Intensive Family Intervention Research Articles

Reimagining care: effectiveness of modifying an adolescent eating disorder intensive service.

The COVID-19 pandemic prompted a surge in adolescent eating disorders and rapid changes in the delivery of intensive community treatments. This study investigates the modification from a group-based day programme to an intensive family treatment approach. A retrospective chart review was performed on data from 190 patients who accessed the intensive service for anorexia nervosa in the past 6 years. Outcomes from the traditional model were compared with the new intensive family model, namely length of admission, percentage median body mass index difference and transfers to in-patient services. There was a significant reduction in the length of intensive treatment (from 143.19 to 97.20 days). The number of transfers to specialist eating disorder in-patient services also significantly reduced, and is decreasing year on year. The findings hold particular relevance as intensive services for adolescent eating disorders continue to be established within health services, with no clear unified approach to treatment.

Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation

BackgroundChild criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation.MethodsThis pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services.ResultsAccrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023.ConclusionsThe results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation.Trial registrationTrial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021—https://doi.org/10.1186/ISRCTN16164816.

Improving interventions for families with multiple problems: Identifying elements that predict improvement

IntroductionMany interventions have been developed to reduce the problems of families with multiple problems (FMP) and to prevent children's out-of-home placement. Evidence is increasing about the effects of these interventions, but is scarce about the elements of care determining these effects. The aim of this study is to examine to what extent provided elements are associated with improved outcomes for FMP. MethodsWe collected data from 499 FMP that received an intensive family intervention. Practitioners collected information every four weeks about provided practice elements (content), the method of provision, recipients and program elements (structure). Parents filled out questionnaires at the start, at the end, and three months after conclusion of the intervention. We used the Reliable Change Index (RCI) to discriminate improvement and non-improvement regarding four outcomes: child externalizing behavior, child internalizing behavior, parenting stress, and social contacts. ResultsWe found that parenting stress was more likely to be reduced when skills were more often practiced with the family. We found no associations between practice elements, methods or recipients and other outcomes. We neither found associations between provided program elements and improved or non-improved outcomes. ConclusionOur research shows that the majority of the individual elements show no or only very limited effect, except for practicing skills with family members. To gain more insight into the contribution of elements of interventions for FMP, we recommend looking further into the association between provided elements and other factors such as the therapeutic alliance and severity of problems.

Parent–child contact problems and family intensive interventions: The crisis of adolescent suicidality and the role of social media

AbstractAlthough clinicians, educators and parents have been alarmed by the decline in the mental health of children and adolescents commensurate with the Covid‐19 pandemic, statistics indicate there has been a downward spiral over the last decade. This has been evident in the overall increase in suicide rates for young people. For legal and mental health professionals working in the Family Court system, this has provided unique challenges. Most vulnerable has been those children and adolescents embroiled in high conflict divorces, especially those exhibiting parent child contact problems. This article focuses upon that population exhibiting parent child contact problems, and their treatment, specifically Family Intensive Intervention. Building Family Resilience is an Intensive family treatment program that has had to address this deterioration in child and adolescent mental health and increase in suicidality. The role of social media in both exacerbating and/or ameliorating mental health issues is explored.

Parental empowerment as a buffer between parental stress and child behavioral problems after family treatment

The present study examined the long-term treatment outcomes of the family-centered program Intensive Family Treatment (IFT) for families with multiple problems. We also tested the hypothesis that parental empowerment at the end of IFT constitutes a buffer between the negative influences of parental stress on their children’s behavioral problems afterwards. We included 275 families with multiple problems. Information about parental empowerment and child behavioral problems was gathered at the start and end of IFT and at follow-up, on average 2.8 years (SD = 1.6) later. At follow-up, information was also collected about parental stress and professional support. Data were analyzed through latent regression analyses. Significant improvements in child behavioral problems (effect size 0.60) and parental empowerment (effect size 0.53) were observed during treatment. Improvements were sustainable for child behavioral problems after IFT. Nevertheless, child behavioral problems remained severe on average and might be a stressor for parents. Together with other environmental stressors after IFT, these problems can increase parental stress and subsequently increase child behavioral problems. However, taking into account that professional support after IFT often still is needed, the findings of our study showed that parental empowerment at the end of IFT constitutes a buffer; parental stress had a less negative influence on child behavioral problems at follow-up when parents had a higher level of parental empowerment at the end of IFT. This study stresses the importance of empowering parents during family treatment to successfully cope with environmental stressors after treatment, including the problematic behavior of the child.

Professional parental status disclosure in intensive family intervention work

Purpose This paper is concerned with what intensive family intervention professionals reveal to the parents with whom they work about whether they themselves are parents or not, as a form of professional self-disclosure in child welfare work. This paper also addresses the act of lying in professional self-disclosure. Design/methodology/approach The paper draws on material from a series of narrative interviews completed with practitioners from one family intervention programme in an English local authority as part of a study looking at how children’s services professionals experience the suffering of parents. The study was based on a psychoanalytically informed methodological approach, which is represented in the analysis provided in the paper. Findings The overall team ethos regarding parental status disclosure is considered briefly first then two participants’ accounts are explored in depth. These involved, what can be considered as, questionable or unorthodox stances regarding parental status disclosure (and self-disclosure more generally). The exploration illustrates the role that practitioners’ personal lives and histories can play in influencing how the act of professional parental status disclosure is experienced and how particular positions are invested in regarding the role of self-disclosure in working relationships with parents. Originality/value Child welfare and family intervention professionals are often asked personal questions by the parents and carers they work with, including questions about whether they are a parent or not. These questions can be difficult to answer and there is a need for dedicated empirical analysis into the ways in which professionals experience, think about and respond to them and what they disclose about themselves when working with families.

Parental Empowerment and Child Behavioral Problems in Single and Two-Parent Families During Family Treatment

We examined (1) the extent to which the family-centered program Intensive Family Treatment (IFT) succeeds in realizing beneficial parental psychological empowerment and child behavioral outcomes both in single-parent and two-parent families and (2) how these outcomes are influenced by the presence of a co-caregiver as a potential source of empowerment. A group of 140 single-mother and 156 mother–father families was compared. Information about empowerment of parents and children’s behavioral problems was collected at the start and end of IFT and analyzed with cross-lagged panel analyses. Although single mothers and mothers in two-parent families were comparable in the extent of improvements in psychological empowerment (effect sizes were respectively 0.52 and 0.57) and child behavioral problems (effect sizes were both 0.49), they differ in how these improvements were achieved. For single-parent families, more maternal empowerment at the start of IFT was directly related to positive changes in child behavioral problems (β = −0.246, p < 0.01). Among two-parent families, more paternal empowerment at the start was directly related to improved maternal empowerment (β = 0.249, p < 0.001) but maternal empowerment at the start was not directly related to changes in the father’s empowerment. This study stresses the importance of taking into account the presence or absence of a co-caregiver as a potential source of psychological empowerment during family-centered programs as IFT.

Intensive family intervention programs: Tailoring interventions to family clinical profiles

IntroductionIntensive family intervention programs intended for families in a crisis situation aim at preventing the emergency placement of adolescents with emotional or behavior problems. However, few studies have focused on intervention tailoring to the clinical profiles of families, although this is a key principle in these programs. ObjectivesThis treatment-process research aims to (1) identify profiles of families based on youth and family characteristics and (2) compare the intervention received by families with different clinical profiles. MethodologyThe study sample includes 237 families that received services under the Crise-Ado-Famille-Enfance (CAFE) program, an intensive family intervention program developed to respond to family crisis situations. AnalysisA latent profile analysis (LPA) was used to distinguish profiles of families based on adolescent and family characteristics. The Bolck-Croon-Hagenaars (BCH) method has helped compare these profiles on program (duration, dosage, intensity) and practice elements (main subject of each session with family). ResultsLPA has led to four distinct profiles: a profile with particularly severe problems across all variables, (n = 22), a profile with less severe problems (n = 95) and two profiles with moderate problems, one (n = 61) with more relational problems and the other (n = 59) with problems related more to the adolescent’s behaviors. The BCH results showed significant differences regarding program and practice elements received by families. DiscussionOverall, findings indicate that intensive family intervention programs target families presenting a wide range of difficulties and highlight a certain lack of adjustment of the intervention to the clinical profiles of families. Implications for both research and practice are discussed.

Abstract P292: THE LACK OF FASTING INSULIN MEASUREMENT DELAYS THE MANAGEMENT OF PREDIABETES IN OBESE ADOLESCENTS.

Background: Insulin resistance is a medical complication associated with obesity and metabolic syndrome in youth. Data have shown that pediatric obesity can stop or even decrease by an adequate clinical management of the insulin resistance-associated syndrome. Despite those new evidences, measurement of insulin resistance in youth remains quite low. Objective: The objective was to review and evaluate the proportion of pediatric obese patients referred to a 2nd line pediatric multidisciplinary obesity clinic among whom insulin resistance was screened or not. Material &amp; Method: We have looked, retrospectively, at the initial blood tests among 133 obese patients (body mass index above 97th percentile with respect for age and sex) above 10 years of age, between July 2017 and April 2019. Sixty percent (60%) of our urban cohort is represented by 1st and 2nd generation immigrants. Hyperinsulinemia was defined as a value above 100 pmol/L. Pediatric obese patients were referred by general practitionniers or community pediatricians. Results: Among the 133 medical files revised, 91 patients shown hyperinsulinemia (68%). Of those 91 patients, 64 were not initially screened for hyperinsulinemia (70%). Interestingly, in the hyperinsulinemia pediatric group, mean HDL-cholesterol was lower, mean triglycérides were higher, as well as the mean alanine transaminase (ALT) compared to the normal insulin group (p smaller than 0.05). In the hyperinsulinemia group, 71,8% of our pediatric cohort was started on metformin therapy in addition to a multidisciplinary intensive educational family interventions as recommended by WHO. Conclusions: Fasting insulin can be variable among puberty stages and general guidelines for the use of metformin in the pediatric population are still to come. However, measurement of elevated fasting insulin among pre- and post-pubertal patients was previously associated with markers of cardiovascular and hepatic complications in obese young patients. Fasting insulin is a simple, cheap, easily accessible measure in all clinical settings. Multidisciplinary health care for pediatric obesity is still embryonic and difficult to access. Appropriate and complete initial clinical investigations, including fasting insulin measurement, should be performed in order not to delay its medical intensive multidisciplinary management both in 1st and 2nd lines practitioners.

Investment in Australian mental health carer services: how much and does it reflect evidence of effectiveness?

Objective The aims of this study were to quantify Australian federal and state government expenditure on mental health carer services for 2014-15, map the types of services being provided and explore how funded service types compare with the evidence base for the outcomes of these carer services. Methods Web searches were conducted to identify in-scope mental health carer services in Australia funded by federal and state and territory governments. Funding estimates were confirmed where possible with available government and carer organisation contacts. A literature search was conducted for reviews of studies investigating mental health carer service outcomes. Results In 2014-15, the estimated Australian national, state and territory government expenditure on mental health carer services was approximately A$90.6million. This comprised A$65.6million in federal expenditure and A$25.0million in state and territory expenditure. Most funding streams provided respite and psychoeducation. The literature showed positive carer outcomes for psychoeducation and intensive family interventions. Evidence was lacking for the effectiveness of respite services. Conclusions These findings suggest a mismatch between what is known about the extent to which different service types deliver positive carer outcomes and the current allocation of funds across Australia's mental health system. This study also highlights the fragmentation of the mental health carer services system, supporting the need to streamline access. What is known about this topic? Informal carers of people with mental disorders provide a critical role to the significant number of individuals with mental illness in Australia, and provide an unpaid workforce to the Australian mental health system. This role comes with significant physical, emotional and financial burden, which government-funded services can assist with to allow mental health carers to continue to serve in their caring role while improving their quality of life. What does this paper add? Using both published data and communication with health and non-government officials, we have estimated federal and state expenditure on mental health carer services at A$90.6million in 2014-15 fiscal year and have provided a mapping of the services this expenditure funds. In addition, through analysis of the literature on outcomes of carer services provided, we have seen a mismatch of expenditure and the evidence base. What are the implications for practitioners? There is a necessity for both more research into service outcomes aimed particularly at mental health carers and thinking critically about whether the current prioritisation of funds can be increased and/or reallocated to create better outcomes for mental health carers.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers.

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P=0.03) and subscale conflict (P=0.04), communication (P=0.01), and problem-solving (P=0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

Family-Based HIV and Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes.

This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.

Consistency of outcomes of home-based family treatment in The Netherlands as an indicator of effectiveness

Most youth care interventions are not supported by evidence from experimental or quasi-experimental studies. Yet children and families have to be treated and financiers and policy makers are asking value for money. For these reasons, evidence from practice-based studies should not be overlooked. Particularly, strengthening the designs of these studies could yield useful indications of effectiveness. The present study shows how this can be done by analyzing consistency in group and individual outcomes over time and across locations. Pre- and post-measures of behavior problems were collected over nine consecutive years at three locations in The Netherlands from nearly 900 children whose families received Intensive Family Treatment (IFT), a home-based treatment for multi-problem families. Over the years, the overall effect size was 0.66 (range of 0.51–0.80). Further analysis showed that these effects were stable over time and across locations. The reliable change index showed that about 63% of the children improved significantly during treatment (range of 56–68%) and 9% deteriorated or relapsed (range of 6–13%). These changes were also stable over time and partially stable across locations. The consistency of these results serves as an empirical indication of the effectiveness of IFT. Due to the lack of studies using control groups, such consistency might help practitioners choose promising interventions that would support their clients and be accountable to financiers and policy makers.

What Kind of Trouble? Meeting the Health Needs of ‘Troubled Families’ through Intensive Family Support

The policy rhetoric of the UK Coalition government's ‘Troubled Families’ initiative, and that of New Labour's earlier Respect Agenda, share an emphasis on families’ responsibilities, or rather their irresponsibility, and their financial costs to society. Giving children a chance of a better life coincides, in this framing, with reducing costs for the taxpayer. The research reported here was based on a national study of Family Intervention Projects (FIPs), funded by the UK government between 2009 and 2012, beginning under New Labour, continuing over a period when the FIP programme was discontinued, and ending after the Troubled Families programme had begun. The research involved over 100 in-depth interviews with stakeholders, including service managers, family key workers, and caregivers and children in twenty families, to consider critical questions about the kinds of trouble that families experience in their lives, and how they are recognised in the policy and practice of intensive family intervention.

Intensive Family Intervention and the Problem Figuration of ‘Troubled Families’

This article examines how intensive family interventions in England since 1997, including the Coalition government's Troubled Families programme, are situated in a contemporary problem figuration of ‘anti-social’ or ‘troubled’ families that frames and justifies the utilisation of different models of intensive family intervention. The article explores how techniques of classification and estimation, combined with the controversial use of ‘research’ evidence in policy making, are situated within a ‘rational fiction’ that constructs ‘anti-social’ families in particular ways. The article illustrates how this problem figuration has evolved during the New Labour and Coalition administrations in England, identifying their similarities and differences. It then presents findings from a study of intensive family intervention strategies and mechanisms in a large English city to illustrate how this national level discourse and policy framework relates to developing localised practice, and the tensions and ambiguities that arise.

A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders

There is a continued need to improve upon the efficacy and availability of treatments for anorexia nervosa. Family-based therapy for anorexia nervosa demonstrates strong empirical evidence; however, trained treatment providers are limited and a subsample of participants receiving the treatment fail to respond. The intensive family treatment program is a brief, time-limited, multi-family program that trains families of adolescents with eating disorders to oversee their adolescents’ recovery at home by providing psychoeducation, skills training, and immersive practice over the course of a 5-day period. This article provide a description of the program by summarizing underlying theoretical principles and key therapeutic components.

Improving collaboration: a qualitative assessment of inter-agency collaboration between a pilot Multisystemic Therapy Child Abuse and Neglect (MST-CAN) program and a child protection team.

Child protection inter-agency collaboration is characterized by strengths and problems. Some literature notes positive attitudes and high trust between teams. However, difficulties with communication, confidentiality, roles, boundaries and divergent paradigms reconciling child protection and parent mental health needs have been documented. This study investigated whether a pilot model of intensive family intervention for maltreated children and associated intensive inter-agency cooperation delivered an effective collaboration. At the completion of the pilot program, a child protection team was interviewed. A qualitative assessment by semi-structured group interview format of inter-agency collaboration was undertaken and evaluated by a thematic analysis. The analysis identified: strong endorsement of the collaborative model; no changes in perception of referred patients; changes in treatment approaches. No perceived conflict between child protection and parent mental health needs were noted. The changes noted may be due to the unique structure and functioning of the pilot Multisystemic Therapy Child Abuse and Neglect program, which encouraged high levels of team communication, strong client engagement, availability and intensive treatment of child and parent mental health problems. The implications for future collaborations are discussed as well as limitations of the study.

It Takes a Family

It Takes a Family

Conceptualising the Contexts, Mechanisms and Outcomes of Intensive Family Intervention Projects

Intensive family intervention projects have become an increasingly prominent mechanism within anti-social behaviour and social policy programmes in the UK and are supported, in principle, by the new coalition government. They have also been the subject of considerable academic controversy within the evaluative and critical literature. This article attempts to inform continuing debates about the purpose and effects of these projects by conceptualising the contexts within which interactions between projects and families occur; classifying the component aspects of roles and support provided; and presenting a three-part typology of potential outcomes from project interventions.

Ten-Year Time Trends in Emotional and Behavioral Problems of Dutch Children Referred for Youth Care

Emotional and behavioral problems assessed with the Child Behavior Checklist (CBCL) were analyzed from 2,739 Dutch children referred to Families First (FF) or Intensive Family Treatment (IFT) from 1999 to 2008, to examine time trends. From the year 2004 onward, six of the eight CBCL-syndrome scales yielded significant decreases from the reference year, 1999. Analyses of statistical interactions indicated that on some scales in later years, younger children and boys scored lower than in 1999, and children referred to FF showed more delinquent behaviors in later years compared with in 1999; whereas, children referred to IFT showed less delinquent behavior than in 1999. These results might be explained by structural changes in the Dutch youth care system, by a huge growth of the number of treated children, by an incident in Dutch youth care, and also by the introduction of new methods of home-based treatment for delinquent youth. An implication of the current results is to consider home-based services more seriously as an alternative for out-of-home placement.