This is a proposal for the study and demonstration of the effect of family therapy on the psychosocial behavior of the hemophiliac and his family. Psychosocial problems greatly impede the management of many chronic, disabling diseases, thereby increasing the overall cost of health care for such patients. Using hemophilia as a model, we postulate that the systematic application of family-oriented psychosocial intervention, i.e., family therapy, can significantly reduce the high incidence of compliance problems, e.g., substance abuse, chroninc overutilization of expensive plasma derivatives, inability to mange home therapy, maladjustment of family members and other evidence of pshychosocial problems. A randomized clinical trail will determine whether family therapy, as an addition to existing comprehensive care, will alter the proportion of patients able to be maintained within the home care setting. A minimum of 200 consenting patients drawn from the Mount Sinai/Cornell Comprehensive Hemophilia Center patient population will be randomized to receive family therapy. The control group will receive the usual psychosocial support provided by Comprehensive Hemophilia Centers throughout the country. Specific instruments and techniques for evaluating family dynamics will be executed by the Ackerman Institute for Family Therapy. This model will be widely applicable to other chronic disease populations.
