Family-based Treatment Program Research Articles

Birth order and intrahousehold allocation of food: Unequal allocation for unwanted children

Background: Food allocation is a fundamental aspect within households, seemingly capable of being distributed evenly among household members, especially among siblings. However, several factors can lead to differences in food allocation among siblings. Method: Using data from IFLS 4 and 5, with food variety as a proxy for food allocation, this study examines two influential factors on food allocation: birth order and imperfect fertility control status. Additionally, this study attempts to elucidate the mechanism of the birth order effect using the aforementioned imperfect fertility control status. FIndings: The findings of this study reveal a negative effect of birth order on household food allocation. Moreover, children with undesired status or belonging to families with undesired status due to imperfect fertility control tend to have lower food variety. Conclusion: However, this study cannot causally explain the mechanism behind the negative effect of birth order through imperfect fertility control status. Novelty/Originality of this article: This study analyzes the effects of birth order and fertility control status on household food allocation, finding adverse effects of birth order and unwanted status on food variation. As a novelty, this study proposes the development of a family-based nutrition intervention program that considers intra-household dynamics, aiming to reduce the gap in food allocation between siblings and improve children's overall nutritional status.

Predictors of parent self-monitoring patterns in a family-based behavioral weight loss treatment program.

Self-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment. A secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns. Latent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group. This study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs. Clinicaltrials.gov Identifier: NCT01197443.

Development of a Family-Based Early Intervention Program to Develop Sign Language Skills in Deaf Children

Family-based early intervention needs to be provided for children who experience obstacles, this aims to ensure that the obstacles experienced by children can be overcome from an early age. The obstacles that are overcome from now on will have a positive impact in the future development. This research aims to develop a family-based intervention program to develop sign language skills for deaf children. The research method used in this research is the descriptive qualitative method. The subject in this study was a 5-yearold deaf child and the child's parents. The results of this research are an intervention program based on family resources to develop deaf children's sign language skills as a modality for children to communicate with the community and a modality in educational settings in elementary schools. It is hoped that this research can help deaf children, parents, and teachers to develop sign language skills in deaf children.

Evaluating Readmission Rates for a Statewide In-Home Ecosystemic Family-Based Treatment Program for Youth with Serious Emotional Disturbance.

Family Based Mental Health Services (FBMHS) with an embedded clinical model, Ecosystemic Structural Family Therapy, is an intervention designed for youth with a serious emotional disturbance (SED) who are at risk of out-of-home placement. The current evaluation examines the association between receipt of FBMHS and rates of out-of-home and community-based care during and after an episode of FBMHS. We identified 25,016 Medicaid-enrolled youth ages 3 to 17 years with receipt of a new FBMHS episode from 1/1/2015 to 6/30/2021. 14% of youth received out-of-home services. Rates of out-of-home service decreased during receipt of FBMHS (14.25-6.98%, p < .0001) and remained lower 6 months following discharge (to 6.95%, p < .0001). Short and longer doses of service were both associated with decreased rates of out-of-home services. FBMHS has been scaled across a large geographic area and is associated with lower rates of out-of-home placement for youth with SED.

Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review.

Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.

A family-based physical activity intervention guided by self-determination theory: Facilitators’ and participants’ perceptions

“Active 1 + FUN” is a family-based and self-determination theory-guided intervention program, designed to increase children's and parents’ physical activity in leisure-time. In this qualitative study, we aimed to provide a comprehensive understanding of the intervention by exploring perceived behavioral and psychological changes, and implementation of the program from the perspective of facilitators and participants. The interviews and focus groups explored facilitators’ and participants’ (children and parents) perceptions of the intervention in terms of the theoretical basis, perceived behavioral changes, basic need satisfaction (i.e., competence, autonomy, and relatedness), and other aspects. The findings suggested that facilitators, children and parents perceived the theory-driven intervention to be effective in increasing family's leisure-time co-physical activity and basic psychological need satisfaction.

Family-Based Early Intervention Based on Family Outcomes for Families with Children with Multiple Disabilities

This study aims to formulate a family-based early intervention program for parents who have children with Multiple disabilities based on Family Outscomes. The background of this study is the lack of family information related to the identification of children with multiple disabilities, family confusion in handling children who experience multiple disabilities, and the absence of family confidence in the situation of their children in the social environment. The subjects in this study were parents who had Children with Multiple Disabilitiesin this case were children with Cerebral Palsy who experienced obstacles in motor, cognitive, social &amp; emotional, and language aspects and intellectual barriers. This research approach is a qualitative approach with three stages of research, namely assessment, validation, and implementation. The result of this study is an increase in family understanding of the child's condition, the occurrence of stimulation carried out by the family to the child, the family has begun to want to socialize their children in the surrounding social environment. The results and discussion of further research are discussed in this study.&#x0D;

Parentification, distress, and relationship with parents as factors shaping the relationship between adult siblings and their brother/sister with disabilities.

According to parentification theory, when the siblings of a brother/sister with disabilities assume parent-like duties, this role reversal is known as sibling-focused parentification. It has a significant impact on these siblings' distress and the quality of their family relationships; 605 Italian adult siblings (19-26 years) of people with disabilities completed the online survey. Measures of siblings' parentification, distress, quality of family relationships, social support, and perceived benefits of parentification were used. The hypothesized model aims to test, on the target sample, the distress and the quality of the relationship with parents as mediators on the interplay between the siblings' parentification and their sibling relationship. Additionally, social support and perceived benefits of parentification as protective factors were considered. Results showed that the distress and the low quality of the relationship with parents negatively affected the interplay between the siblings' parentification and the relationship with their own brother/sister with disabilities. Social support and the perceived benefits of parentification decreased the siblings' distress levels; the perceived benefits of parentification served as a protective factor for the quality of the relationship with parents. Current findings extend the knowledge regarding the risk and protective factors of the siblings' mental health when disability occurs in the family. Additionally, they inform family-based intervention programs, which should involve the whole family system for reducing distress and improving the wellbeing of siblings without disabilities.

Effects of a Family-Based Lifestyle Intervention Plus Supervised Exercise Training on Abdominal Fat Depots in Children With Overweight or Obesity

Excess abdominal fat is a major determinant in the development of insulin resistance and other metabolic disorders. Increased visceral adipose tissue (VAT) seems to precede the development of insulin resistance and is therefore a prime target of childhood lifestyle interventions aimed at preventing diabetes. To examine the effect of added exercise to a family-based lifestyle intervention program designed to reduce VAT plus subcutaneous (ASAT), intermuscular (IMAAT), and pancreatic (PAT) adipose tissue in children with overweight or obesity and to explore the effect of changes in VAT on insulin resistance. This 2-group, parallel-design clinical trial was conducted in Vitoria-Gasteiz, Spain. A total of 116 children with overweight or obesity participated and were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). Data were collected between September 1, 2014, and June 30, 2017, and imaging processing for fat depot assessments and data analysis were performed between May 1, 2019, and February 12, 2021. The compared interventions consisted of a family-based lifestyle and psychoeducation program (two 90-minute sessions per month) and the same program plus supervised exercise (three 90-minute sessions per week). The primary outcome of this study was the change in VAT between baseline and 22 weeks as estimated by magnetic resonance imaging. The secondary outcomes were changes in ASAT, IMAAT, and PAT. The effect of changes in VAT area on insulin resistance was also recorded. The 116 participants included in the analysis (62 girls [53.4%]) had a mean (SD) age of 10.6 (1.1) years, and 67 (57.8%) presented with obesity. Significantly greater reductions were recorded for the exercise group in terms of reduction in VAT (-18.1% vs -8.5% for the control group; P = .004), ASAT (-9.9% vs -3.0%; P = .001), and IMAAT (-6.0% vs -2.6%; P = .02) fat fractions compared with the control group. Changes in VAT explained 87.6% of the improvement seen in insulin resistance (β = -0.102 [95% CI, -0.230 to -0.002]). These findings suggest that the addition of exercise to a lifestyle intervention program substantially enhanced the positive effects on abdominal fat depots in children with overweight or obesity. In addition, the reduction in VAT seemed to largely mediate the improvement of insulin sensitivity. These results highlight the importance of including exercise as part of lifestyle therapies aimed at treating childhood obesity and preventing the development of type 2 diabetes. ClinicalTrials.gov Identifier: NCT02258126.

Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

65.2 Treating Parents to Treat Kids

The presentation describes an outpatient family-based treatment (FBT) program within a child and adolescent psychiatry clinic. FBT provides therapy and medication management to adult caregivers alongside their children’s mental health care via an integrated FBT team. This treatment modality provides a “one-stop shop” of enhanced outpatient care for families that incorporates multilevel knowledge of familial stressors and strengths. Indiana ranks 45th in per capita child and adolescent psychiatrists.

“For me, it's a real pain”: A Foray into the Experience of Parents Involved in Family-Based Treatment

Eating disorders are undoubtedly challenging for the adolescents experiencing them, but they can also be challenging for their parents. The current study employed a qualitative research design to examine the challenges endured by parents raising adolescents with eating disorders and undergoing a Family-Based Treatment (FBT) program. Six mothers of adolescents with anorexia nervosa or bulimia were interviewed about the challenges they face as parents of a child with an eating disorder and the changes they have had to make in their lives. Overall, results highlighted challenges from a personal, family, and parental role lens. Findings also call attention to the difficult responsibilities placed on parents during FBT programs such as involvement in their child's refeeding plan and the emotional toll their child's experience places on them. Implications for the level of support needed by parents are discussed according to their role in FBT programs.

Impact of family-based nutrition education intervention program on eating habit among obese school age children in Rania city / Iraq

Background and objectives: Childhood obesity nowadays is a main health issue and growing disease that has become a global major public health concern. The children obesity can be decreased by changing eating habits. The aim of this study was to explore the impact of family-based nutrition education intervention program on eating habit among obese children in Rania city. Methodology: A quantitative design, quasi-experimental study was conducted in Rania city. Purposive samples of 47 obese school children with their parents were comprised. Participants were divided into intervention and control groups. Nutrition education program was. Mediterranean Diet Quality Index questionnaire was used to assess participant’s adherence to the Mediterranean Diet. Student t-test was used to compare between two means and paired t-test to test a group at twice (at pre and post-test). Results: The findings revealed that, 55% of obese children were male. The highest level of obese children (29.8%) were 10-years old. Primary school education was the highest level of education of both parents. The majority of families, 85.1% were within barely sufficient economic status. Among obese children, 63.8% of them were poorly adhere to the healthy Mediterranean Diet.

Supporting Youth and Families in Gaza: A Randomized Controlled Trial of a Family-Based Intervention Program.

Background: A total of 450 million children are now living in active conflict zones. The negative consequences for children are significant and long lasting. In response to the urgent need for sustainable interventions for children and families, the current study evaluated a brief (12 hr, 8 session) family-based coping and support program, Promoting Positive Family Futures (PPFF), in Gaza. Methods: Families (n = 68, mother/father/adolescent triads) were randomized into the PPFF intervention or another lengthier (50 hr, 25 session) locally well-established psychosocial support program (treatment as usual; TAU). Results: Improvements were found for both conditions for paternal and maternal depression, emotion regulation using cognitive reappraisal, family-wide emotional security, and adolescent adjustment. Effect sizes were medium to large (d = 0.35–1.27). Fathers in the PPFF condition reported lower depression and higher emotion regulation using cognitive reappraisal at post-test than did fathers in the TAU condition. Mothers in the PPFF condition reported higher levels of emotion regulation using cognitive reappraisal at post-test than did mothers in the TAU condition. PPFF was also indirectly associated with improved depression at post-test for both mothers and fathers via improvements in emotion regulation using cognitive reappraisal and with adolescent adjustment at six months via improvements in maternal emotion regulation using cognitive reappraisal. Conclusions: These findings suggest that the PPFF intervention has many benefits comparable with a longer and locally well-established program. PPFF was also associated with unique positive implications for family-wide adjustment over time. Support was also identified for transdiagnostic processes of improvement associated with the PPPF intervention consistent with the theoretical models informing the approach.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study.

BackgroundMental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.Materials and MethodsSelf-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11–17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.ResultsParental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.ConclusionThe findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

Using NIH-ADOPT Process to Characterize Adolescents with Obesity and Prediabetes

ObjectivesObesity and youth-onset type 2 diabetes (T2D) are both increasing in adolescents in the United States. To identify the behavioral, biological, psychosocial, and environmental characteristics that lead to obesity, the Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project, supported by the National Institutes of Health (NIH), recommends that these criteria are assessed in obesity research. Our objectives were to assess ADOPT criteria in our Dietary Intervention for Glucose tolerance In Teens (DIG IT), a randomized controlled trial (RCT) that involves an evaluation of health-coaching for prevention of youth-onset T2D.MethodsBoys and girls, ages 10–21 years and body mass index (BMI) > 85th percentile, were recruited into the ongoing DIG IT study. Baseline characteristics on behavior included diet and physical activity; on biology included BMI Z-scores and hemoglobin A1c (HgA1c); on psychology included emotional eating and binge eating; and on environment included parent/guardian's self-rating of their overall health; all per methods published in our protocol paper. Descriptive statistics include proportions, means and standard deviations.ResultsWe characterized baseline data on 59 participants with 61% female; age, 16.0 ± 2.8 years; BMI Z score, 2.3 ± 0.4; sagittal abdominal diameter (SAD), 23 ± 5 cm; fasting glucose, 92.3 ± 7.4 mg/dL and 49% meeting the criteria of pre-diabetes. From ADOPT criteria we highlighted several factors that promote risk of obesity and T2D including 53% consuming >10% of added sugar/day; 91% consuming <3 ounces of whole grains/day; 68% having sedentariness >10 hours/day, HgA1c of 5.5 ± 0.3, 40% of parent/guardian's self-rated overall health as fair, 65% parent/guardian rating of how often child complains of limiting food portions as sometimes or often, 46% of parent/guardian rating how often child binge eats as sometimes or often.ConclusionsWithin the ADOPT criteria, in the DIG IT population of adolescents, we identified several risk factors that promote obesity and T2D. Such risk factors may be targeted in family-based intervention programs to prevent youth-onset T2D.Funding SourcesIndiana Clinical and Translational Sciences Institute (NIH, UL1TR002529), McKinley Education Foundation, Showalter Research Trust.

Internet Addiction: The Role of Parental Care and Mental Health in Adolescence.

Internet addiction in adolescence is a social issue which is being increasingly discussed worldwide. Hence, deepening the knowledge of its development is necessary to prevent short- and long-term negative outcomes. This study involving 266 adolescents (mean age = 16.1 years, SD = 1.4) aimed at analyzing the relationship between quality of parental care, Internet addiction and adolescents’ mental health, by means of the following self-report tools: the Parental Bonding Instrument, the Internet Addiction Test, and the Strengths and Difficulties Questionnaire. The findings, collected through structural equation model analyses, showed that perceived care from both father and mother had significant indirect effects on Internet addiction problems through adolescents’ mental health problems. Furthermore, Internet addiction problems were demonstrated to be negatively associated with maternal care but not with paternal care. The study provides empirical support to the need of family-based prevention and intervention programs to take care of Internet addiction.

Qualitative Comparative Analysis of Program and Participant Factors That Explain Success in a Micropolitan Pediatric Weight Management Intervention.

Background: Building Healthy Families (BHF) was developed through a community-academic partnership to provide a 12-week family-based obesity treatment program. Nine cohorts of BHF have been delivered in multiple micropolitan settings between 2009 and 2016, but participant outcomes have varied. This study sought to explore the variation in BHF outcomes to identify the necessary and sufficient conditions that are associated with larger 12-week reductions in BMI z-scores. Methods: A qualitative comparative analysis was used to determine potential causal conditions or combination of conditions associated with larger reductions in BMI z-score. Seventy-five participants with 12-week outcome data were rank ordered as the 10 most successful participants (largest reductions in BMI z-score; m ± std = -0.64 ± 0.18) and the 10 least successful participants (smallest reductions or an increase in BMI z-score; m ± std = 0.02 ± 0.04). The conditions selected for analysis were identified based on theory and the delivery team's experience with implementing BHF. Results: Necessary conditions (i.e., present in all highly successful participants, but also some less successful participants) included children with high attendance and self-regulation, at least one adult with high attendance and self-regulation, a mother who lost weight during the program and achieved clinically meaningful weight loss. Sufficient conditions (i.e., present in only the highly successful participants) included mothers with self-regulation scores >45% (range 46.7%-98.2%), and children with a combination of high attendance (72%-100%) and self-regulation scores ≥45% (45%-92.7%). Conclusion: Program implementers should continue to focus on encouraging high attendance and emphasize the necessity of enacting self-regulation strategies at both the child and parent level.

Siblings of children with chronic disorders: Family and relational factors as predictors of mental health.

Siblings of children with chronic disorders are at increased risk of mental health problems. Predictors of siblings' mental health require further study to identify children in need of interventions and to design effective intervention programs. Siblings of children with chronic disorders (n = 107; M age = 11.5 years; SD = 2.1, 54.6% girls) and their parents (n = 199; 50.3% mothers) were included in a survey study. Siblings and parents completed questionnaires on mental health. Siblings completed questionnaires on parent-child communication, relationships with parents, and an adjustment measure on the sibling situation. Multiple linear regression analyses were applied to identify predictors of siblings' mental health. Sibling-reported relationship with parents was a significant predictor of sibling mental health reported by siblings, fathers, and mothers (R2 = 0.26 - R2 = 0.46). Siblings' adjustment was significantly associated with fathers' report of siblings' mental health (r = .36), but not mothers' report (r = .17). Siblings' relationships (d = 0.26) and communication (d = 0.33) with mothers were significantly better than with fathers. We conclude that the sibling-parent relationship is a significant factor in identifying siblings at risk and that family-based intervention programs should be developed.

Protective parenting behavior buffers the impact of racial discrimination on depression among Black youth.

The adverse impact of racial discrimination on youth, and particularly its impact on the development of depressive symptoms, has prompted attention regarding the potential for family processes to protect youth from these erosive effects. Evidence from non-experimental studies indicates that protective parenting behavior (PPB) which occurs naturally in many Black families can buffer youth from the negative impact of racial discrimination. Of interest is whether "constructed resilience" developed through family-centered prevention programming can add to this protective buffering. The current paper examines the impact of constructed resilience in the form of increased protective parenting using 295 families randomly assigned either to a control condition or to the Protecting Strong African American Families (ProSAAF) program, a family-based prevention program previously shown to enhance protective parenting. We found that baseline racial discrimination was predictive of change in youths' depressive symptoms across the pre-post study period. Second, we found that parents participating in ProSAAF, relative to those randomly assigned to the control group, significantly improved in their use of an intervention targeting PPB. Third, we found a significant effect of change in PPB on the association of discrimination with change in depressive symptoms. Finally, we found that ProSAAF participation buffered the impact of racial discrimination on change in depressive symptoms through change in PPB. Results provide experimental support for constructed resilience in the form of change in PPB and call for increased attention to the development of family-based intervention programs to protect Black youth from the pernicious effects of racial discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).