\'s
disorder and identify specific knowledge deficits of clinical
significance. The overall goal of the parent history is to allow the
clinician to achieve a full perspective of parental strengths and
weaknesses.

See Principle 1 above and Appendix A in the original guideline document
for interviewing guidelines.

**Principle 8**. For Complex Cases, the Clinician Should Consider
Ancillary Techniques to Gather and Organize Relevant Data About Family
Functioning.

Two helpful products of the family interview can be the family genogram
and the family timeline. A genogram is a diagram made in conjunction
with the family, or by the clinician alone, that identifies facts and
relationship patterns of three or more generations of family members.
Such a tool is essential in more complex family histories. The content
of the genogram allows a family history to be seen in generational
context beyond the presenting complaint and concerns of immediate family
members. A timeline is a simple yet graphically useful instrument that
maps a sequence of important events. The timeline provides a visual
representation of the onset of psychiatric problems linked to clear
precipitants and family context.

Because of the complexity of family assessment, a video record of family
interactions can be useful for the clinician and, at times, for the
family to view themselves. Video is often used in training settings but
has limitations in other settings, largely due to the time-intensive
nature of video review.

**Principle 9**. The Evaluation of the Family Requires the Clinician\'s
Sensitive Awareness of Cultural Differences.

The family\'s cultural background directly affects its views of
normative family structure, communication style, belief systems, and
child development. The involvement of extended family members, style of
emotional expression, and family values are examples of culturally
influenced aspects of family function. It is important to understand the
family\'s religion or world view/philosophy of life, especially when the
presenting complaint involves issues directly related to these ideas.

**Principle 10**. A Comprehensive Family Assessment Should Lead to
Treatment Interventions That Interrupt Family Functions That May
Precipitate, Predispose, or Maintain Clinical Problems and Potentiate
Family Functions That Promote Health and Optimize Disease Management.

Contemporary developmental psychopathology emphasizes risk and
protective factors as etiologically relevant in the onset of
psychopathology. The family is but one of these factors. When the family
assessment is complete, it should be integrated with the other findings
of the comprehensive psychiatric assessment. With the integrated data,
the clinician can develop a formulation with respect to the reciprocal
effects of family influence. The clinician must have a clear
understanding of the factors within the family that have affected the
child and the aspects of the child\'s condition that have stressed the
family. The complex judgment of determining the directional effects of
family influence can be facilitated by considering certain aspects of
the data gathered. Once complete, this case formulation guides the
clinician in determining an approach to the family\'s role in treatment.

**Areas of Family Assessment Related to Treatment Planning**

-   Family understanding of developmental norms

-   Influence of parental psychiatric disorder

-   Quality of parental commitment to the child\'s well-being

-   Parental achievements apart from child rearing

-   Family members and developmental task mastery

-   Assessment of the heritability of the child or adolescent\'s
    disorder

-   Level of parents\' mutual support of each other

-   Relationship of the child\'s behavior to environmental change

Refer to Appendix C in the original guideline document for more
information on the areas of family assessment related to treatment
planning.

The goal in preparation for psychiatric treatment is to determine how
and when to include the family on the basis of the collection of
historical and observational family data. When it is determined that the
family\'s interactions are responses to a child\'s condition that is
primarily biologically mediated, a supportive psychoeducational approach
follows that optimizes disease management. In some cases the family
assessment suggests that family factors have maintained the problem,
predisposed the child to the problem, or acutely precipitated the
problem. Such a formulation indicates the need for an intervention to
alter patterns of family interaction. Some family treatments will
involve a combination of both approaches. The communication of a
formulation is an essential part of the assessment and must be
empathically presented, in comprehensible terms, to parents and child.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation. Although empirical evidence may be available to support
certain principles, principles are primarily based on expert opinion and
clinical experience.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate assessment of the family of the child or adolescent with a
psychiatric disorder

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

American Academy of Child and Adolescent Psychiatry (AACAP) practice
parameters are developed to assist clinicians in psychiatric decision
making. These parameters are not intended to define the standard of
care, nor should they be deemed inclusive of all proper methods of care
or exclusive of other methods of care directed at obtaining the desired
results. The ultimate judgment regarding the care of a particular
patient must be made by the clinician in light of all of the
circumstances presented by the patient and his or her family, the
diagnostic and treatment options available, and available resources.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Josephson AM, AACAP Work Group on Quality Issues. Practice parameter for
the assessment of the family. J Am Acad Child Adolesc Psychiatry 2007
Jul;46(7):922-37. \[50 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17581454)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2007 Jul

#### GUIDELINE DEVELOPER(S)

American Academy of Child and Adolescent Psychiatry - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

American Academy of Child and Adolescent Psychiatry

#### GUIDELINE COMMITTEE

Work Group on Quality Issues

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

This parameter was developed by Allan M. Josephson, MD, principal
author.

*Work Group on Quality Issues Members*: William Bernet, MD (Co-Chair);
Oscar Bukstein, MD (Co-Chair); Heather J. Walter, MD (Co-Chair); Valerie
Arnold, MD; Joseph Beitchman, MD; R. Scott Benson, MD; Allan Chrisman,
MD; Tiffany Farchione, MD; John Hamilton, MD; Helene Keable, MD; Joan
Kinlan, MD; Jon McClellan, MD; David Rue, MD; Ulrich Schoettle, MD; Jon
A. Shaw, MD; Saundra Stock, MD

*AACAP Staff*: Kristin Kroeger Ptakowski; Jennifer Medicus

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr. Bukstein receives or has received research support from, acted as a
consultant to, and/or served on the speakers\' bureaus of Cephalon,
Forest Pharmaceuticals, McNeil Pediatrics, Shire, Eli Lilly, and
Novartis. Drs. Josephson, Bernet, and Walter have no financial
relationships to disclose.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American Academy of Adolescent and Child Psychiatry (AACAP) Web
site](http://www.aacap.org/galleries/PracticeParameters/JAACAP_Family-2007.pdf).

Print copies: Available from AACAP, Communications Dept., 3615 Wisconsin
Ave, NW, Washington, DC 20016. Additional information can be obtained
through the [AACAP Publication Store for Parameters and
Guidelines](http://www.aacap.org/page.ww?section=Publication+Store&name=Practice+Parameters+and+Guidelines).

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on October 23, 2007.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Any reproduction,
retransmission, or republication of all or part of the original
guideline is expressly prohibited, unless AACAP has expressly granted
its prior written consent to so reproduce, retransmit, or republish the
material. All other rights reserved.

### DISCLAIMER

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Date Modified: 11/3/2008