Family Intervention Research Articles

A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability.

The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old. Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size. Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication. Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.

Feasibility of a Home-Based Developmental Behavioral Intervention for Children With Autism Spectrum Disorder in Underserved Taiwanese Families

Purpose: This study aims to investigate the feasibility of the home-based parent- mediated intervention Naturalistic developmental behavioral intervention (HB-NDBI) in underserved Taiwanese families of children with Autism spectrum disorder (ASD) and explore its effects on children’s developmental skills and parents’ parenting stress. Method: 24 underserved Taiwanese families of children with ASD (mean age = 46.5 months) received 12-week HB-NDBI programs. Social Responsiveness Scale, Second Edition (SRS-2), Mullen Scales of Early Learning (MSEL), Child Behavior Checklist (CBCL/1.5-5), and Parenting Stress Index (PSI) were administered before and after the HB-NDBI programs. Results: Following the HB-NDBI programs, significant improvements in social cognition, social communication subscales, receptive language subscale, internalizing, externalizing, and total behavioral problems scales of children, and release of parenting stress were observed. Conclusion: This study demonstrated the feasibility of home-based parent-mediated intervention for underserved families in Taiwan. These promising results might facilitate the development of such interventions for underserved families.

SFT for ASD: A systemic intervention for neurodiverse families

AbstractTo increase the number of family‐based interventions and deal directly with the family dynamic that creates maladaptive manners of coping and connection, structural family therapy (SFT) for autism spectrum disorder (ASD) was developed. The model slowly supports families in being more flexible in their relationships and dynamics while imparting interpersonal skills which enhance communication particularly between the children with ASD and their parents by reforming and supporting an appropriate family structure and family dynamic.

Focused on the Family: Development of a Family-Based Intervention Promoting the Transition to Adult Health Care for Adolescents with Type 1 Diabetes

Background/Objectives: There is minimal evidence for current interventions promoting the transition to adult healthcare for youth with type 1 diabetes (T1D). Few interventions exclusively target modifiable individual and family-based factors that contribute to transition readiness. The purpose of this paper is to describe the development of Behavioral Family Systems Therapy for Diabetes Transition (BFST-DT), a virtual family-based transition readiness intervention for adolescents with T1D. Methods: The development of BFST-DT occurred in three phases. In phase 1, focus groups with adolescents and young adults with T1D, their caregivers, and pediatric and adult diabetes providers were conducted to assess perspectives on common family challenges surrounding diabetes management and the transition to adult healthcare. In phase 2, focus group data were used to create video vignettes to be used as part of the intervention. In phase 3, BFST-DT was created through the adaptation of a previous evidence-based family intervention for families of adolescents with T1D. Results: BFST-DT is a virtual, 6-month family-based intervention involving four multi-family group meetings and six individual family meetings. It targets the modifiable and reciprocal interactions among individual and family transition readiness factors. Conclusions: BFST-DT is the first family-focused intervention promoting transition readiness in adolescents with T1D and is currently being tested. Intervention development benefits from prioritization of engagement with patients, caregivers, and providers, as their perspectives are invaluable for creating interventions that are relevant and acceptable to communities.

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

Is It Possible to Combine Non-Invasive Brain Stimulation and Evidence-Based Psychosocial Interventions in Schizophrenia? A Critical Review

In schizophrenia, it was suggested that an integrated and multimodal approach, combining pharmacological and non-pharmacological interventions, could improve functional outcomes and clinical features in patients living with schizophrenia (PLWS). Among these alternatives, evidence-based psychosocial interventions (EBPIs) and Non-Invasive Brain Stimulation (NIBS) represent feasible treatment options targeting the clinical features that are unmet needs of PLWS (especially negative and cognitive symptoms). As no clear evidence is available on the combination of these non-pharmacological approaches, this review aimed to collect the available literature on the combination of EBPIs and NIBS in the treatment of PLWS. We demonstrated that the field of combining EBPIs and NIBS in schizophrenia is in its infancy, as only 11 studies were reviewed. In fact, only a few trials, with divergent results, combined these non-pharmacological modalities; while emerging evidence is available on the combination of cognitive remediation and rTMS/iTBS, inconclusive results were obtained. Conversely, albeit preliminary, more solid findings are available on the combination of HF-rTMS and family intervention. Moreover, despite the fact that cognitive activation could not be considered an EBPI, promising results are available in combination with tDCS to improve the working memory domain. To overcome these limitations, we considered several methodological issues to promote research in this field.

Learning apps at home prepare children for school.

The usage of high-quality learning applications (apps) at home may increase children's mathematical and literacy competencies. This approach was tested in a family intervention study. Intervention families (n = 302) in two German cohorts (N = 500; M (SD)age = 61.0 (4.6) months; n♀ = 302) received tablets with newly developed learning apps focusing either on mathematical or literacy learning for every-day usage at home across half a kindergarten year. Compared with two control groups with and without tablets, children in the intervention groups significantly enhanced their specific competencies (η2 = .03-.10). Higher app usage was associated with greater gains (ΔR2 = .01-.02). Consequently, an easy-to-apply app-based intervention supports children's development of cognitive competencies and helps prepare them for school.

Prevalence and Predictors of Stress Among Caregivers of Children with Developmental Disorders.

Medical care advances pose challenges with rising caregiving costs and fewer informal caregivers, shifting healthcare responsibilities to families. Healthcare systems adapt to technological changes, stressing person-centered care but lack support for caregivers. Addressing parental stress is crucial, given its impact on both parent and child well-being, highlighting the necessity for customized support. The study aimed to evaluate caregivers' perceived stress and its connection with socio-demographic factors and children's characteristics. Conducted at a Rehabiltation Institute's Psychology Outpatient Department, 200 mothers were enrolled using non-probability consecutive sampling. Ethical clearance was obtained, and demographic data were collected. The mean perceived stress score (PSS-10) was 31.94, indicating a positive correlation between stress and socio-demographic and disability-related variables. Significant differences in stress levels were observed between joint and nuclear family caregivers, p < .01, and those with daughters versus sons with disabilities < 0.001. Pearson's correlation analysis revealed positive correlations between perceived stress and caregiver p = < 0.001 and child age p = < 0.001, number of children p = < 0.001, and time since diagnosis p = < 0.001, with negative correlations with caregiver education p = < .001and income p = < 0.001. Multiple linear regression indicated that caregiver and child age, time since diagnosis, and the number of children positively predicted while income and education of the caregiver negatively predicted perceived stress. No significant association was found between other variables like family volunteers' education, disability type, and caregiver stress. Caregivers exhibited high perceived stress levels, highlighting the reciprocal relationship between child characteristics and parental stress, emphasizing the need for comprehensive family interventions.

A nationwide longitudinal survey of infantile injury and its recurrence in Japan.

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

Parent-Child Relationships and Adolescents' Non-Cognitive Skills: Role of Social Anxiety and Number of Friends.

This study aimed to examine the association between parent-child relationships and adolescents' non-cognitive skills, while also investigating the mediating effect of social anxiety and number of friends. A survey was conducted with 773 students, ranging from grade 4 to 9, in five public schools of Guangdong Province of China (49.9% male), with a mean age of 12.20 years old. Latent mediation structural equation modeling was used to analyze the data. The findings revealed that (1) the father-child relationship and mother-child relationship both had a positive influence on grit, innovation, conscientiousness, and hope; (2) social anxiety had a negative effect on adolescent non-cognitive skills including innovation, conscientiousness, and hope; (3) the number of positive friends was found to be positively associated with the development of non-cognitive skills in adolescents, whereas the presence of negative friends correlated negatively with grit but positively with innovation; (4) social anxiety emerged as a significant mediating variable between parent-child relationships and adolescents' non-cognitive skills, including innovation, conscientiousness, and hope; and (5) the mediating effect of the number of positive friends on the relationship between parent-child relationships and grit, innovation, conscientiousness, and hope was also found to be significant. Educational programs and family interventions should take these factors into account, providing a more holistic approach to supporting adolescent growth.

Feasibility of a complex psychosocial intervention for families with parental cancer: acceptability, suitability, implementability, and perceived support

PurposeThis study aimed to assess the feasibility of a comprehensive psychosocial intervention for families coping with parental cancer.MethodsA quasi-experimental trial with intervention and control group, employing a mixed-methods approach, was conducted. A total of 472 families affected by parental cancer participated. The feasibility of the intervention was evaluated based on study monitoring measures (on-site visits, team supervision meeting observations, case conference observations, best practice workshops, coordinating information exchange between intervention sites, and reviewing intervention documentation), process evaluation (semi-structured interviews, focus group discussion) and survey data. Data analysis involved thematic coding and descriptive statistics.ResultsThe intervention was well-received by the participating families, with a high degree of acceptance observed. The feasibility of the intervention was found to be associated with specific dynamics within each family system and the motivation of the family members. The success of the intervention was described as dependent on the family-centered arrangement of the encounters, including factors such as frequency, duration, and mode, which greatly influenced its overall acceptability.ConclusionThe family-scout intervention demonstrates its feasibility as an effective intervention to reduce the burden experienced by families coping with parental cancer. Psychosocial oncology services should continue to develop and implement family-centered interventions to offer support to families during their cancer journey.Trial registrationClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019.

Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation.

Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523.

Care professionals’ experiences within a multidisciplinary and cross-sectorial intervention for childbearing women and families in vulnerable positions: a focus group study

ABSTRACT Inequality in health persists in childbearing families in socially or mentally vulnerable positions. The FACAM project was developed as an intervention aiming to enhance health outcomes for childbearing families. Purpose The aim of this study was to gain a deeper understanding of the experiences and perspectives of care professionals in multidisciplinary and cross-sectorial collaboration, and their experiences of interactions with childbearing families within the context of the FACAM project. Methods Eight focus groups were conducted with 32 multidisciplinary care professionals working with childbearing families in vulnerable positions. A thematic analysis was conducted, with positioning theory as the theoretical framework focusing on storylines, positioning and speech-acts. Results Two overall themes were constructed. Theme one: Cross-sectorial collaboration and the influence on the care provided. Theme two: Interaction with and assessment of women and families’ care needs and their influence on the care provided, with three subthemes; a) Establishment of a trustful relationship, b) Assessments of vulnerable positions in relation to function in everyday life, c) Interactions with the woman or family depending on their needs. Conclusion Care professionals found needs-adapted and tailored care meaningful. Well-functioning multidisciplinary and cross-sectorial collaboration was important to support the families.

The associations between mothers’ and grandmothers’ self-control, mother-grandmother coparenting relationships and caregiver-child attachment: An actor-partner interdependence mediation model

More and more grandparents are involved in parenting and share the responsibility of raising children with parents in China. Less is known, however, regarding the mutual effects of caregivers on children in intergenerational coparenting families. This study aimed to examine how mothers’ and grandmothers’ self-control, mother-grandmother coparenting relationships, and caregiver-child attachment were associated and to investigate whether the pathways were different in mother-child and grandmother-child dyads. Participants were mothers and grandmothers from 501 intergenerational coparenting households. The results from Actor-Partner Interdependence Mediation Modeling (APIMeM) indicated that mothers’ and grandmothers’ self-control were indirectly related to their own caregiver-child attachment through their self-report coparenting relationships. Additionally, the effect of mothers’ self-control spilled over to the grandmother-child attachment through grandmothers’ self-report coparenting relationships. Overall, the findings indicated that mothers’ and grandmothers’ self-control, mother-grandmother coparenting relationships, and their attachment to the child significantly differed between mother-child dyads and grandmother-child dyads. This study contributes to a deeper understanding of women caregiver-child attachment processes and highlight the implications of using the dyadic approach in understanding and improving family functioning in intergenerational coparenting families, which provide implications for family interventions.

Family resources, resilience beliefs, and parental adaptation: A moderated mediation analysis.

Despite the extensive body of evidence documenting how pandemic-related stressors (e.g., disruptions in daily routine) impact individuals' mental health, research examining family mechanisms through which stressors impact parental stress remains insufficient. The present study aims to address this gap by exploring a moderated mediation model that predicts parental stress resulting from the accumulation of pandemic-related stressors. Specifically, we hypothesized a second-stage moderated mediation model in which family resilience beliefs moderated the second-stage indirect paths through family relationships and marital satisfaction, resulting in conditional indirect effects. Study data were collected from American parents (n = 1386). There was no evidence that family relationships and marital satisfaction mediated the association between stressor pile-up and parent stress. In addition, family resilience beliefs did not significantly impact how marital satisfaction or family relationships affect parental stress. However, marital satisfaction mediated the relationship between stressor pile-up and parental stress across all levels of family resilience beliefs. The findings of this study carry significant implications for post-pandemic family interventions, suggesting the incorporation of resilience belief training and stress management strategies to improve intrafamilial communication.

Perception of father absence in family assessment and intervention: are they not involved because they don’t want to be?

ABSTRACT Child protection services intervene with mothers, leaving fathers on the sidelines. However, fathers’ involvement is beneficial. The aim is to explore fathers’ and professionals’ perceptions of the factors influencing fathers’ involvement in family assessments and interventions. A qualitative design was used and 5 focus groups with 9 professionals, 10 mothers and 8 fathers, and 6 in-depth interviews with 6 fathers were carried out in Gran Canaria (Spain). A thematic content analysis was carried out using QSR NVivo 12. The category Determinants of paternal involvement in family assessment and intervention was obtained, made up of 3 subcategories: Personal characteristics of the father, Social characteristics and Influence of the mother on the father’s decision. Fathers claim that fathers’ personal characteristics condition their involvement, while professionals argue that it is due to mothers’ influence. Implications for professional practice and work with men are discussed. This study is part of a funded research project.

Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms

BackgroundUp to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM).MethodsThe MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement.DiscussionThe overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination.Trial registrationClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system.

Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

The role of caregiver emotion regulation in youth mental health during the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (M age = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Cascade effects of a parenting-focused program for divorced families on three health-related outcomes in emerging adulthood.

Using data from a 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families (N = 240) with children aged 9-12, the current study examined alternative cascading pathways through which the intervention led to improvements in offspring's perceived health problems, BMI, and cigarette smoking in emerging adulthood. It was hypothesized that the program would lead to improvements in these health-related outcomes during emerging adulthood through progressive associations between program-induced changes in parenting and offspring outcomes, including mental health problems, substance use, and competencies. Intervention-induced improvements in positive parenting at posttest led to improvements in mental health problems in late childhood/early adolescence, which led to lower levels of mental health and substance use problems as well as higher levels of competencies in adolescence, which led to improvements in the health-related outcomes. Academic performance predicted all three health-related outcomes and other aspects of adolescent functioning showed different relations across outcomes. Results highlight the potential for intervention effects of preventive parenting interventions in childhood to cascade over time to affect health-related outcomes in emerging adulthood.