Behavioural Family Intervention Research Articles

Building Bridges Triple P: Pilot study of a behavioural family intervention for adolescents with autism spectrum disorder

BackgroundMany parents of adolescents with autism spectrum disorder (ASD) report that they are ill-equipped to support their children’s behaviour, and these youths are known to be at substantially greater risk of emotional or behavioural problems compared to their typically developing peers. There is a need for an efficient and tailored parenting program for parents of adolescents with ASD that includes guidance on how to best support these youths’ development and well-being. AimsThe current study examined the feasibility of Building Bridges Triple P (BBTP), an eight-week (11.5 h) parenting program specifically targeted to the needs of parents of adolescents with a developmental disability. MethodsA pretest-posttest single group design was used to evaluate the feasibility and acceptability of BBTP, and the potential of the program to have desired intervention effects, with nine parents of adolescents with ASD. ResultsAfter participating in BBTP, parents reported significant reductions in their adolescent’s behaviour problems, increased parenting confidence, decreased lax and overreactive responding, and decreased symptoms of depression and stress. These effects were mostly observed at post-test but were more pronounced at 3-month follow-up. Parents reported that they were satisfied with the content and format of BBTP. ConclusionsResults provide preliminary support for the feasibility and acceptability of BBTP, and that the program has a number of desired intervention effects.

Family therapy in India

Origins of family therapy are traced, acknowledging that this is in fact a group of therapeutic approaches. An overview of work done at major mental health centers in India is followed by an attempt at outlining key differences in Indian vis-a-vis Western approaches to family therapy, addressing some of the unique problems that are encountered in our country. Traditional systems of arranged marriage and a joint family, in vitro fertilization interventions and the family pressures to have a baby, the impact of work on family life and the onslaught of social media and family migrations across the globe are some of the issues outlined. Major approaches to family therapy are selected, and their key features are highlighted. Specifically, Minuchin's structural family therapy and Virginia Satir's conjoint family therapy are described. Touching very briefly on Milton Erickson's strategic family therapy, the article moves on to White and Epston's narrative family therapy; and each approach is described vis-a-vis its strengths when applied to an Indian family setup. The article ends on preventive, promotive, and rehabilitative approaches espoused by the author as also by many therapists in India. Behavioral family interventions by Sanders are outlined as is the positive parenting program and its Indian avatar in Palakshaala. Preventive approaches such as functional family therapy by Sexton and Alexander are described. Rehabilitative work with patients and caregivers is outlined, citing examples. The article ends by highlighting some recent changes in the social fabric that seem to be deeply affecting family structures.

Supplemental Material for A Behavioral Family Intervention for Children With Overweight and Asthma

Supplemental Material for A Behavioral Family Intervention for Children With Overweight and Asthma

Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale, design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers

Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardian's motivation to make changes in diet and activity and providing tools to do so at the guardian's level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed.This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.

Antecedents of Treatment Resistant Depression in Children Victimized by Peers.

Children victimized by peers are at increased risk of ongoing depression. This study investigates treatment resistant depression in children victimized by peers, following participation in a targeted cognitive behavioral family intervention. The sample comprised 39 children aged 6-12years with elevated depression compared with a general sample, prior to the intervention. Six months after the intervention, 26 were no longer depressed and 13 were still depressed. This study investigated the differentiation of these two groups on the basis of parenting and child factors. Children with treatment resistant depression were discriminated from other children by lower levels of peer support and facilitative parenting immediately after the intervention. It was concluded that ongoing support from parents and peers is needed to reduce the risk of ongoing depression even if victimization has been reduced. Further research could develop a comprehensive profile of children at risk of depression following peer victimization.

A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies.

A systematic review of the literature exploring if the UK recommendations for psychological interventions for schizophrenia were being met was carried out. Rates of implementation for cognitive behavioural therapy (CBT) and family intervention (FI) were compared. The barriers against implementation and described strategies aimed at improving implementation were reviewed. A literature search of electronic bibliography databases (Psychinfo, Medline, Pubmed, AMED, CINHAL, and EMBASE), reference and citation lists, the Evaluation and Review of NICE Implementation (ERNIE) database, a manual search of Clinical Psychology Forum, governmental reports, charity, and service user group reports was conducted. Twenty-six articles met the inclusion criteria, 11 provided data on implementation rates, 13 explored the barriers to implementation, and 10 gave information about improvement strategies. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI, and studies varied in the methodology used and quality of the articles. Previously reported barriers to implementation were found, with organisational barriers being most commonly followed by barriers met by staff members and service users. Implementation strategies discovered included training packages for CBT, FI, and psychosocial interventions as well as empirical evidence suggesting methods for engagement with service users. Rates of implementation for CBT and FI are still below recommended levels with wide variation of rates found. This suggests inequalities in the provision of psychological interventions for schizophrenia are still present. Previously identified barriers to implementation were confirmed. Attempted implementation strategies have been met with modest success. Inequalities in the provision of psychological therapies for schizophrenia persist. Good quality cognitive behavioural therapy and FI training do not ensure implementation. Collaboration at all levels of healthcare is needed for effective implementation.

Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial

ObjectiveTo evaluate the efficacy of a behavioural family intervention, Stepping Stones Triple P (SSTP), combined with an Acceptance and Commitment Therapy (ACT) workshop in improving parent, family and couple outcomes following paediatric acquired brain injury (ABI). Participants and settingFifty-nine parents (90% mothers) of children (mean age 7 years; 35 males, 24 females) with ABI. InterventionParticipants were randomly assigned to a treatment (10-week group SSTP and ACT program) or a care-as-usual (CAU) control condition (10 weeks). Those in the CAU condition received the treatment after the waitlist period. OutcomesSelf-report measures of parent psychological distress, parent psychological flexibility, parenting confidence, family functioning, and couple relationship, assessed at: pre-intervention, post-intervention, and 6-months post-intervention. ResultsPost-intervention, the treatment group showed significant, small to medium improvements relative to the CAU group (at the p < .05 level) on parent psychological distress, parent psychological flexibility, parent confidence in managing behaviours, family adjustment,and number of disagreements between parents. Most improvements were maintained at 6-months. ConclusionsParent skills training and ACT may be efficacious in improving parent, family, and couple outcomes in families of children with an ABI.

Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants.

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.

Erratum to: The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

Erratum to: The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

Parental experiential avoidance as a potential mechanism of change in a parenting intervention for parents of children with pediatric acquired brain injury.

To consider the relationship of parental experiential avoidance (EA) to psychological symptoms and problematic parenting strategies after pediatric acquired brain injury (ABI). Using available data from a randomized controlled trial of a group-based Acceptance and Commitment Therapy (ACT) workshop plus a behavioral family intervention (BFI) for parents of children with ABI (n = 59), correlational and mediational analyses were conducted to consider the role of parental EA as a process of change for parent outcomes. Parent EA positively correlated with ineffective parenting behaviors and levels of psychological distress, both cross-sectionally and longitudinally. Reductions in EA mediated the treatment effect on reducing ineffective parenting behaviors and parent distress, but issues of temporality were present. EA is related to parent outcomes following pediatric ABI. A larger and methodologically rigorous study is called for to further elucidate this finding and specifically determine the benefits of targeting EA with interventions such as ACT, in conjunction with evidence-based BFIs.

Using an Evidence-Based Parenting Intervention with African American Parents

There has been a rise over the past several years in behavior problems among preschoolers. Young children who exhibit disruptive behavior are at increased risk of problematic outcomes later in life. Children from racial or ethnic minority groups and/or disadvantaged backgrounds may be at greater risk for behavioral problems. Therefore, interventions are needed before these behaviors become more entrenched. Parents of children with disruptive behaviors have reported higher parenting stress levels, which has a negative effect on parenting behaviors. Three models of parenting styles and behaviors are discussed, with a focus on the literature on African American parenting styles. To contribute to the literature addressing parenting training programs with African American populations, a case is presented as an example of the usefulness of an evidence-based behavioral family intervention with a low-income African American single parent family. Treatment recommendations are presented when applying evidence-based parenting programs with African American and other racial or ethnic minority groups.

An Efficacy Trial: Positive Parenting Program for Parents of Teenagers

Studies on the efficacy of parent training programs have mostly been conducted with preadolescents, with only a few studies investigating family treatment models in adolescents. In this article, a study is described that evaluates Standard Teen Triple P (Positive Parenting Program), a behavioural family intervention for parents of 11- to 16-year-old teenagers. Participants were 46 families with a teenager who was experiencing detectable behavioural and emotional problems. Compared to parents in the waitlist control condition, parents participating in the intervention condition reported decreased levels of teen disruptive behaviours and parent adolescent conflict, as well as a reduction in the use of ineffective parenting strategies and conflict over child-rearing issues. These positive changes were maintained at the 3-month follow-up. Results suggest that Standard Teen Triple P is a promising parenting intervention for tackling adolescent externalising problems.

Using a Behavioural Family Intervention to Produce a Three-Generational Benefit on Family Outcomes: A Case Report

Background:Grandparents have a significant role in providing regular child care to their grandchildren. As such, they are in a unique position to help with the prevention of child disruptive disorders. However, the child-care role grandparents provide can also negatively impact the grandparent-parent relationship.Aims:This case study examined the impact of a parenting program designed specifically for grandparents on a grandparent providing regular child care to her granddaughter.Method:A case study is presented of a 56-year-old grandmother providing between 31–40 hours of care per week to her granddaughter, who is at risk of developing an early onset child disruptive disorder. The grandparent was measured on outcomes of child behaviour; parenting style; parenting confidence; psychological wellbeing in terms of stress, depression, and anxiety; and relationship satisfaction with the parent. The parent was also measured on child behaviour outcomes and relationship satisfaction with the grandparent. Measures were given at baseline, post-intervention, and at 6-month follow-up.Results:The grandparent reported significant reductions in stress, anxiety and depression; improved relationship satisfaction with the parent; and decreased reliance on dysfunctional parenting practices. The parent also reported decreased child behaviour problems and increased relationship satisfaction with the grandparent. No findings were found for parenting confidence.Conclusion:This case study provides encouraging findings for a new parenting program designed specifically for grandparents, and it is recommended that future research evaluate its efficacy in a randomised controlled trial.

A randomized controlled trial evaluating a parenting program designed specifically for grandparents

Grandparents providing regular child care to grandchildren contribute to the nurturing environment in which children are raised. This study evaluated the efficacy of a behavioral family intervention designed specifically for grandparents, Grandparent Triple P. Fifty-four grandparents (M = 60.89) and 48 parents (M = 34.52) participated in the evaluation. Grandparents predominantly provided between 12 and 20 h of care per week (64.81%), to a grandchild (62% male) aged between 2 and 9 years (M = 4.42). Families were randomly assigned to one of two conditions (intervention or grandparent care-as-usual) and were assessed using a multiple informant approach at three time points (preintervention, postintervention, and six-month follow-up). Relative to the grandparent care-as-usual group, significant short-term improvements were found in the intervention group on grandparent-reported child behavior problems; parenting confidence; grandparent depression, anxiety, stress; and improved relationship with the parent. Parents also reported significant reductions in child behavior problems, despite not participating in the program. Short-term effects were predominantly maintained at six-month follow-up.

Getting psychosocial interventions into mental health nursing practice: a survey of skill use and perceived benefits to service users

To investigate the use of psychosocial interventions by mental health nurses following training and perceived benefits to service users. Psychosocial interventions are recommended to support the recovery of persons with enduring mental illness. Despite two decades of postgraduate training in psychosocial interventions internationally, implementation challenges still remain. A cross-sectional exploratory, descriptive survey was employed. A survey was mailed to the total population of nurses (n=58) working in some health regions in Ireland who completed training in psychosocial interventions between 2005-2010. Data were collected between November 2011-January 2012, yielding a response rate of 64%. Descriptive and correlational statistics were used to analyse the data. There were statistically significant increases in the use of psychosocial interventions post training. Cognitive behavioural therapy and family interventions were the least used interventions. Assessment and outcome measures, concordance therapy and relapse prevention were preferential interventions. Perceived outcomes for service users were awareness of relapse indicators, enhanced coping skills and fewer admissions. Case load demands, lack of access to supervision and time constraints prevented implementation. Free text comments indicated a dissonance between generic nursing roles and implementation of structured psychosocial interventions in practice. The findings indicate a requirement for nursing leadership to legitimize psychosocial interventions as core nursing work. For service users to experience this type of nursing, we propose the nomination of dedicated psychosocial intervention nurses to multidisciplinary teams. Support through guidelines, clinical supervision and audit by senior nurse managers is critical to implementation.

Efficacy of Stepping Stones Triple P Plus a Stress Management Adjunct for Parents of Children with an Acquired Brain Injury: The Protocol of a Randomised Controlled Trial

Paediatric acquired brain injury (ABI) is the most common cause of acquired disability in childhood. It frequently results in significant personality, cognitive, emotional and behavioural changes, and consequent impairment in independent functioning, education, employment and interpersonal relationships. Additionally, paediatric ABI impacts on the entire family system, with parents commonly reporting significant distress and adjustment difficulties. Despite this, there is currently limited research into effective programmes to support families following their child's ABI. This protocol describes a wait-list randomised controlled trial of a behavioural family intervention plus a parent stress management programme for paediatric ABI. Interventions will be conducted with parents in a group format, aiming to improve child outcomes by improving parenting behaviour and coping. Outcomes assessed will be: (i) child behaviour and emotional outcome as measured by parent and teacher reports; (ii) parental style and confidence; (iii) parental adjustment (stress, anxiety and depression symptoms); (iv) family functioning; (v) parent relationship; and (vi) parent psychological flexibility. Assessments will be via questionnaires conducted pre-, mid- and post- intervention, and at a 6-month follow-up. The theoretical basis, study hypotheses, methods and planned analyses are described.

Psychological interventions for adolescent psychosis: A pilot controlled trial in routine care

PurposeEvidence for the recommendation to deliver Cognitive Behavioural Therapy (CBT) and Family Interventions (FI) to under-18s with psychosis derives from adult research, and no previous study has focused exclusively on an adolescent population. We evaluated adaptations of these therapies for adolescent inpatients with psychosis (CBTpA and FIpA), delivered as an adjunct to inpatient standard care (SC). Subjects and methodsThirty adolescent inpatients with psychotic symptoms on admission were sequentially allocated to receive CBTpA+SC (n=10); FIpA+SC (n=10) or SC alone (n=10). Psychotic symptoms and functioning were measured at admission and discharge. ResultsGroup comparisons did not reach conventional significance, but effect sizes in this pilot study showed a promising impact of CBTpA compared to SC alone, in reducing symptoms (ES: d=0.6), with smaller effect sizes for functioning (d=0.2) and for FIpA (symptoms, d=0.1 and functioning, d=0.4). There was no advantage of either additional treatment in reducing length of stay, but self-report satisfaction ratings were higher for both psychological therapies. Discussion and conclusionsThe study is the first to focus on an exclusively adolescent population, using appropriately adapted therapy protocols. Findings suggest that the interventions are feasible, acceptable and helpful for adolescents with psychosis. Larger randomised controlled trials are now needed.

Experience and outcomes of stepping stones triple P for families of children with autism

This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the "attribution of cause" of misbehaviour, (2) "Who's the boss?" reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) "Rewarding is rewarding!" reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.

Childhood Feeding Difficulties

Difficulty with feeding is common during early childhood. Behavioral techniques have shown considerable utility for difficult feeding, although large-scale studies of behavioral parenting interventions with typically developing young children, and in group formats, are limited. The current study aimed to evaluate the efficacy of a group-based, behavioral family intervention for typically developing healthy children with problem eating via a fully randomized 2-group design. : Ninety-six families of children aged 1.5 to 6 years with feeding difficulties participated in a trial of Hassle Free Mealtimes Triple P (A. Morawska and M.R. Sanders, unpublished data, 2008) in regional and metropolitan Queensland (Australia). Results support the utility of a group-based behavioral parenting program for childhood feeding issues, with significant improvements to the mealtime and general behavior of target children, the mealtime and general practices of parents, parental confidence and cognitions, compared with a waitlist control. Six-month follow-up data and clinical and reliable change indices support the intervention's utility. Parents were also highly satisfied with the program. The current study provides evidence of the efficacy of a group-based behavioral family intervention for mealtime difficulties, including observational and more extended outcome measures. Future directions and clinical implications of this research are discussed.

Healthy families study: Design of a childhood obesity prevention trial for Hispanic families

BackgroundThe childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. MethodsThe study will enroll 272 Hispanic families with children ages 5–7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children's body mass index. Secondary outcomes are changes in children's waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time. ResultsEnrollment and data collection are in progress. ConclusionThis study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities.