Abstract
ObjectiveHome-based treatment of families with low socio-economic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects.MethodsWe examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables.ResultsAll variables showed significant improvement rates (pre- vs. post- treatment) with medium to high effect sizes (mean of Cohen’s d = 1.04, range = 0.34 – 2.18). All variables showed a sustained or even further improvement at follow-up.ConclusionThis study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.
Highlights
Multi-Problem FamiliesMulti-problem families (MPFs) are families who experience a multitude of complex problems in various areas of life
The length of the two groups’ respective treatment was significantly different: families participating in the follow-up had a significantly shorter treatment duration of 24.9 months compared to 34 months for the non-participating families [F(1,83) = 4.92; p = 0.029]
The results suggest that the drop-out group did not systematically differ from the follow-up group
Summary
Multi-problem families (MPFs) are families who experience a multitude of complex problems in various areas of life Their difficulties usually arise on the level of the family system (psycho-social factors) as well as in their environment (low socio-economic status) (Tausendfreund et al, 2016; Bachler et al, 2018). They range from parenting issues, psychiatric problems, troubled relationships, to financial debt, health-, and housing-related issues, as well as repeated contact with social authorities or the criminal justice system (Tausendfreund et al, 2016). In MPFs, these childhood adversities are highly prevalent, interrelated, and associated with impaired family functioning (Bachler et al, 2018)
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