Family-based Treatment Research Articles

Poly-Victimization across Time in Juvenile Justice-Involved Youth Receiving Behavioral Health Treatment

ABSTRACT Diversion and community-based treatment for juveniles involved in the justice system is commonly used across jurisdictions as an alternative to incarceration. While evidence-based approaches to assessment have allowed courts and treatment providers to more accurately identify areas of treatment needs, studies have rarely examined how needs change during treatment. One specific area of treatment needs common to juvenile justice-involved youth is exposure to violence (ETV). This study extended a previous cross-sectional study that examined the importance of contextual location on conceptualizing ETV by examining how ETV changes during treatment for youth involved in the justice system. Using Latent Transition Analyses, the data revealed three stable groups: (a) low ETV, (b) Home and School ETV, and (c) Poly-Location ETV. While there was little interclass movement, family history of mental health problems predicted movement from the low ETV to another class. Results confirm the importance of examining the contextual location of the exposure, the relative stability of exposure during treatment, and the importance of providing family-based behavioral health treatment for JJI youth. These findings suggest that juvenile justice-involved youth receiving community-based treatment are likely to continue to experience ETV and that treatment approaches should address this area of need.

An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children

BackgroundThis case report discusses the presentation and treatment of a nine-year-old female with a history of significant weight loss and food refusal using a combined approach of Family-Based Treatment (FBT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C).Case presentationThe patient was diagnosed with avoidant/restrictive food intake disorder (ARFID), separation anxiety disorder, and a specific phobia of choking, and subsequently treated with a modified version of FBT, in conjunction with the UP-C. At the end of treatment, improvements were seen in the patient’s weight and willingness to eat a full range of foods. Decreases in anxiety regarding eating/choking, fears of food being contaminated with gluten, and fears of eating while being away from parents were also observed.ConclusionsThese findings highlight promising results from this combined treatment approach, referred to as FBT + UP for ARFID. Further research is needed to evaluate the use of this treatment in patients presenting with a variety of ARFID symptoms.

Parents Can Experience Impairment Because of Their Children's Weight and Problematic Eating Behaviors.

Pediatric obesity and eating disorders have adverse consequences on children's health and psychosocial functioning. Parents are involved in children's daily lives and their health, but the extent to which children's eating behaviors or weight impact parents' daily functioning is unknown. The present study examined parent and child impairment because of child eating problems and weight in key life domains, including work/school, social life, and family life. Participants were parents (N= 861; 35.5% fathers) who completed an online cross-sectional survey, including perceived impairment because of their child's weight and eating behaviors. Overall, 7.0% of parents reported clinically significant impairment because of child weight, and 6.9% reported clinically significant impairment because of child eating behaviors. Significantly more parents of children categorized as having obesity reported clinically significant parent and child impairment than other weight categories. Parents of children who regularly engaged in secretive eating reported greater child impairment than those without problematic eating. When child weight and problematic eating behaviors were analyzed jointly with parent sex, child sex, and parents' overinvestment in their child's weight, parents' overinvestment in child weight was associated significantly with parent and child impairment, and secretive eating maintained a significant association, but weight status was no longer associated significantly with impairment. Understanding and considering individual and family impairment associated with obesity and problematic eating behaviors is critical for family-based prevention and treatment programs.

Role of appetitive phenotype trajectory groups on child body weight during a family-based treatment for children with overweight or obesity.

Objective:Emerging evidence suggests that individual appetitive traits may usefully explain patterns of weight loss in behavioral weight loss treatments for children. The objective of this study was to identify trajectories of child appetitive traits and the impact on child weight changes over time.Methods:Secondary data analyses of a randomized noninferiority trial conducted between 2011–2015 evaluated children’s appetitive traits and weight loss. Children with overweight and obesity (mean age=10.4; mean BMIz=2.0; 67% girls; 32% Hispanic) and their parent (mean age=42.9; mean BMI=31.9; 87% women; 31% Hispanic) participated in weight loss programs and completed assessments at baseline, 3-,6-,12- and 24 months. Repeated assessments of child appetitive traits, including satiety responsiveness, food responsiveness and emotional eating were used to identify parsimonious grouping of change trajectories. Linear mixed-effects models were used to identify the impact of group trajectory on child BMIz change over time.Results:One hundred fifty children and their parent enrolled in the study. The 3-group trajectory model was the most parsimonious and included a high satiety responsive group (HighSR; 47.4%), a high food responsive group (HighFR; 34.6%), and a high emotional eating group (HighEE; 18.0%). Children in all trajectories lost weight at approximately the same rate during treatment, however, only the HighSR group maintained their weight loss during follow-ups while the HighFR and HighEE groups regained weight (adjusted p-value <0.05).Conclusions:Distinct trajectories of child appetitive traits were associated with differential weight loss maintenance. Identified high-risk subgroups may suggest opportunities for targeted intervention and maintenance programs.Trial registrationClinicaltrials.gov Identifier:

77.4 TREATING ADOLESCENT ANOREXIA NERVOSA USING FAMILY-BASED TREATMENT

This presentation provides a practical review of the delivery of manualized family-based treatment for adolescents with anorexia nervosa.

A Pilot Study of Family-Based Exposure-Focused Treatment for Youth with Autism Spectrum Disorder and Anxiety.

Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6-17years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45-55min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.

Inclusion of Family Therapy in Rehabilitation Program of Substance Abuse and Its Efficacious Implementation

The family has been described as the center or heart of societal relationships. There has been a historic neglect of research in area of counseling for the family members of substance abusers. As result, treatment for individual family members affected by alcoholism and drug addiction remains a neglected component of majority of addiction programs. The study used a sample of 36 families who participated in family therapy intensive outpatient and inpatient treatment program during 2 years. This study explored the efficacy of family-based treatment in changing family’s attitudes toward people with addiction and toward specific relative with addiction. The participants were in two groups; ethnographic technique of action research model was used. Participants in the treatment group received treatment session and participants in the control group did not receive treatment session but had a general treatment program in health centers. This study had two phases: (1) recruiting, selecting, interviewing, and determining eligibility of family members from both groups in the study and (2) applying the intervention to the treatment group with the help of cognitive-behavioral group counseling. This treatment program comprised of solution-focused family skilled training therapy, action learning techniques, community and peer mentorship, and parent training was effective in reducing addicts drug ingestion, changing their attitudes about drug use, increasing knowledge of the physical consequences of drug use, and improving competent behaviors. Family therapy enhanced family resilience, structure, and strong ties; the program improved problem-solving skills, coping skills, and family resiliency levels of the addicts.

Evaluating the Acceptability and Feasibility of Providing Egg or Cereal Breakfast during a Family-Based Treatment for Children with Overweight/Obesity: The Families and Breakfast Pilot Trial.

Background: Family-based behavioral treatment (FBT) is the most successful weight-loss treatment for children with overweight and obesity, however, long-term success is only achieved by a third of children over time. The use of foods that induce satiety, such as eggs, could improve adherence to calorically restricted diets in children and improve outcomes. This study explored the consumption of eggs (FBT+egg) or cereal (FBT+cereal) for breakfast as part of an FBT program, when breakfast foods were provided to families. Methods: Fifty 8-12-year-old children with overweight and obesity and their parents were randomized to a 4-month FBT+egg or FBT+cereal treatment program. Families were provided the ingredients for their assigned breakfast at each treatment session, and instructed to consume the breakfast a minimum of 5 days per week. Families attended assessments at baseline, post-treatment, and 4-months post-treatment. Results: Results showed that both treatments were well liked, FBT attendance was similar, and there was high compliance with consumption of the specified breakfast. Children experienced moderate weight loss at post-treatment [-0.11 standardized BMI (BMIz)] through 4-month follow-up (-0.09 BMIz), with no statistically significant differences (mean difference -0.05 BMIz, 95% confidence interval -0.19 to 0.09) observed between egg and cereal conditions across any anthropometric or appetitive measures. Conclusions: The use of eggs for breakfast in children enrolled in FBT was well tolerated, and future studies should include larger samples and longer follow-up periods to assess the potential differential effects of prescribed breakfasts on children's weight and eating behaviors.

Adapting family-based treatment for paediatric obesity: A randomized controlled pilot trial.

This pilot study aimed to refine and test an adaption of family-based treatment (FBT) for eating disorders that addressed the distinct clinical needs of adolescents with overweight or obesity in the absence of eating disorder pathology. Our hypothesis was that FBT for paediatric obesity (FBT-PO) would be feasible to implement and superior to a nutrition education counselling (NEC) condition delivered to both parents and patients, thereby controlling for key information dissemination across groups while manipulating active therapeutic content and strategy. Seventy-seven adolescents were randomized to FBT-PO or NEC across two sites. Results supported our core prediction, in that weight status among adolescent study participants receiving FBT-PO remained stable while increasing among participants randomized to NEC. Attrition was high in both conditions. FBT-PO, while not seeming to yield a marked decrease in body mass index z-score, may arrest an otherwise-occurring weight-gain trajectory for these adolescents. This efficacy finding is consistent with the overall PO literature supporting parental involvement in the treatment of PO. Future research efforts should address retention in FBT-PO.

Family involvement and treatment for young children with Obsessive-Compulsive Disorder: Randomized control study

()Background/ObjectiveThe aim of this paper was to evaluate the diferential efficacy of cognitive behavioral family treatment in children under 8 years of age with Obsessive-Compulsive Disorder (OCD) in the reduction of obsessive-compulsive responses and secondary outcomes in three treatment conditions: (a) Treatment of parents and child, (b) Treatment of mother and child, and (c) Treatment of mother.MethodForty-four children with obsessive-compulsive disorder, aged 5.2-7.9 years old and their parents, were randomized to one of three groups in a 1:1:1 ratio. Seventy-five percent was male and 100% Caucasian (White-European). Treatment involved 12 individual sessions of is Cognitive-Behavioral Family-Based Treatment delivered.ResultsThe three conditions produced clinical improvements in post-test and follow-up in the primary (symptom severity OCD) and secondary outcomes. The results showed no intergroup differences in variables related to OCD symptom severity, although statistically significant differences were found in groups in Internalizing and Externalizing problem, mother and fathers accomodation.ConclusionsThe most efficient condition was that including a greater number of family members even when there was high family accommodation. The direct involvement of the child in the psychological treatment was important in achieving better results.

Therapist adherence to family-based treatment for adolescents with anorexia nervosa: A multi-site exploratory study.

This exploratory study is the first to examine family-based treatment (FBT) adherence and association to treatment outcome in the context of a large-scale, multi-centre study for the treatment of adolescents with anorexia nervosa. One hundred and ninety recorded FBT sessions from 68 adolescents with anorexia nervosa and their families were recruited across multiple sites (N=6). Each site provided 1-4 tapes per family over four treatment time points, and each was independently rated for therapist adherence. There were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46)=8.6, p<.001, and phase, F(3, 42)=12.7, p<.001, with adherence decreasing in later phases. Adherence was not associated to end of treatment percent ideal body weight after controlling for baseline percent ideal body weight (r=.088, p=.48). Results suggest that FBT can be delivered with adherence in phase one of treatment. Adherence was not associated with treatment outcome as determined using percent ideal body weight.

Updates on Treatments for Adolescent Anorexia Nervosa.

This article provides background information, descriptions, and evidential support for the more recent treatments for adolescents with anorexia nervosa, including family-based treatment, adolescent focused therapy, cognitive behavioral therapy, systemic family therapy, and psychopharmacologic treatments. At this time, family-based treatment has the best evidence of efficacy and cost-effectiveness. Future directions in treatment research for adolescent anorexia nervosa are discussed.

Update on Treatments for Adolescent Bulimia Nervosa.

There are few systematic studies of treatment of bulimia nervosa (BN) in adolescents. Although family-based treatment has demonstrated preliminary evidence to support involvement of caregivers in treatment, there is significant opportunity for improvement in mitigating binge-eating and purging symptoms among adolescents afflicted with BN. When caregivers are unable to participate in treatment, there is evidence that BN-specific cognitive behavioral therapy approaches are helpful for some adolescents. Further research is needed to determine for whom, and under what conditions certain types of family involvement might be most effective in adolescent treatment of BN.

The Role of Higher Levels of Care for Eating Disorders in Youth.

Many eating disorder patients are successfully treated in outpatient settings. Family-based treatment allows youth to recover at home. Higher levels of care may be necessary for medical or psychiatric stabilization, or to provide added structure. Historically, hospital lengths of stay were long. Currently, insurance limitations encourage intermediate care levels to support patients not requiring inpatient treatment but not ready for outpatient care. Options include inpatient medical stabilization, locked units for individuals with suicidal ideation, and outpatient programs offering daily meal support and group therapy. Outpatient teams and families collaborate to determine the appropriate level of care.

A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods

While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice — particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IdentifiersClincialtrials.gov: NCT03245775.

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

Family-Based Psychological Treatment for Obsessive Compulsive Disorder in Children and Adolescents: A Meta-analysis and Systematic Review.

A significant number of children and adolescents with obsessive compulsive disorder (OCD) demonstrate poor response to the current gold standard treatment, cognitive behaviour therapy (CBT) with exposure and response prevention (ERP). Recent findings suggest that family variables affect treatment response highlighting the need for a meta-analytic review of the precise impact of family variables on OCD-related symptoms and processes. The current review and meta-analysis examined the effect of family-based interventions on OCD symptom and family factor outcomes for children and adolescents with OCD. The moderating effects of the degree of parental involvement and number of family factors targeted in treatment were investigated. An extensive literature search identified 37 eligible studies (1727 OCD participants). Large significant pooled mean effect sizes for OCD symptoms and Family Accommodation (FA), respectively, were obtained at posttest (g = 1.56; g = 1.00) and follow-up (g = 1.69; g = 1.98). Moderator analyses indicated that the number of family factors targeted in treatment significantly moderated outcomes on measures of FA (z = 2.21, p = 0.03), but not on Children's/Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS) outcomes. FA has been significantly correlated with OCD symptom severity and poorer treatment outcomes, and there is data to suggest that FA may mediate OCD symptom outcomes (e.g.,Piacentini et al. in J Am Acad Child Adolesc Psychiatry 50:1149-1161, 2011). Findings show that the greater the number of family factors targeted, the greater the reduction in FA at post, highlighting the importance of addressing a range of family factors in child OCD treatment to optimise outcomes.

Parent-Facilitated Behavioral Treatment for Avoidant/Restrictive Food Intake Disorder: A Case Report

Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical utility of innovative therapeutic approaches. Here we describe a novel parent-facilitated behavioral treatment for youth with ARFID (PBT-ARFID) that is grounded in learning theory, as well as components of well-established family-based treatment (FBT) for eating disorders. We propose a two-factor theory of avoidance learning within a biopsychosocial model to explain behavior in ARFID and utilize counterconditioning as a core intervention to reverse paired, classically conditioned association between food and aversive state (i.e., disgust and/or anxiety). This report details a step-by-step comprehensive treatment approach for ARFID that can be adapted to a broad range of youth and their families, along with a case study illustrating application of the model. This pilot case provides preliminary evidence that the PBT-ARFID model incorporating counterconditioning may be a powerful treatment for youth with ARFID. More case and pilot studies are needed to justify formally investigating its efficacy in a randomized controlled trial.

Using Jones’s Integration Approach to Accommodate Attachment-Based Family Therapy to Christian Treatment of Depression in Adolescence

The overarching goal of this article was to practice a faith-integration process focused on an empirically supported, family-based treatment approach for adolescent depression, Attachment-Based Family Therapy (ABFT). First, we describe the ABFT treatment model and evaluate the extant empirical support for its use. Next, using the theological framework by Balswick and Balswick (2007), we investigate a scriptural understanding of healthy family functioning. Finally, we engage in a dialogical process that includes a critical evaluation and constructive modification of ABFT, based on the previous investigation of empirical, theological, and scriptural sources of knowledge. We found that the goals and treatment approach of ABFT are consistent with biblical and theological notions of healthy family functioning, and we suggested two modifications that might enhance services to Christian populations. Thus, we provide specific recommendations for accommodating a particular treatment (ABFT) to Christians, and, at a general level, we encourage Christian mental health providers to engage in their own process of practical integration, such as demonstrated in this article, to inform their clinical use of interventions supported by clinical psychological science.

Effectiveness of family-based treatment for pediatric eating disorders in a tertiary care setting.

Effectiveness of family-based treatment for pediatric eating disorders in a tertiary care setting.