Chronic Illness and Disability: A Multisystemic Practice Model

Serious health conditions can severely strain family relationships. This article describes the Family Systems Illness (FSI) model to provide a guiding framework to help individuals, couples, and families navigate the changing landscape in the experience of illness and disability over time. This resilience-oriented practice approach distinguishes three dimensions of the illness experience and trajectory over time: (a) "psychosocial types" of health conditions, based on the pattern of onset, course, outcome, disability, and level of uncertainty; (b) major developmental phases in their evolution over time (initial crisis, chronic, terminal), facilitating longitudinal thinking about chronic conditions as an ongoing process with transitions and changing demands; (c) key family system variables, emphasizing: the interweaving of illness, individual, and family development; multigenerational themes and legacies related to illness and loss that influence coping and adaptation; family health belief systems (e.g., meaning-making, including influences of culture, ethnicity, spirituality, gender, and race), and the goodness of fit in the patient/family/health care provider relationship. The FSI model is intended for a broad spectrum of health conditions in children and adults, diverse health care professional disciplines, and clinical settings. Discussion includes timely, cost-effective applications in different clinical settings, including the use of prevention-oriented family consultations, psychosocial checkups, and brief and intensive interventions.