Evidence-based Family Interventions Research Articles

Families living with parental mental illness and their experiences of family interventions.

Introduction Although research has shown that evidence-based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method Five families with children aged 10-12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child-rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners.

Using implementation science to guide the integration of evidence-based family interventions into primary care.

This article is a demonstration of how an implementation-science (IS) framework can be coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We used our experiences across 2 pilot trials in which the family check-up (Smith, Montaño, Mauricio, Berkel, & Dishion, 2016), an evidence-based family intervention, was integrated into primary care. In these pilot trials, the exploration, preparation, implementation, and sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into health-care settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those "in the trenches" who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach. (PsycINFO Database Record

Identifying Daily Stress, Family Conflict and Health Care Resource Gaps at the Sri Lankan Tamil Refugee Camps in India: Implications for Developing an Evidence-based Family Intervention for Refugees

Identifying Daily Stress, Family Conflict and Health Care Resource Gaps at the Sri Lankan Tamil Refugee Camps in India: Implications for Developing an Evidence-based Family Intervention for Refugees

EHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents.

This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions.

Current Challenges in the Management of LGBT Suicide

Current Challenges in the Management of LGBT Suicide

Cultural Adaptation and Implementation of Family Evidence-Based Interventions with Diverse Populations.

Family evidence-based interventions (FEBIs) are effective in creating lasting improvements and preventing children's behavioral health problems, even in genetically at-risk children. Most FEBIs, however, were designed for English-speaking families. Consequently, providers have difficulty engaging non-English-speaking populations in their own country or in other countries where the content, language, and recruitment methods of the FEBIs do not reflect their culture. The practical solution has been to culturally adapt existing FEBIs. Research suggests this can increase family engagement by about 40%. This article covers background, theory, and research on FEBIs and the need to engage more diverse families. Steps for culturally adapting FEBIs with fidelity are presented based on our own and local implementers' experiences in 36 countries with the Strengthening Families Program. These steps, also previously recommended by a United Nations Office on Drugs and Crime panel of experts in family skills interventions, include: (1) creating a cultural advisory group, (2) assessing specific needs of cultural subgroups, (3) language translation, (4) hiring implementers from the culture, (5) developing culturally adapted training systems, (6) making cultural adaptations cautiously during repeated delivery, (7) continuous implementation quality and outcome evaluation to assure effectiveness in comparison with the original FEBI, (8) developing local and international dissemination partnerships, and (9) securing funding support for sustainability. Future efficacy trials should compare existing FEBIs to culturally adapted versions to determine comparative cost effectiveness.

Revealing the Community Within: Valuing the Role of Local Community Structures Within Evidence-Based School Intervention Programmes

Schools and the families they serve are sometimes perceived as deficient and in need of fixing. One response has been the implementation of evidence-based family intervention programmes, which may be highly regulated and prescriptive as a condition of their (often philanthropic) funding. This article seeks to explore and bring to the foreground the often hidden role of the pre-existing, informal community networks with a view to more authentic evaluation of these externally imposed programmes. The article draws on a range of qualitative data reflecting the lived experiences of participants—including parents and other community members—in a family and parenting programme at an English primary school. The analysis uses the work of Tonnies as a theoretical lens. It suggests that while there are tensions caused by the rigid requirements of external programmes, these are overcome in many cases by the highly effective, but often unacknowledged, contributions of the informal aspects of community. It is argued that these operate within and complement the formal programme. Far from subverting the more overt procedures, they actually enable it to function successfully, leading to additional, unanticipated transformations among participants. The article concludes that these organic, often invisible connections need to be identified, documented and nurtured if their full potential is to be recognised and realised when evaluating similar interventions.

Evidence-Based Family Assessment and Interventions: Providing Mental Health Professionals Techniques for Integrating Mental Health Treatment Into the Family Setting

In this session, participants will learn about the following: 1) the principles of family assessment in busy clinical practice; 2) cardinal systemic family interventions based on the classical systemic family therapy schools; and 3) practicing creative family interventions in clinical practice, such as family rituals, prescribing symptoms, circular questioning, etc., in various scenarios.

Evidence-Based Family Interventions for Adolescents and Young Adults With Bipolar Disorder.

An individual can develop bipolar disorder at any age, but emergence during adolescence and young adulthood can lead to a number of problematic behaviors and outcomes. Several drugs are available as first-line treatments, but even optimal pharmacotherapy rarely leads to complete remission and recovery. When added to pharmacologic treatment, certain targeted psychosocial treatments can improve outcomes for young patients with bipolar disorder. Because bipolar disorder affects family members as well as patients, and because adolescents and young adults often live with and are dependent on their parents, the patient's family should usually be included in treatment. Family-focused treatment and dialectical behavior therapy are promising methods of conducting family intervention. With effective treatment and the support of their families, young patients with bipolar disorder can learn to manage their disorder and become independent and healthy adults.

Resilience in perinatal HIV+ adolescents in South Africa

ABSTRACTIncreasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β = -0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =−0.399, p = .010), greater caregiver supervision (β = −1.261, p = .012), more social support seeking (β = −0.453, p = .002), higher youth self-esteem (β = −0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth.

Enhancing Parent–Child Interaction Therapy With Motivational Interviewing Techniques

Parent–child interaction therapy (PCIT) is an evidence-based family intervention for young children with disruptive behavior. Parents and children who complete PCIT show greater immediate and long-term treatment gains than those who discontinue treatment prematurely. PCIT is a time- and effort-intensive treatment, and parents ambivalent about its value for their child or their ability to master the treatment skills may discontinue treatment before engaging sufficiently to experience change. Motivational interviewing (MI) is a client-centered therapeutic method of increasing motivation for change through the resolution of ambivalence. This paper describes how clinicians may incorporate MI strategies into PCIT to enhance parental motivation when signs of ambivalence arise. Vignettes and scripted therapy exchanges illustrate use of the strategies to decrease ambivalence in PCIT, improve homework adherence, increase parenting self-efficacy, and reduce attrition, thereby improving outcomes for young children with disruptive behaviors and their families.

An innovative child psychiatry training program using a family-based model for at-risk military families

IntroductionFew child psychiatrists are well trained in family-based interventions for military families who experience significant trauma, intergenerational posttraumatic stress disorder, substance abuse, depression and high rates of suicide (Ramsawh et al., 2014). The innovative VA/UCLA/LACDMH Child and Adolescent Psychiatry Training program, sponsored jointly by the VA Greater Los Angeles Healthcare System (VA) and the Los Angeles County Department of Mental Health (LAC DMH), will address unmet needs of at-risk military families using a family-focused model also applicable to other families exposed to trauma.ObjectivesTo present the curriculum of the VA/UCLA/LACDMH training program and details of the collaboration between the LA VA and LAC DMH.AimsTo highlight how innovative child psychiatry training programs can be developed through creative institutional collaborations.MethodsThe VA/UCLA/LACDMH program family-based model and FOCUS (Lester et al., 2011) intervention were structured to meet regulatory standards of child psychiatry training programs.ResultsA specialized family-based child training program was created to meet the needs of at-risk military families while providing rigorous child and adolescent psychiatry training. Components Early Intervention Family Clinic for At-Risk Children provides family psychoeducation, and identifies children and adolescents at risk.FocusAn evidence-based early intervention for at-risk military families to enhance resilience and mitigate stress through improved coping, increased problem solving, and effective communication.ConclusionsA successful collaboration between the LA VA and LAC DMH can lead to an innovative family-based child psychiatry training program.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda.

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.

The trajectory of fidelity in a multiyear trial of the family check-up predicts change in child problem behavior.

Therapist fidelity to evidence-based family interventions has consistently been linked to child and family outcomes. However, few studies have evaluated the potential ebb and flow of fidelity of therapists over time. We examined therapist drift in fidelity over 4 years in the context of a Family Check-Up prevention services in early childhood (ages 2-5 years). At age 2, families engaging in Women, Infants, and Children Nutritional Supplement Program services were randomized and offered annual Family Check-Ups. Seventy-nine families with a child in the clinical range of problem behaviors at age 2 years were included in this analysis. Latent growth modeling revealed a significant linear decline in fidelity over time (M = -0.35, SD = 0.35) and that steeper declines were related to less improvement in caregiver-reported problem behaviors assessed at ages 7.5/8.5 years (b = -.69, p = .003; β = -.95, 95% CI [-2.11, -0.22]). These findings add to the literature concerning the need to continually monitor therapist fidelity to an evidence-based practice over time to optimize family benefits. Limitations and directions for future research are discussed.

An Experimental Study of Procedures to Enhance Ratings of Fidelity to an Evidence-Based Family Intervention.

The valid and reliable assessment of fidelity is critical at all stages of intervention research and is particularly germane to interpreting the results of efficacy and implementation trials. Ratings of protocol adherence typically are reliable, but ratings of therapist competence are plagued by low reliability. Because family context and case conceptualization guide the therapist's delivery of interventions, the reliability of fidelity ratings might be improved if the coder is privy to client context in the form of an ecological assessment. We conducted a randomized experiment to test this hypothesis. A subsample of 46 families with 5-year-old children from a multisite randomized trial who participated in the feedback session of the Family Check-Up (FCU) intervention were selected. We randomly assigned FCU feedback sessions to be rated for fidelity to the protocol using the COACH rating system either after the coder reviewed the results of a recent ecological assessment or had not. Inter-rater reliability estimates of fidelity ratings were meaningfully higher for the assessment information condition compared to the no-information condition. Importantly, the reliability of the COACH mean score was found to be statistically significantly higher in the information condition. These findings suggest that the reliability of observational ratings of fidelity, particularly when the competence or quality of delivery is considered, could be improved by providing assessment data to the coders. Our findings might be most applicable to assessment-driven interventions, where assessment data explicitly guides therapist's selection of intervention strategies tailored to the family's context and needs, but they could also apply to other intervention programs and observational coding of context-dependent therapy processes, such as the working alliance.

Overview of the Evidence Base for Family Interventions in Child Psychiatry.

This article provides updated information about evidence-based family interventions for child and adolescent mental health issues. The article reviews randomized controlled trials for family-based interventions carried out over the last 15 years. The studies were selected from an evidence-based clearinghouse search for family therapy, and specific child and adolescent psychiatric disorders. It is hoped this review guides clinical treatment and encourages clinicians to consider family involvement in treatment. This is specifically necessary when there is a limited response to psychopharmacologic and individual or group psychotherapy treatment.

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.

Improving Addiction Care in South Africa: Development and Challenges to Implementing Training in Addictions Care at the University of Cape Town

South Africa has a high lifetime prevalence of substance use disorders, estimated at 13.3% of the general population. Despite this high prevalence, treatment rates remain relatively low compared to need. A key reason for low treatment rates is the lack of expertise among professionals for the detection and treatment of substance use disorders and the limited size of the addiction care workforce. Workforce development is thus essential for the implementation of a comprehensive strategy to reduce substance-related harm within South Africa. In response to this need, the University of Cape Town has introduced a Postgraduate Diploma in Addictions Care and a Master of Philosophy in Addictions Mental Health. These postgraduate courses have been designed to equip health and social welfare professionals with the necessary skills to provide evidence-based early intervention, treatment and aftercare services for children, adolescents, adults and families affected by substance use disorders. This paper provides an overview of both programmes and reflects on lessons learnt from the inaugural group of students enrolled for the Postgraduate Diploma in Addictions Care and from the cohort of professionals who completed the Master of Philosophy in Addictions Mental Health since its inception.

The Impact of a Web-Based Educational and Support Intervention on Parents’ Perception of Their Children’s Cancer Quality of Life

The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated-15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers' evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.

Family-based interventions for the prevention of substance abuse and other impulse control disorders in girls.

Standardized family-based interventions are the most effective way of preventing or treating adolescent substance abuse and delinquency. This paper first reviews the incidence of adolescent substance abuse worldwide emphasizing gender and causes by etiological risk and protective factors. New epigenetic research is included suggesting that nurturing parenting significantly prevents the phenotypic expression of inherited genetic diseases including substance abuse. Evidence-based family interventions are reviewed including family change theories behind their success, principles and types of family-based interventions, research results, cultural adaptation steps for ethnic and international translation, and dissemination issues. The author's Strengthening Family Program is used as an example of how these principles of effective prevention and cultural adaptation can result in highly effective prevention programs not only for substance abuse, but for other impulse control disorders as well. The conclusions include recommendations for more use of computer technologies to cut the high cost of family interventions relative to youth-only prevention programs and increase the public health impact of evidence-based prevention programs. The paper recommends that to reduce health care costs these family-based approaches should be applied to the prevention and treatment of other impulse control disorders such as obesity and type 2 diabetes, sexually transmitted diseases, and delinquency.