Multifamily Group Research Articles

Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members

The rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. This study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. Funded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the "Summary of Diabetes Self-Care Activities." Evaluations were made at baseline and at 3, 6, and 12 months. This study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. ClinicalTrials.gov NCT03092063; https://clinicaltrials.gov/ct2/show/NCT03092063. DERR1-10.2196/44793.

1.90 Adolescent DBT in Multi-Family Groups: Effects on Family Functioning and Parental Stress

A growing body of research supports the efficacy of adolescent DBT. This therapy is often delivered in a multifamily group (MFG) format, but little attention has been paid to its effects on parent and family functioning. This study examines these effects in 2 DBT skills-based programs: a 12-week MFG (“DBT Lite”) and 19-week MFG that also provides weekly individual therapy (“Full DBT”). Both programs are for youth aged 13 to 17 years with emotional dysregulation. Participants were not randomized; the treatment was selected according to severity of illness.

The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters.

Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.

Common patient experiences across three resource-oriented interventions for severe mental illness: a qualitative study in low-resource settings

IntroductionResource-oriented interventions can be a low-cost option to improve care for patients with severe mental illnesses in low-resource settings. From 2018 to 2021 we conducted three randomized controlled trials testing resource-oriented interventions in Bosnia and Herzegovina (B&H), i.e. befriending through volunteers, multi-family groups, and improving patient-clinician meetings using the DIALOG+ intervention. All interventions were applied over 6 months and showed significant benefits for patients’ quality of life, social functioning, and symptom levels. In this study, we explore whether patient experiences point to common processes in these interventions.MethodsIn-depth semi-structured interviews were conducted with 15 patients from each intervention, resulting in a total sample of 45 patients. Patients were purposively selected at the end of the interventions including patients with different levels of engagement and different outcomes. Interviews explored the experiences of patients and were audio-recorded, transcribed, and analysed using the thematic analysis framework proposed by Braun and Clark.ResultsThree broad themes captured the overall experiences of patients receiving resource-oriented interventions: An increased confidence and agency in the treatment process; A new and unexpected experience in treatment; Concerns about the sustainability of the interventions.ConclusionsThe findings suggest that the three interventions – although focusing on different relationships of the patients – lead to similar beneficial experiences. In addition to being novel in the context of the mental health care system in B&H, they empower patients to take a more active and confident role in treatment. Whilst strengthening patients’ agency in their treatment may be seen as a value in itself, it may also help to achieve significantly improved treatment outcomes. This shows promise for the implementation of these interventions in other low-resource countries with similar settings.

Group therapy in Schizophrenia. What’s the evidence?

IntroductionThe American Psychiatric Association and NICE’s Guidelines for schizophrenia recommend psychosocial interventions as adjuvants to pharmacological treatment, highlighting the role of cognitive behavioral therapy for psychosis, psychoeducation, family intervention, cognitive remediation, autonomy training, social skills training, and supported employment. Although highly recommended in their individual forms current guidelines make no definitive statement about their group applicability.ObjectivesThe goal of this work was to critically review the evidence of group interventions in schizophreniaMethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “group therapy”.ResultsGroup therapy has shown important benefits in different conditions over the years, likely through mechanisms such as peer motivation, controlled confrontation, increased insight and even a tendency to homogenous results between group participants through peer influence. These results have been reproduced in schizophrenia though the benefits of applying group concepts to structured psychosocial interventions is still under study.ConclusionsRecent evidence suggests some evidence-based interventions can be applicable in group form, namely social skills training, cognitive remediation, psychoeducation, and multifamily groups, synergizing the already known benefits with newer therapy models and decreasing costs for patients and healthcare systems. Adequate controlled studies between individual and group therapy will shed further light on this matter.DisclosureNo significant relationships.

585-P: African-American Youth and Parent Perspectives on Advanced Technologies in Diabetes Management: Closing the Loop on Health Disparities

Background: Research has shown that African American (AA) youth with type 1 diabetes (T1D) are at increased risk for suboptimal glycemic control, and less often utilize advanced technologies for diabetes management (DM) . Objective: To better understand challenges to optimal DM for AA youth and willingness to use advanced technologies. Methods: Twenty-one AA youth with T1D and their parents participated in multi-family focus groups or individual family semi-structured interviews addressing barriers to DM and attitudes about new technologies such as the advanced hybrid closed loop (AHCL) insulin pump. Groups and interviews were recorded and conducted either in-person or using telehealth methods. Based on verbatim transcripts, content analysis was conducted using NVivo to develop a code book; two independent raters coded responses into themes and a third rater resolved discrepancies. Results: The 21 youth participants (8 girls and 13 boys) had a mean age of 14.0 years and mean HbA1c of 9.6%; 16 (76%) had Medicaid; (47.6%) were using CGM and six (28.5%) had insulin pumps. Qualitative analyses revealed six main themes encompassing current regimens, life with diabetes, parenting, ethnicity, willingness to try new DM technologies, and hesitancy to utilize an AHCL system. Thirteen (62%) youth-parent dyads reported being very willing to try the AHCL system while just two (9.5%) reported they preferred to stay with their current regimen of injections and blood glucose checks; six dyads (28.5%) were open but not ready to commit, citing concerns about reliance on technology, potential side effects, and need for more information. Conclusions: Innovative technology such as the AHCL insulin pump system may help to improve glycemic outcomes and reduce health disparities for AA youth. Many AA youth with T1D and their parents are ready to try advanced technologies but may require individualized support from the health care team to achieve optimal outcomes. Disclosure A.M.Delamater: None. E.R.Pulgaron: None. G.Guevara: None. S.A.Washington: None. D.Z.Franz: None. R.Gomez: None. D.Felipe: None. J.Bhat: None. S.Chalew: Advisory Panel; Medtronic. Funding National Institutes of Health (1R21DK118643)

Athens multifamily therapy after a first psychotic episode: Online therapy during the COVID-19 pandemic

IntroductionThe Athens Multifamily Therapy Project (A- MFTP) aims to provide systemic multifamily group therapy to youths who experienced a first psychotic episode (FEP) and their familiesObjectivesSince 2017, we run five groups of five-four families, with a duration of ten months and frequency every two weeks. Participants were recruited from the longitudinal study, Athens FEP Project, which aimed to investigate the involvement of genetic and environmental determinants on psychosis risk.MethodsDuring the Covid-19 pandemic, the provision of therapy to the current groups continued through online sessions. Participants were asked to answer qualitative questions on the perceived effectiveness of the therapy on their life as well as on the presenting problem(s) at three time points: middle, end of therapy and 6-month follow-up.ResultsAll members highlighted the significance of the reciprocity in the group communication. They mentioned that “sharing” and “exchanging” experiences helped them listen to others and felt heard by them. They moved from feeling fear and embarrassment when discussing the diagnosis and the aftermath, to feeling safety and comfort talking about their difficulties. Qualitative analysis showed no difference in participants’ perception of multifamily therapy as helpful between live therapy and online therapy.ConclusionsResults suggest that MFT can be a viable way to provide early intervention in FEP even in at online modality.DisclosureNo significant relationships.

Multifamily therapy in first episodes of psychosis: a pilot study

IntroductionMultifamily interventions have shown to reduce the risk of relapse of psychotic symptoms in first episodes of psychosis (FEPs) but are not frequently implemented in specific treatment programs. We have develop a pilot study for the implementation of the interfamily therapy in FEPs within a Mental Health Centre in the Community of Madrid.ObjectivesThe aims were to examine: relapses (measured as re-hospitalization), duration of re-hospitalizations and voluntary versus involuntary re-hospitalizations during participation in MFG compared with the previous year.Methods21 subjects participated in a MFG during 12 months, 11 participants with a diagnosis of psychosis and 10 family members. Interfamily therapy works as a new model of interactive psychoeducation among families where they share their own experiences and look for comprehension and solutions all together.ResultsOur clinical experience in an interfamily therapy intervention over 12 months has led us to identify a high degree of participation and acceptance by users and their families, and we have observed a lower relapse rate, with fewer of psychiatric admissions and of shorter duration among patients during the year of participation in the MFG compared to the year before treatment.ConclusionsMFG has been well accepted by both patients and their families, with a high degree of participation.The results observed in our experience of MFG treatment are consistent with the findings of previous studies that support the reduction of the relapse rate, the number of hospitalizations and their duration when family interventions are incorporated into treatment in recent-onset psychosis, especially in a multi-family group format.DisclosureNo significant relationships.

Implementation of a multi-family intervention for children with behavioural and emotional problems in a semi-rural population

ObjectiveTo determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia. MethodsQualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families. ResultsThe contents of the sessions and the topics and experiences that were most significant for the children and their families are described. ConclusionsThe adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.

Virtual care during the pandemic: Multi-family group sessions for Hong Kong Chinese families of adolescents with intellectual disabilities.

The suspension of social services in Hong Kong during the COVID-19 pandemic increased the caregiver strain for families of adolescent children with intellectual disabilities, possibly aggravating their family relationships. This article reports on an online Multi-Family Group (MFG) conducted during the pandemic for Hong Kong Chinese families of adolescents affected by mild-to-moderate intellectual disabilities. A thematic analysis of the experiences of the participating service users revealed three positive effects of the intervention model: improved family relationships, mutual helpful influences occurring among families, and a new understanding of family members with intellectual disabilities. The therapeutic group process used to promote family development is illustrated by a group vignette. The challenges and the practical considerations for conducting an MFG online are discussed.

Multifamily therapy in first psychotic episodes: a pilot study

ABSTRACT Background Multifamily groups (MFG) have shown to reduce the risk of relapse of psychotic symptoms in first episodes of psychosis (FEPs) but are not frequently implemented in treatment programs. This paper describes the implementation of the interfamily therapy-model in a FEP early intervention program within a Mental Health Centre in Spain . The aims were to examine (a) relapses (measured as re-hospitalization), (b) duration of re-hospitalizations and (c) voluntary versus involuntary re-hospitalizations during participation in MFG compared with the previous year. Methods Twenty-one subjects participated in a MFG over 12 months, 11 participants with a diagnosis of psychosis and 10 family members. Results Patients and their relatives participated in around 50% of treatment sessions and manifested satisfactory experience during treatment. Among the patients who participated in MFG, a lower relapse rate was observed: a lower number of psychiatric admissions (7 versus 3) and of shorter duration [23.57 (SD 18.5) days pretreatment versus 19.33 (SD 10.2) days during treatment] although it was not statistically significant (p > 0.05), probably due to small sample size. Discussion Multifamily therapy has been well accepted by both patients and their families, with a high degree of participation. Our impression is that the simultaneous participation in different therapeutic activities (individual, group and multifamily) improves the experience of the therapeutic process.

Multifamily groups for patients with schizophrenia: an exploratory randomised controlled trial in Bosnia and Herzegovina

BackgroundSchizophrenia has a significant and lasting impact on the quality of life of patients and their families and is a leading cause of disability globally. Family interventions can be beneficial and may be particularly appropriate in settings with limited resources. We conducted an exploratory trial testing the effectiveness of a multifamily group intervention, which draws on the traditions of psychoeducation and trialogue, for improving the quality of life of patients with schizophrenia in Bosnia and Herzegovina.MethodsWe conducted an exploratory, randomised controlled trial with patients with schizophrenia attending an outpatient clinic in Sarajevo. Our primary outcome was improved quality of life at 6-month follow-up. Secondary outcomes included objective social outcomes, psychiatric symptoms and psychiatric hospitalisation measured at 6 and 12 months. Experiences of participants were assessed in post-intervention interviews.Results72 patients were randomly assigned to either one of six multifamily groups or treatment as usual. Follow-up assessments were completed with 53 patients (74%) at 6 months and 55 patients (76%) at 12 months. The intervention significantly improved quality of life at 6 months (Cohen’s d = 0.78, F = 6.37, p = 0.016) and 12 months (d = 1.08, F = 17.92, p < 0.001), compared with treatment as usual. Re-hospitalisation rates at 6 months and symptom levels also improved significantly whilst changes in other secondary outcomes failed to reach statistical significance.ConclusionThese findings suggest multifamily groups can be effective for improving the quality of life of patients with schizophrenia in Bosnia and Herzegovina. Further research is required to assess how multifamily groups may be scaled up in similar settings with limited resources.

A Multifamily Group Curriculum for Family Members of Individuals with Substance Use Disorders: Updates, Perceptions, and Outcomes

ABSTRACT Substance use disorders (SUDS) are highly prevalent chronic health conditions that have dire impacts on the health and wellbeing of not only the individual with an SUD, but on their family members as well. This is important as the family is often one of the most important support groups for an individual seeking recovery from an SUD. The present study provides an update regarding a previously published and implemented multifamily group curriculum (MFGC) for family members of those with an SUD. More specifically, changes to the curriculum are highlighted, and results from data analyses on important factors associated with individual and family member recovery are shared and discussed. There is evidence of this updated MFGC continuing to be an effective intervention for family members with a loved-one seeking recovery from an SUD; however, greater and more long-term support for family members is still needed. Additionally, results of this study showed that change in important factors associated with family member wellbeing and family recovery is associated with relapse status of the loved-one seeking recovery from a SUD at a follow-up time point.

Focus Group Findings of Trial Participants in a Caregiver Psychosocial Intervention: Savvy Caregiver Program

Previous work highlights the importance of sociobehavioral interventions to address dementia caregiving health and wellbeing outcomes. By empowering caregivers to become objective managers of their loved one’s illness, and own self-care, they are less likely to exhibit negative outcomes. We are conducting a mixed-method, randomized trial to test manualized, multi-family psychoeducational group interventions: Savvy Caregiver Express, and Savvy Caregiver Program. This poster describes the qualitative findings of four focus group interviews recently conducted to elucidate the study participation experiences of family caregivers enrolled in the parent study. Twenty-five racially and ethnically diverse participants (21 women, 4 men) caring for a family member with cognitive decline participated in focus group interviews conducted via videoconferencing methods. We captured more nuanced experiences from the perspective of study participants with regards to the caregiver interventions and their research participation. Interviews were conducted by trained research personnel, lasted 60-75 minutes, and followed an open-ended questioning route. Based on thematic analyses, we identified the following themes: 1) Changing one’s mindset: Seeing life through their shoes; 2) Getting information in one place; 3) Expanding the personal experience; 4) Fears and vulnerability; 5) Time constraints vs. wanting more; 6) Not everyone is at the same place; 7) Technology: It’s going to be part of our lives; and 8) Research: Not always in sync. Our findings indicate high satisfaction with most components of the program while specific recommendations were offered to improve the intervention and study experience such as tailoring materials to stage-specific needs.

Transference and Countertransference Dynamics in a Multifamily Group for Transgender Adolescents.

This article is an account of a pioneering multifamily group for transgender adolescents. Meetings were conducted in a Sexual Identity Consultation Service in a Child and Adolescent Psychiatry Department in Paris. In addition to enabling both teenagers and their parents to escape a certain form of isolation, this novel mental health care setting also reinforced the ability of participants to free associate and to cathect substitute objects. The author highlights specific characteristics of transference movements and countertransference reactions of the therapists in this framework. An additional goal is to promote these innovative groups and to recommend similar groups for transgender adolescents and their parents.

“Together We Stand”: A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers

This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility was based on screening, eligibility, content, retention, completion, and intervention adherence rates. Acceptability was assessed at post-intervention through a focus group interview. Self-reported anxiety and depression and patients’ inter-dialytic weight gain (IDWG) were also measured. The screening (93.5%), retention (85.7%), and completion (100%) rates were satisfactory, whereas eligibility (22.8%), consent (18.4%), and intervention adherence (range: 16.7–50%) rates were the most critical. Findings showed that participants appreciated the intervention and perceived several educational and emotional benefits. The results from the Wilcoxon Signed-Rank Test showed that a significant decrease in anxiety symptoms (p = 0.025, r = 0.646) was found, which was followed by medium to large within-group effect sizes for changes in depression symptoms (p = 0.261, r = 0.325) and patients’ IDWG (p = 0.248, r = 0.472), respectively. Overall, the results indicated that this family-based psychoeducational intervention is likely to be feasible, acceptable, and effective for patients undergoing HD and their family caregivers; nonetheless, further considerations are needed on how to make the intervention more practical and easily implemented in routine dialysis care before proceeding to large-scale trials.

Parental Conflicts and Posttraumatic Stress of Children in High-Conflict Divorce Families

Parental conflicts consistently predict negative outcomes for children. Research suggests that children from high-conflict divorces (HCD) may also experience post-traumatic stress symptoms (PTSS), yet little is known about the association between parental conflicts in HCD families and child PTSS. We investigated this association, hypothesizing that parental conflicts would predict child PTSS. We also tested the moderating role of interparental contact frequency, hypothesizing that frequent contact would intensify the association between parental conflicts and child PTSS. This study was part of an observational study on the outcomes of No Kids in the Middle (NKM), a multi-family group intervention for HCD families. A total of 107 children from 68 families participated in the study with at least one parent. We used pre- (T1) and post-intervention (T2) data. Research questions were addressed cross-sectionally, using regression analyses to predict PTSS at T1, and longitudinally, using a correlated change (T1 to T2) model. The cross-sectional findings suggested that mother- and child-reported conflicts, but not father-reported conflicts, were related to the severity of child PTSS. Longitudinally, we found that change in father-reported conflicts, but not change in child- or mother-reported conflicts, were related to change in child PTSS. The estimated associations for the different informants were not significantly different from one another. The frequency of contact between ex-partners did not moderate the relationship between parental conflicts and child PTSS. We conclude that there is a positive association between parental conflicts and child PTSS in HCD families independent of who reports on the conflicts.

A mixed methods exploration of the role of multi-family groups in community treatment of patients with depression and anxiety in Pakistan

BackgroundAn open, non-controlled trial was conducted to explore the feasibility, experiences and outcomes of multi-family groups in community mental health care of patients with depression and anxiety.MethodsThe study was conducted in community settings within the catchment area of a free of cost primary care center in Karachi, Pakistan. 30 patients with symptoms of depression and anxiety, their caregivers and 3 lay counsellors were recruited enrolled in the study between May–September 2019. Patients were enrolled for monthly multi-family group meetings conducted over 6 months in groups of 5–6 patients and 1–2 nominated caregivers each. Meetings were facilitated by the non-specialist trained counsellors. The primary outcome was quality of life (assessed using Manchester Short Assessment of Quality of Life) and secondary outcomes were symptoms of depression and anxiety (assessed on Aga Khan University Depression and Anxiety Scale), social outcomes (Social Outcome Index), and caregiver burden (Burden Assessment Scale). Change in all measures was assessed pre and 6-month post intervention using t-test. In-depth interviews were conducted with 7 patients, 7 caregivers and the 3 lay counsellors.ResultsA total of 36 family intervention meetings were conducted with six groups with a total of 30 patients, 34 caregivers and 3 counsellors. Between baseline and the end of the intervention, subjective quality of life increased significantly from 3.34 to 4.58 (p < 0.001, 95% CI 0.93–1.54). Self-reported depression and anxiety scores reduced from 34.7 to 19.5 (p < 0.001, 95% CI 10.8–19.8) and the Social Outcome Index improved from 3.63 to 4.52 (p < 0.001, 95% CI 0.39–1.39). There was no change in family burden. Participants reported that the group meetings were seen as a safe space for shared learning, and that the experience helped improve self-regulation of emotions and behaviors and instilled a sense of belonging.ConclusionMulti-family groups in community treatment of common mental health disorders facilitated by non-specialist mental health service providers is feasible, experienced positively and has the potential for large and positive effects on subjective quality of life, self-reported depression and anxiety, and objective social outcomes.Trial Registration: ISRCTN, ISRCTN12299326. Registered 05 June 2019. Retrospectively registered, https://doi.org/10.1186/ISRCTN12299326.

Impact of Working Together for adults with autism spectrum disorder: a multifamily group intervention

BackgroundAdults with autism spectrum disorder (ASD) have lower engagement in their communities, higher rates of unemployment/underemployment, and continued difficulties with challenging behavior compared to their neurotypical peers. Multi-family psychoeducation emphasizes education and problem-solving with the goal of improving these outcomes for the individual with the disability.MethodsUsing a randomized waitlist control design, the present study evaluated a multi-family group psychoeducation intervention, Working Together, for adults on the autism spectrum without intellectual disability (n = 40). Five waves of data were collected at 3-month intervals. In this design, families in the intervention condition participated in intervention during the 6 months between baseline and time 3 data collection; the waitlist control condition received the intervention immediately after the time 3 data collection. We compared these two conditions, intervention group (n = 20) vs waitlist control group (n = 20), on key outcomes for the adults with ASD: engagement in work-related activities, engagement in meaningful activities, and behavior problems.ResultsResults indicated medium to large effect sizes associated with the Working Together intervention across key outcomes, including adults on the spectrum experiencing significant increases in meaningful activities and decreases in internalizing problems. Although increases in work-related activities were not statistically significant, an observed one-half of a standard deviation difference from before to after the intervention indicated clinically significant change. We also found maintenance of the treatment effect through 6 months post-treatment for the intervention group and replication of the treatment effect within the control group after they received the intervention.ConclusionWorking Together is a promising multi-family group psychoeducation intervention designed to improve functioning during adulthood. These findings highlight the need for more intervention services research during adulthood and specifically the need for family-centered supports.

The experience of intolerance of uncertainty for parents of young people with a restrictive eating disorder

PurposeThis study aimed to explore how parents of young people with a restrictive eating disorder (ED) experience and manage uncertainty.MethodsSeventeen parents of young people with a restrictive ED were recruited from multi-family therapy groups run within a specialised ED clinic. Five focus groups were conducted asking parents about their experience of uncertainty both prior and after the onset of their child’s illness.ResultsData were analysed using interpretative phenomenological analysis which yielded seven superordinate themes. (1) Anorexia nervosa and uncertainty, (2) Positive and negative experiences of uncertainty (3), Helpful and unhelpful ways of coping with uncertainty, (4) Parent’s self-efficacy and uncertainty (5), Needs of parents, (6) Parents’ perceptions of intolerance of uncertainty in their children and (7) Impact of uncertainty on family life.ConclusionParents caring for young people with a restrictive ED exhibit a strong intolerance of uncertainty, particularly in relation to their child’s illness. This ‘negative uncertainty’ was thought to reduce their confidence as parents in how they managed their child’s ED. Targeting high levels of intolerance of uncertainty in parents caring for young people with an ED could be beneficial for supporting parents when faced with their child’s illness, increasing parental self-efficacy, decreasing accommodating behaviours and ultimately contributing to improved treatment outcomes.Level of evidenceLevel V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.