Family Involvement In Treatment Research Articles

Provider perceptions of systems-level barriers and facilitators to utilizing family-based treatment approaches in adolescent and young adult opioid use disorder treatment

BackgroundAmidst increasing opioid-related fatalities in adolescents and young adults (AYA), there is an urgent need to enhance the quality and availability of developmentally appropriate, evidence-based treatments for opioid use disorder (OUD) and improve youth engagement in treatment. Involving families in treatment planning and therapy augments medication-based OUD treatment for AYA by increasing treatment engagement and retention. Yet, uptake of family-involved treatment for OUD remains low. This study examined systems-level barriers and facilitators to integrating families in AYA OUD treatment in Rhode Island.MethodsAn online survey was administered to clinic leaders and direct care providers who work with AYA in programs that provide medication and psychosocial treatments for OUD. The survey assessed attitudes towards and experiences with family-based treatment, barriers and facilitators to family-based treatment utilization, as well as other available treatment services for AYA and family members. Findings were summarized using descriptive statistics.ResultsA total of 104 respondents from 14 distinct treatment programs completed the survey. Most identified as White (72.5%), female (72.7%), and between 25 and 44 years of age (59.4%). Over half (54.1%) of respondents reported no experience with family based treatment and limited current opportunities to involve families. Barriers perceived as most impactful to adopting family-based treatment were related to limited available resources (i.e. for staff training, program expansion) and lack of prioritization of family-based treatment in staff productivity requirements. Barriers perceived as least impactful were respondent beliefs and attitudes about family-based treatment (e.g., perception of the evidence strength and quality of family-based treatment, interest in implementing family-based treatment) as well as leadership support of family-based treatment approaches. Respondents identified several other gaps in availability of comprehensive treatment services, especially for adolescents (e.g. services that increase social recovery capital).ConclusionsFamily-based treatment opportunities for AYA with OUD in Rhode Island are limited. Affordable and accessible training programs are needed to increase provider familiarity and competency with family-based treatment. Implementation of programming to increase family involvement in treatment (i.e. psychoeducational and skills-based groups for family members) rather than adopting a family-based treatment model may be a more feasible step to better meet the needs of AYA with OUD.Trial registration: not applicable.

Experiences of families of men with prostate cancer on supportive care received from nurses

Background: Family members of men diagnosed with prostate cancer (PCa) experience a range of supportive care needs. Literature indicated inconsistent supportive care from nurses to families of men diagnosed with PCa.Aim: Exploring and describing the experiences of family members of men diagnosed with PCa on the supportive care received from nurses.Setting: The study was conducted in the oncology departments of the Intermediate Hospital Oshakati.Methods: Qualitative, exploratory, descriptive, phenomenological and contextual designs were adopted. A sample of seven family members of men diagnosed with PCa was selected using a non-probability purposive sampling technique. Individual face-to-face interviews were conducted. Interview guide and field notes were used to collect data. All interviews were recorded with an audio recorder and transcribed verbatim. Content analysis using Tesch’s eight steps of open coding was adopted to analyse data. Criteria for establishing trustworthiness of the data were used. Fundamental ethical principles were adhered to.Results: The study revealed lack of family involvement in treatment and decision-making. Two themes emerged: (1) feeling of being devalued in the healthcare system, and (2) non-conducive environment for counselling men.Conclusion: It became evident that family members of men diagnosed with PCa are rarely considered in clinical practice. Recommendations are made in terms of policy formulation, organisational changes in the hospital protocols and staff training.Contribution: The study proposed the introduction of national policy on supportive care of men with PCa and an inclusion of their families during treatment and decision-making.

Improving Adherence to Taking Medication through Family Support for Hypertensive Elderly in the District Area of the Patient

Age isa period of human growth that is prone to various health problems such as hypertension. Hypertension is also the highest incidence of non-communicable diseases (NCDs) compared to other NCDs, which is 76.5% in Central Java Province. Uncontrolled hypertension can lead to more serious health problems. Management of hypertension requires the elderly to take medication regularly. Elderly compliance is the key to success in controlling blood pressure. Family involvement in treatment certainly has a positive impact on the success of treatment therapy. Objective: to determine the relationship between family support and medication adherence in hypertensive elderly in Pati Regency. Research Method: A type of correlational descriptive quantitative research with a cross sectional approach. The population is all hypertensive elderly in Pati Regency and the number of samples is 44 elderly according to inclusion and exclusion criteria. Results: Seniors who received good category family support tended to be more compliant with taking medication. The results of statistical tests using the Chi Square test obtained a p value of 0.002 (<0.05). Conclusion: There is a relationship between family support and medication adherence in hypertensive elderly in Pati Regency.

Key person-centered care domains for residential substance use disorder treatment facilities: former clients’ perspectives

BackgroundWhile person-centered care (PCC) includes multiple domains, residential substance use disorder (SUD) treatment clients may value certain domains over others. We sought to identify the PCC domains most valued by former residential SUD treatment clients. We also sought to explore conceptual distinctions between potential theoretical PCC subdomains.MethodsWe distributed an online survey via social media to a national convenience sample of former residential SUD treatment clients. Respondents were presented with ten PCC domains in an online survey: (a) access to evidence-based care; (b) integration of care; (c) diversity/respect for other cultures; (d) individualization of care; (e) emotional support; (f) family involvement in treatment; (g) transitional services; (h) aftercare; (i) physical comfort; and (j) information provision. Respondents were asked to select up to two domains they deemed most important to their residential SUD treatment experience. We used descriptive statistics to identify response frequencies and logistic regression to predict relationships between selected domains and respondents’ race, gender, relationship status, parenting status, and housing stability.ResultsOur final sample included 435 former residential SUD treatment clients. Diversity and respect for different cultures was the most frequently selected domain (29%), followed by integration of care (26%), emotional support (26%), and individualization of care (26%). Provision of information was the least frequently chosen domain (3%). Race and ethnicity were not predictive of selecting respect for diversity. Also, parental status, relationship status and gender were not predictive of selecting family integration. Employment and housing status were not predictive of selecting transitional services.ConclusionsWhile residential SUD treatment facilities should seek to implement PCC across all domains, our results suggest facilities should prioritize (a) operationalizing diversity, (b) integration of care, and (c) emotional support. Significant heterogeneity exists regarding PCC domains deemed most important to clients. PCC domains valued by clients cannot be easily predicted based on client demographics.

A quality assessment of clinical practice guidelines with recommendations for family involvement in the care of individuals diagnosed with schizophrenia, bipolar mood disorder, and major depressive disorder: Critical appraisal utilizing AGREE II.

Evidence suggests that family-center collaborative care is useful for individuals identified with chronic mental illness. Clinical practice guidelines offer specific recommendations primarily based on to be had studies and are beneficial in informing evidence-based practice and guiding destiny studies. Identify current scientific practice guidelines including family-center collaborative care suggestions for individuals with Bipolar Mood Disorder, Schizophrenia, and Major Depressive Disorder and analyze the selection of guidelines for their methodological quality. A systematic search was conducted on seven electronic databases (G-I-N), (NICE), (MOH), (SIGN), (WHO), (NIH) and (APA) and additional sources. Three referees independently reviewed articles and selected guidelines for inclusion criteria. Subsequently, 18 trained appraisers independently assessed all 15 guidelines using AGREE II. The mean scores for domains and overall quality were computed. For the overall assessment of the guidelines, 60% reached the quality threshold with domain scores of 60%. The overall average quality rating for these guidelines was 58/29%. The applicability of the guidelines needs to be improved in order to improve their relevance and clinical utilization. As individuals with chronic mental illnesses progress through their disease course, families and health care providers play a crucial role in helping them. The analysis of research knowledge on effective rehabilitation techniques, including the involvement of families in treatment, can be enhanced by using well-developed and appropriate methods.

Diversité des prises en charge hospitalières de l’anorexie mentale en psychiatrie en France

BackgroundHospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). MethodsThe eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. ResultsFour of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. ConclusionThere is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their “team culture”. The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Family involvement in treatment and recovery for substance use disorders among transition-age youth: Research bedrocks and opportunities

This article presents a narrative review and conceptual framework for research on family involvement across the continuum of substance use disorder (SUD) services for transition-age youth (ages 15–26). Though families are powerful resources for enhancing treatment and recovery success among youth with SUDs, they are not routinely included in clinical practice. This article summarizes youth SUD prevalence and service utilization rates and presents developmental and empirical rationale for increasing family involvement in services. It then describes key research issues on family involvement across the SUD services continuum: Problem Identification, Treatment Engagement, Active Treatment, Recovery Support. Within each phase, it highlights bedrock research findings and suggests promising opportunities for advancing the scientific knowledge base on family involvement. The main goals are to endorse family-oriented practices for immediate adoption in routine care and identify areas of research innovation that could significantly enhance the quality of youth SUD services.

Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder.

With opioid use at crisis levels, it is imperative to support youth ages with opioid use disorders (OUD) in taking medication and accessing behavioral services over long periods. This article presents a conceptual framework for telehealth strategies that can be adopted to increase family involvement across a four-stage continuum of youth OUD treatment and recovery: Treatment Preparation, Treatment Initiation, Treatment Stabilization, OUD Recovery. It first identifies provider-delivered tele-interventions that can enhance OUD services in each of the four stages, including family outreach, family engagement, family-focused intervention, and family-focused recovery maintenance. It then introduces several types of direct-to-family tele-supports that can be used to supplement provider-delivered interventions. These include both synchronous tele-supports (remote interactions that occur in real time) such as helplines, peer-to-peer coaching, and online support groups; and asynchronous tele-supports (communications that occur without participants being simultaneously present) such as automated text messaging, self-directed internet-based courses, and digital web support.

Instruments to Measure Outcomes in Pediatric Palliative Care: A Systematic Review.

Pediatric palliative care (PPC) is intended to promote children's quality of life by using a family-centered approach. However, the measurement of this multidimensional outcome remains challenging. To review the instruments used to assess the impact of PPC interventions. Five databases (Embase, Scopus, The Cochrane Library, PsychInfo, Medline) were searched. Inclusion criteria were as follows: definition of PPC used; patients aged 0 to 18 years; diseases listed in the directory of life-limiting diseases; results based on empirical data; and combined descriptions of a PPC intervention, its outcomes, and a measurement instrument. Full-text articles were assessed and data were extracted by 2 independent researchers, and each discrepancy was resolved through consensus. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers From a Variety of Fields checklist. Nineteen of 2150 articles met the eligibility criteria. Researchers in 15 used quantitative methods, and 9 were of moderate quality. Multidimensional outcomes included health-related quality of life, spiritual well-being, satisfaction with care and/or communication, perceived social support, and family involvement in treatment or place-of-care preferences. PPC interventions ranged from home-based to hospital and respite care. Only 15 instruments (of 23 reported) revealed some psychometric properties, and only 5 included patient-reported (child) outcome measures. We had no access to the developmental process of the instruments used to present the underlying concepts that were underpinning the constructs. Data on the psychometric properties of instruments used to assess the impact of PPC interventions were scarce. Children are not systematically involved in reporting outcomes.

Consensus-based perspectives of pediatric inpatient eating disorder services.

There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. A modified Delphi technique was used to develop consensus-based opinions. Participants (N = 74) were recruited for three panels: clinicians (n = 24), carers (n = 31), and patients (n = 19), who endorsed three rounds of statements online. A total of 167 statements were rated, 79 were accepted and reached a consensus level of at least 75% across all panels, and 87 were rejected. All agreed that families should be involved in treatment, and thatpsychological therapy be offered in specialist inpatient units. Areas of disagreement included that patients expressed a desire for autonomy in sessions being available without carers, and that weight gain should be gradual and admissions longer, in contrast to carers and clinicians. Carers endorsed that legal frameworks should be used to retain patients if required, and that inpatients are supervised at all times, in contrast to patients and clinicians. Clinicians endorsed that food access should be restricted outside meal times, in contrast to patients and carers. The findings indicate areas of consensus in admission criteria, and that families should be involved in treatment, family involvement in treatment, while there was disagreement across groups on topics including weight goals and nutrition management. Perspectives from patients, carers, and clinicians may be useful to consider during future revisions of best practice guidelines.

Family-focused practices in addictions: a scoping review protocol

IntroductionFamilies are significantly impacted by addictions and family involvement in treatment can reduce the harms and can also improve treatment entry, treatment completion and treatment outcomes for the individual coping...

Family Involvement in Treatment and Discharge Planning

Family Involvement in Treatment and Discharge Planning

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.

Family Involvement in Treatment Among Youth in Residential Facilities

Youth treated in a residential treatment center (RTC) receive an array of services to address their mental health and behavioral issues, including psychotherapy and medication. Prior studies have shown that youth continue to receive a considerable number of services after discharge from a RTC. This study describes the characteristics of children and youth served in Florida’s Medicaid-funded residential treatment facilities, examines whether family involvement in treatment is associated with discharge to a family-like setting, and assesses continuity of treatment after discharge. Data for this study were obtained from the SIPP Provider Monthly Report Database from January 2005 through December 2011. These data contain information on family involvement during treatment. Post-discharge data were from Medicaid enrollment/claims files and Prepaid Mental Health Plan encounters. Results of this study suggest that family contacts for interventions and treatment planning are associated with a greater likelihood of discharge to a family-like setting. Among youth discharged to a family-like setting, family involvement during treatment was associated with receiving follow-up outpatient care. Results support the continued emphasis on including family members in the treatment of youth with mental health needs to ensure better outcomes and continuity of treatment.

Characteristics Associated With the Continuity of Atypical Antipsychotic Treatment Among Youth Discharged From Residential Treatment

This article examined the continuity of atypical antipsychotic medications among children and adolescents following discharge from a residential mental health treatment facility in the state of Florida from 2005 through 2011. Discharge data are reported by the residential providers, while post-discharge data are from Medicaid enrollment and claims files. Fifty-five percent of youth were receiving antipsychotic medications when discharged from residential treatment. Of those receiving such medications, 55% continued with their medication after discharge. Antipsychotics were more likely at discharge among youth who were older, had longer treatment episodes, showed greater improvements during treatment, and had prior involuntary examinations and out-of-home treatment episodes. Continuation of antipsychotic medication was more common among youth who had greater family involvement in treatment, longer treatment episodes, improved more during treatment, and had prior involuntary examinations. Continuation was less likely for youth with prior out-of-home treatment episodes. These results contribute to the existing literature by examining the continuity of atypical antipsychotic medication among children and adolescents following residential treatment.

Parent-based treatment for childhood and adolescent OCD

Despite the efficacy of E/RP and pharmacotherapy for OCD, many children do not respond adequately to therapy. Furthermore, many children exhibit low motivation or ability to actively participate in therapy, a requirement of E/RP. Research has underscored the importance of family accommodation for the clinical course and treatment outcomes of childhood OCD. Recent studies highlighted the potential of family involvement in treatment to enhance outcomes for challenging cases. These interventions however still require child participation. The goal of this clinical report is to describe an exclusively parent-based intervention and present preliminary indications of its acceptability, feasibility and potential efficacy. The Supportive Parenting for Anxious Childhood Emotions (SPACE) Program is a manualized treatment focused on reducing accommodation and coping supportively with the child's responses to the process. The theoretical foundation of the intervention is presented and its practical implementation is illustrated, with excerpts from the treatment manual and a clinical vignette. Preliminary results from the parents of 6 children, who refused individual therapy, are presented. Parents participated in 10 weekly sessions and reported high satisfaction and reduced child symptoms. Research is required to investigate the potential of SPACE as a complement or alternative to other evidence based interventions for childhood OCD.

Family Involvement in Treatment among Youth in Residential Facilities: Association with Discharge to Family-Like Setting and Follow-Up Treatment

Background: Youth treated in a RTC receive an array of services to address their mental health and behavioral issues, including psychotherapy and medication. Prior studies have shown that youth continue to receive a considerable number of services after discharge from a RTC. Objective: This study describes the characteristics of children and youth served in Florida’s Medicaid-funded residential treatment facilities, known as the Statewide Inpatient Psychiatric Program (RTC), examines whether family involvement in treatment is associated with discharge to a family-like setting and continuity of treatment after discharge. Method: Data for this study were obtained from the RTC Provider Monthly Report Database (SPMRD) from January 2005 through December 2011. These data contain information on family involvement during treatment. Post-discharge data are from Medicaid enrollment/claims files and Prepaid Mental Health Plan (PMHP) encounters. Results: Results of this study suggest that family contacts for interventions and treatment planning are associated with a greater likelihood of discharge to a family-like setting. Among youth discharged to a family-like setting, family involvement during treatment was associated with receiving follow-up outpatient care. Conclusion: Results support the continued emphasis on including family members in the treatment of youth with mental health needs to ensure better outcomes and continuity of treatment.

Terapia Cognitivo-Comportamental para Transtornos Alimentares: A Visão de Psicoterapeutas sobre o Tratamento

Os transtornos alimentares (TA) constituem uma área de crescente interesse dos profissionais da saúde. Todavia, ainda há poucos estudos brasileiros sobre o tratamento dessas patologias pela Terapia Cognitivo-Comportamental (TCC). O presente artigo se propõe a investigar como se dá o tratamento dos TA na visão de quatro terapeutas especializados nessa abordagem. O delineamento utilizado foi o de Estudos de Caso Múltiplos e as informações foram obtidas através de entrevistas abertas. Os resultados mostraram consenso sobre a importância do vínculo terapêutico, da interdisciplinaridade e do envolvimento familiar no tratamento. Entre as vantagens da TCC foram citadas a resposta rápida e a eficácia das técnicas. Quanto às limitações, foram mencionados aspectos como pouca motivação dos pacientes e questões econômicas. O principal critério de alta é um funcionamento global adequado. Finalmente, todos concordam em que novas pesquisas na área são importantes. Salienta-se especialmente a necessidade de novas investigações no contexto nacional.

Enhancing the developmental appropriateness of treatment for depression in youth: integrating the family in treatment.

Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.

Effectiveness of the Challenging Horizons After-School Program for Young Adolescents With ADHD

There are no empirically supported psychosocial treatments for adolescents with attention-deficit hyperactivity disorder (ADHD). This study examined the treatment benefits of the Challenging Horizons Program (CHP), a psychosocial treatment program designed to address the impairment and symptoms associated with this disorder in young adolescents. In addition to evaluating social and academic functioning outcomes, two critical questions from previous studies pertaining to the timing, duration, and family involvement in treatment were addressed. Forty-nine students recruited in two cohorts were randomly assigned to receive either the CHP or a community care condition. Outcomes suggested that students who received the CHP improved compared to students in the control condition on measures of symptoms and impairment. Implications related to timing, duration, and family involvement are reported, as well as recommendations for future studies.