Family Therapy Interventions Research Articles

What about lay counselors\u2019 experiences of task-shifting mental health interventions? Example from a family-based intervention in Kenya

BackgroundA key focus of health systems strengthening in low- and middle-income countries is increasing reach and access through task-shifting. As such models become more common, it is critical to understand the experiences of lay providers because they are on the forefront for delivering care services. A greater understanding would improve lay provider support and help them provide high-quality care. This is especially the case for those providing mental health services, as providing psychological care may pose unique stressors. We sought to understand experiences of lay counselors, focusing on identity, motivation, self-efficacy, stress, and burnout. The goal was to understand how taking on a new provider role influences their lives beyond simply assuming a new task, which would in turn help identify actionable steps to improve interventions with task-shifting components.MethodsSemi-structured interviews (n = 20) and focus group discussions (n = 3) were conducted with three lay counselor groups with varying levels of experience delivering a community-based family therapy intervention in Eldoret, Kenya. Thematic analysis was conducted, including intercoder reliability checks. A Stress Map was created to visualize stress profiles using free-listing and pile-sorting data collected during interviews and focus group discussions.ResultsCounselors described high intrinsic motivation to become counselors and high self-efficacy after training. They reported positive experiences in the counselor role, with new skills improving their counseling and personal lives. As challenges arose, including client engagement difficulties and balancing many responsibilities, stress and burnout increased, dampening motivation and self-efficacy. In response, counselors described coping strategies, including seeking peer and supervisor support, that restored their motivation to persevere. At case completion, they again experienced high self-efficacy and a desire to continue.ConclusionsFindings informed suggestions for ways to incorporate support for lay providers into task-shifting interventions at initiation, during training, and throughout implementation. These include acknowledging and preparing counselors for challenges during training, increasing explicit attention to counselor stress in supervision, fostering peer support among lay providers, and ensuring a fair balance between workload and compensation. Improving and building an evidence base around practices for supporting lay providers will improve the effectiveness and sustainability of lay provider-delivered interventions.

The Treatment of Suicide and Self-Injurious Behaviors in Children and Adolescents

Suicide is currently the second leading cause of death for 10–34 year-olds. Moreover, up to 20% of adolescents report engaging in non-suicidal self-injury (NSSI) at some point in their lifetime. Despite the urgent need, the literature on effective treatment options for children and adolescents struggling with suicide, NSSI, and other self-injurious behaviors (SIBs) is relatively limited. This article reviews the efficacy of current treatments for youth suicidality and SIBs. Most of the existing literature on treatment for suicidality and NSSI in children and adolescents is focused on psychotherapy, specifically cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), psychoeducation, family therapy, and school-based interventions. In contrast, psychopharmacology studies have focused on addressing disorders related to suicidality and NSSI such as major depressive disorder, rather than on the behaviors themselves. Currently, there is no single treatment that is considered the gold standard for child and adolescents struggling with suicidality and NSSI. While individual psychotherapies, including CBT and DBT, and psychopharmacological agents, such as selective serotonin reuptake inhibitors (SSRIs), show promise in addressing suicide and related psychopathology, there is considerable need for novel approaches to address the underlying mechanisms leading to youth suicidality and NSSI.

SAFE, a new therapeutic intervention for families of children with autism: study protocol for a feasibility randomised controlled trial

IntroductionIncidence of autistic traits, mental health problems, stress and poor coping is high among family members of children with autism. These problems are coupled with challenging behaviour among children with...

Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model

The large burden of mental health disorders among young people worldwide calls for scalable prevention and treatment models that reach children and families in low-resource settings. This paper describes the development of an evidence-informed family therapy intervention designed for lay counselor delivery in low-resource settings and presents findings on the feasibility and acceptability of implementation in Kenya. Qualitative data guided the development of a components-based family therapy that integrates multiple strategies from solution-focused and systems-based therapies, as well as those from parenting skills training and cognitive behavioral therapies. Eight lay counselors delivered the intervention, with 10 families completing treatment. Lay counselors demonstrated adequate fidelity and clinical competency when treating families with a wide range of presenting clinical problems. Unique elements of the implementation model proved feasible and acceptable, including recruiting “natural” lay counselors from communities already engaged in informal counseling for families; participants indicated trust and respect in the counseling relationship that facilitated their participation. Both counselors and families reported positive perceptions of intervention content and strategies, including those least similar to local counseling practices. Results support the potential of this implementation strategy that aims to add evidence-based practices to local practices and routines rather than creating new cadres of lay counselors or health workers. Supervision, provided by psychology student trainees, also proved feasible and mutually beneficial, with phone-based supervision as acceptable as in-person meetings; this suggests the potential feasibility of this model for use in remote locations. Future directions include integrating these delivery approaches into existing social structures to develop and evaluate a comprehensive implementation model for scale-up.

Children, Separation, and Divorce: Legal, Facilitative and Family Therapy Interventions and Research

Children, Separation, and Divorce: Legal, Facilitative and Family Therapy Interventions and Research

Art and prose in honour of the rights of children Norma Williams and Louisa Whettam

Australian and New Zealand Journal of Family TherapyVolume 40, Issue 1 p. 163-170 Original Article Art and prose in honour of the rights of children Norma Williams and Louisa Whettam First published: 07 April 2019 https://doi.org/10.1002/anzf.1355Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume40, Issue1Special Issue: Children, Separation, and Divorce: Legal, Facilitative and Family Therapy Interventions and ResearchMarch 2019Pages 163-170 RelatedInformation

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial.

BackgroundThe Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas.ObjectiveThis pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation.MethodsA total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act–compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes.ResultsNo families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004).ConclusionsThis pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our findings are very promising, but more research is needed to ultimately influence mental health practices and policies that pertain to video-delivered mental health interventions in unsupervised settings (eg, homes).

A Brief Family Therapy Intervention with A Central American Immigrant Family: A Case Study in Resiliency

This case study explores the experience of a Spanish-speaking family of four of Central American descent living in the United States who engaged in a brief family therapy intervention with the author. A detailed discussion of this family’s progression in therapy highlights several important elements that may be considered when working as a social worker or psychotherapist with immigrant families from Central America: (1) The utility of a primary care clinic as a neutral site/entry point for reducing the perceived stigma of behavioral health services; (2) a prolonged joining process that supports flexible inclusion of individual patient as well as relevant family members; (3) the process of co-creating a powerful, intercultural therapeutic alliance and (4) a blended model of brief family therapy as an effective option for improving family and individual well-being. Names and certain identifying details are changed to protect the family’s confidentiality.

Measuring Therapeutic Changes for a British Chinese Family UsingSCORE‐15

This paper details the findings and reflections of family therapy treatment outcomes for a British‐Chinese family usingSCORE‐15, a reliable and valid systemic outcome measure developed in theUK. It aims to examine the clinical usefulness ofSCORE‐15 through its application to a single case study. The two culture‐specific treatments were conducted at the Marlborough Cultural Therapy Centre (MCTC), which was part of the Marlborough Family Service in London.MCTCwas a mental health specialist service for ethnic minorities in their preferred languages that operated for 18 years within the mainstream mental health setting of the National Health Service (NHS). The overall family functioning was found to have improved and problem severity decreased, apart from some aspects rated by the mother. Reflections and discussions with the family with regard to theSCORE‐15 findings facilitated understanding and feedback about clinical changes in the systemic intervention.

Your inner midwife: hands on practical artistic creative workshop to make simple cloth dolls representing our midwife identity

Pregnant and parenting women who use substances report high rates of comorbid depression and anxiety. Due to the significant impact of this comorbidity on treatment adherence and maternal/child outcomes, effective psychosocial and behavioral interventions to address depression and anxiety in this population are necessary. A directed search of PubMed, PsycINFO, and CINAHL databases produced 22 articles from 20 distinct studies examining non-pharmacologic interventions with an effect on depression and anxiety among pregnant or parenting women using substances. Of the 20 studies reviewed, 8 were randomized controlled trials, 7 were quasi-experimental studies, and 5 were cohort studies. Results revealed a wide array of interventions targeting intrapersonal, interpersonal, and/or structural factors within these women's lives. Parenting therapy and psychosocially enhanced treatment programs had the strongest evidence for positive treatment effect in improving symptoms of depression and anxiety. The use of contingency-management, case-managed care, patient or wellness navigators, mindfulness-based therapy, maternal-child relationship-focused therapy, family therapy, peer support, and therapeutic community-based interventions show promise but warrant further experimental exploration. Comprehensive and gender-specific residential treatment was observationally associated with improvements in depression and anxiety; however, the specific modality of efficacy is unclear. Future research should focus on identifying which modalities are most cost-effective, feasible, and acceptable among this uniquely vulnerable population.

Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments

BackgroundTo date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program. Case PresentationsFive out of six cases were female and median age of patients at assessment was 12.9 (SD = 1.13) years. On average, patients’ percentage of treatment goal weight was 80.5% at initial assessment (SD = 8.56) and 81.9% (SD = 7.08) when family therapy began. Cases 1, 2 and 3 were admitted to a specialized inpatient unit at assessment due to medical instability (2) or failed outpatient treatment (1), and all six cases presented with severe co-morbid anxiety. All patients were treated using a combination of medical monitoring, family therapy, medication (including olanzapine, fluoxetine and in two cases cyproheptadine), and cognitive behavioural therapy. At treatment termination, all six patients had achieved their goal weight.ConclusionThese cases illustrate the complex ways in which young patients with ARFID can present, the illness’ effect on development and mental health, and the positive outcomes associated with weight gain and concurrent treatment for co-morbid anxiety disorders.

Evaluating the effectiveness of a culturally adapted behavioral family psycho-educational program for Egyptian patients with schizophrenia.

Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia.

Psychological Interventions for Runaway and Homeless Youth.

In this review we examined previous studies of psychological interventions for runaway and homeless youth and evaluated the effectiveness of these interventions in terms of mental health outcomes. Literature review. A search of various databases, including PubMed, EMBASE, Cochrane Library, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), was conducted. In this review we systematically described the characteristics of the included studies and interventions, and conducted a narrative synthesis and meta-analyses of the mental health outcomes of the interventions. Five types of psychological interventions were identified in the included 11 studies: art therapy, cognitive behavioral therapy (CBT)-based interventions, family therapy, motivational interviewing, and strengths-based interventions. The narrative synthesis found positive effects of family therapy on substance use and positive effects of CBT-based interventions on depression. However, according to the meta-analyses, none of the interventions had any significant effects. Family therapies are likely to be effective in cases of substance use, and CBT-based interventions are likely to be effective in dealing with cases of depression. However, as the quantitative synthesis did not support the effects of any of the psychological interventions on mental health outcomes, further research is needed. Nurse-led interventions were identified in two studies. Mental health nurses should assess the mental health status of runaway and homeless youth and provide timely and effective interventions.

Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis.

BackgroundFamily therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms.ObjectiveThis systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning.MethodsThis study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning.ResultsSeven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples.ConclusionAlthough a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed.Systematic review and meta-analysis protocol registrationPROSPERO, CRD42017075150.

Couple therapy, family therapy and systemic interventions for adult‐focused problems: the current evidence base

AbstractThis paper updates previous similar reviews published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couple therapy, family therapy, and systemic interventions for adults with a range or relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, alcohol problems, psychosis and adjustment to chronic physical illness.

Family therapy and systemic interventions for child‐focused problems: the current evidence base

AbstractThis review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.

An Interdisciplinary Model for Meeting the Mental Health Needs of Transgender Adolescents and Young Adults: The Mount Sinai Adolescent Health Center Approach

Transgender and gender nonconforming (TGNC) adolescents and young adults face significant mental health disparities, including increased rates of suicidality, depression, and self-harm. These disparities are multidetermined and stem, in part, from the emotional consequences of family rejection, peer and community victimization, social isolation, and discrimination and transphobia in both daily settings (e.g., school) and society as a whole. In order to meet the mental health needs of TGNC youth, we must intervene in multiple levels of youths’ lives and provide gender-affirming evidence-based therapies. In this paper, we describe an integrated model of meeting the mental health needs of TGNC youth, with the ultimate goal of reducing mental health disparities. We provide guidance for macro-level interventions, including efforts to implement social change; mezzo-level interventions, including structuring a health care setting to be gender-affirming; and micro-level interventions, including gender-affirming dialectical behavior therapy, cognitive behavioral therapy, family therapy and support group interventions. Throughout, we highlight our descriptions of interventions with case examples in order to provide additional practical guidance.

Therapeutic Day School Intervention for Children and Adolescents with Community-Diagnosed Bipolar Disorders: Multiple-Case Study Analyses

ABSTRACTA field-based case study methodology examined the effectiveness of placement in a public therapeutic day school for 11 children and adolescents (ages 8–15 years) with community-diagnosed bipolar disorders. The treatment protocol integrated a behavioral point and level system with cognitive behavioral and brief family therapy interventions. Within- and cross-case analyses were conducted to assess academic progress in the areas of reading, mathematics, writing, science, and social studies; behavioral/social-emotional performance regarding on task/work completion, compliance, physical aggression, and social and coping skills; and immediate educational outcomes related to behavioral level system progress and home-school reintegration. Results indicated that a majority of students improved performance in areas of relative academic and behavioral/social-emotional weakness while sustaining performance in areas of relative strength and achieved positive immediate educational outcomes. Deficits in social and coping skills and in mathematics were exhibited by nearly all students. Two distinct patterns of physically aggressive behavior were identified: a “spike” pattern and a “low levels” pattern. Therapeutic school interventions were determined to be generally effective for students with community-diagnosed bipolar disorders.

Externalizing Metaphors Therapy and Innovative Moments: A Four-Session Treatment Group for Anxiety

ABSTRACTThe zeitgeist for brief services psychotherapy efficacy is well underway within the individual and family therapy treatment modalities. However, this paradigm shift, to produce clinically significant mental health outcomes in a much shorter time, has evolved to a much lesser degree within the treatment group format. Longer-term treatment group protocols typically do not match treatment-seeking behaviors with high dropout rates for clients. The current authors describe a structured, four-session treatment protocol that integrates the tenets of Externalizing Metaphors Therapy (EMT) with Innovative Moments (IMs) in addressing anxiety for children and youth. EMT is based upon the externalization of problems, transformation of metaphoric imagery, and the shifting of underlying maladaptive emotional schemas. It is suggested that treatment outcomes are enhanced through the integration of three IMs between-session exercises.

Systematic Review and Meta-analysis of Stepping Stones Triple P for Parents of Children with Disabilities.

The aim of this systematic review and meta-analysis was to examine the effectiveness of Stepping Stones Triple P (SSTP) parent training programs on child behavior problems and parenting outcomes in families of children with developmental disabilities. Sixteen suitable studies including data from over 900 families were identified in a search for English language published and unpublished controlled outcome studies. SSTP has five levels on a graded continuum of increasing intensity targeting families with differing degrees of treatment need from low intensity media-based parenting information campaigns at level 1, through brief interventions at levels 2 and 3, to more intensive parent training and family therapy interventions at levels 4 and 5. Analyses were conducted on the combination of all levels of SSTP and separately for each level. For combined levels, significant overall effect sizes were found for parent-reported child problems (d=0.46), researcher observed child behavior (d=0.51), parenting style (d=0.70), parenting satisfaction/self-efficacy (d=0.44), parental adjustment (d=0.27), and coparental relationship (d=0.26), but not researcher-observed parent behavior. Strong support was found for level 4 SSTP as an effective intervention for improving child and parent outcomes in families of children with disabilities who have clinically significant problems. Less intensive SSTP interventions for cases with circumscribed difficulties yielded fewer significant treatment effects, and there were relatively few studies of such interventions.