Delivering a family‐based child mental health promotion program among two resettled refugee communities during the COVID‐19 pandemic: Lessons learned in a hybrid type II implementation‐effectiveness randomized controlled trial

Few treatments specifically target father depression and alcohol use, despite their high prevalence worldwide and adverse impacts on families and youth. Fathers are also less likely to engage in treatment than female caregivers. To address this gap, a team of US- and Kenyan-based clinician-researchers developed Learn, Engage, Act, Dedicate (LEAD), a five-session, task-shifted psychosocial intervention for fathers in Eldoret, Kenya. This hybrid type-1 study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of LEAD, a peer-father delivered psychosocial intervention for fathers at risk for depression and alcohol use. Secondary aims include exploring changes in child mental health and family functioning, potential mechanisms of change, and key implementation outcomes such as fidelity. We will conduct a hybrid type-1 pilot study using a parallel randomized controlled trial (RCT) design, enrolling 102 fathers randomized 2:1 to LEAD or a waitlist control group. All participants will be offered treatment as usual at baseline, with waitlist participants receiving LEAD following the waitlist period. Assessments will be conducted with fathers, their female partners, and one child aged 8-17. Primary aims are to explore changes in fathers' depression and alcohol use; secondary aims include examining changes in family functioning and child well-being, understanding mechanisms driving change or nonresponse, and assessing the feasibility and acceptability of peer-father counselor implementation. Findings will inform a future hypothesis-testing hybrid trial to examine LEAD's effectiveness in improving father and child mental health and evaluate associated implementation strategies. This work will contribute to strategies for engaging and retaining men in mental health services. Trial Registration #: NCT06489314 (ClinicalTrials.gov); July 4, 2024.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

An Initial Pilot Study Examining Child Social Skills, Caregiver Styles, and Family Functioning in the PEERS® for Preschoolers Program for Young Autistic Children and their Caregivers

The effects of the COVID-19 pandemic on family well-being and functioning were generally a concern for healthcare providers in many countries. To explore the changes in family functioning and family happiness during the pandemic in Thailand and to investigate factors associated with the changes in family happiness. This was a cross-sectional study conducted between November and December 2021. Online questionnaires regarding family functioning, family happiness, domestic violence, and COVID-19-related experiences were used. A total of 485 participants were included in this study. The perceived family happiness slightly decreased from 8.19 (pre-pandemic score) to 7.62 (post-pandemic score). In contrast, the general family functioning (SCORE-15 index), strength, and communication subscale scores after the onset of the COVID-19 pandemic were significantly lower than those of the pre-pandemic period. Moreover, the prevalence of verbal and physical violence significantly reduced during the pandemic. In addition, the change in family functioning was the strongest factor associated with the change in family happiness. In general, family functioning slightly improved; however, perceived family happiness decreased during the pandemic. In addition, the change in family functioning was the strongest factor associated with the change in family happiness.

Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6-month post-discharge period. A prospective, longitudinal study was conducted. A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1-, 3-, and 6-month intervals post-discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis. Approximately 59.6%-77.6% of primary family caregivers presented unhealthy family functioning during the 6-month post-discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively. This study highlights affiliate stigma and family empowerment as long-term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care. Family-centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge.

The purpose of this study was to identify which domains of family functioning were associated with odds of internalizing versus externalizing mental health disorder, past-year health professional consultations, hospitalizations, and length of hospital stay in a sample of children with a mental health disorder. One hundred children aged 6–17 years who received mental health services (inpatient or outpatient) and their parents at a large clinical paediatric tertiary care centre in Ontario were recruited in this cross-sectional study. The final recruited and analyzed sample was children aged 8–17 years. Family functioning was measured using the McMaster Family Assessment Device (FAD), child mental health disorder using the Mini International Neuropsychiatric Interview, and mental health service use using items from the 2012 Canadian Community Health Survey (Mental Health). Higher scores on affective involvement and problem solving were associated with greater odds of major depressive disorder [OR = 2.12 (1.01, 4.43)] and social phobia [OR = 1.80 (1.09, 2.98)]. Reports of better communication were correlated with lower odds of generalized anxiety disorder [OR = 0.55 (0.35, 0.84)] and shorter length of stay in hospital [OR = 0.93 (0.89, 0.97)]. Higher scores on behaviour control were associated with lower odds of social phobia and oppositional defiant disorder [OR = 0.48 (0.27, 0.86) and OR = 0.52 (0.32, 0.84)], respectively. Future research should aim to gain an understanding of strategies that ameliorate family functioning to limit the impact and severity of childhood mental health conditions.

Effects of maternal traumatic distress on family functioning and child mental health: An examination of Southeast Asian refugee families in the U.S.

Our objectives were to (a) estimate the prevalence of children's mental health problems, (b) assess family functioning, and (c) investigate the relationship between children's mental health and family functioning in Rhode Island. From the 2003 National Survey of Children's Health, Rhode Island data for children 6 to 17 years of age were used for the analyses (N = 1326). Two aspects of family functioning measures, parental stress and parental involvement, were constructed and were examined by children's mental health problems, as well as other child and family characteristics (child's age, gender, race/ethnicity, special needs, parent's education, income, employment, family structure, number of children, and mother's general and mental health). Bivariate analyses and multivariate logistic regression were used to investigate the relationship. Among Rhode Island children, nearly 1 (19.0%) in 5 had mental health problems, 1 (15.6%) in 6 lived with a highly stressed parent, and one third (32.7%) had parents with low involvement. Bivariate analyses showed that high parental stress and low parental involvement were higher among parents of children with mental health problems than parents of children without those problems (33.2% vs 11.0% and 41.0% vs 30.3%, respectively). In multivariate logistic regression, parents of children with mental health problems had nearly 4 times the odds of high stress compared with parents of children without those problems. When children's mental health problems were severe, the odds of high parental stress were elevated. However, children's mental health was not associated with parental involvement. Children's mental health was strongly associated with parental stress, but it was not associated with parental involvement. The findings indicate that when examining the mental health issues of children, parental mental health and stress must be considered.

Child mental health disorders represent a major burden to public health in Australia due to high prevalence rates, the widespread impact across domains, and the potential for difficulties to persist into adolescence and adulthood. Extensive evidence exists for the use of parent management training and cognitive behavioural therapy to treat difficulties experienced by children; however, a proportion of children do not benefit as expected from these treatments. The use of complementary therapeutic approaches and variations to the mode and intensity of existing intervention is warranted; family inpatient units represent a unique example of this. The aim of this study is to evaluate the effectiveness of a well‐established Australian inpatient unit that admits the whole family, for children aged 12 years and younger referred with mental health, behavioural, or emotional difficulties. This study's longitudinal within‐subject study design utilised routinely collected outcome data from the systemic clinical outcome and routine evaluation, 15 item (SCORE‐15)—a valid and reliable measure of family functioning—from a sample of 980 participants attending the Family Residential Program. This study reported significant improvement in family functioning across all outcome variables between baseline and post‐intervention, with no variables returning to pre‐intervention levels at follow‐up. Clinically significant changes in overall family functioning showed that 37% of participant scores moved from the clinical range at baseline to the nonclinical range post‐intervention. This study represents the first empirical evaluation of the Family Residential Program, and the reported results provide compelling evidence for the program to effect improvement in family functioning for families with long‐standing and severe difficulties. Poor rates of questionnaire completion following intervention frequent the literature base of family inpatient units, with low post‐intervention (56%) and follow‐up (12%) rates evident in this study. This study uniquely contributes to the growing evidence base of family inpatient units using rigorous evaluation methods.

This article reports a systematic review of the literature examining the relationship between adverse childhood experiences (ACEs), family functioning (FF) and mental health (MH) problems among children and adolescents. The current review aims to thoroughly investigate the relationship between ACEs, FF and MH, and to synthesise the findings in the literature. Three databases were searched, and a narrative synthesis of the final thirty‐four articles is presented. The results of the systematic review indicate that the association between FF and child/adolescent MH is mixed; ACEs and child/adolescent MH are related; ACEs and FF are related; and demographic factors impact on the association between the three main variables. The literature suggests a strong association between ACEs, child and adolescent MH problems, and FF, and some overlap between these variables is evident. This systematic review highlights the importance of family‐focused care and the value of asking children about their experience of adverse childhood experiences in clinical practice.Practitioner points The literature suggests a strong relationship between ACEs, FF, and MH problems FF mediates the relationship between specific ACEs, and child/adolescent MH problems, although further research is warranted Clinicians working with children and adolescents with MH problems should be mindful of family‐centred care and ask children about their experience of ACEs

Changes in family functioning during treatment and drinking outcomes for high and low autonomy alcoholics.

Predictors of family functioning one year following traumatic brain injury in children.

The present study examined the relationships of (a) changes in adolescent-reported family functioning and (b) changes in identity confusion to onset of substance use and sexual behavior in a sample of 250 Hispanic adolescents from immigrant families. Adolescents were followed for 3 years. Results indicated that adolescents whose identity confusion scores increased over time were most likely to initiate cigarette use, alcohol use, and sexual behavior during the course of the study. Adolescents whose identity confusion scores remained stable over time were less likely to initiate, and adolescents whose identity confusion scores decreased over time were least likely to initiate. The data were consistent with the proposition that initial levels of and changes in family functioning appeared to be responsible for these associations. Implications for identity research and intervention are discussed.

Democratic family functioning has traditionally been interpreted as effects of parenting, leaving little room for the adolescent in shaping the democratic climate. Here we argued that an understanding of the democratic family functioning has to involve both adolescent and parental behaviors. We hypothesized that parental openness and fair treatment, and adolescent openness, each uniquely predict changes in democratic family functioning. Also, we argued that family functioning constellations characterized by parental openness and fair treatment, and adolescent openness, should be the constellations adolescents experience as democratic, and where parents know much about their adolescents’ whereabouts outside home. We used a longitudinal study following a group of 13–15-year-old adolescents (N = 527) over 2 years. Results using variable-oriented methods confirmed that both adolescent and parental behaviors were prospectively linked to adolescents’ perceptions of the democratic family climate. Person-oriented methods showed that adolescents perceived a highly democratic family climate, and that parents’ knowledge was highest, in families characterized by both parental and adolescent openness and parental fair treatment. Over-time changes in family functioning corresponded to changes in parental knowledge and adolescents’ perceptions of democratic family functioning. We conclude that conceptions of the democratic functioning of the family have to include the behaviors of both parents and adolescents, and that mutual responsivity is a marker of the democratic family functioning.

Child focus is a central construct within Bowen family systems theory (Bowen theory). A clinical implication is that mental health treatment focusing on a child may unwittingly reinforce the operation of child‐focused processes, which undermine rather than enhance child well‐being. The concept of child focus in Bowen theory presents significant implications for professionals working in school settings and in fields such as children's mental health, which are inherently child‐focused. Bowen theory is the guiding theoretical framework for School‐Based Filial Therapy (SBFT). SBFT is a play therapy intervention that was initially established in remote and outer‐regional New South Wales, Australia in response to the low availability of children's mental health services and the significant barriers associated with caregiver engagement in children's mental health treatment. It involves trained school personnel facilitating therapeutic play sessions with children experiencing emotional–behavioural problems. The intervention occurs on school grounds, during school hours, and children's family members do not participate in the intervention. This mixed‐methods study examines the impact of children's participation in SBFT upon family functioning. Interviews with caregivers (n = 10) of children who participated in 10 SBFT sessions were analysed using content analysis. Quantitative data were collected using the Differentiation of Self Inventory – Short Form and Visual Analogue Scale – Family Functioning. A Wilcoxon signed rank test was used to analyse the pre‐ and post‐data. Qualitative outcomes indicated changes in the categories of child functioning, caregiver functioning, and extended family functioning, whilst child‐focused processes remained dominant but changed in intensity and valence following SBFT.