Utilizing Family Strengths and Resilience: Integrative Family and Systems Treatment with Children and Adolescents with Severe Emotional and Behavioral Problems (original) (raw)
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Family Process, 48, 395-416, 2009
Community mental health agencies are consistently challenged to provide realistic and effective home-based family-centered treatment that meets local needs and can realistically fit within available budget and resource capabilities. Integrated Family and Systems Treatment (I-FAST) is developed based on existing evidence-based approaches for working with at-risk children, adolescents, and families and a strengths perspective. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol; this is done in a way that builds on and is integrated with mental health agencies' existing expertise in home-based treatment. This is an intervention development study in which we conducted an initial feasibility trial of I-FAST for treating families with children at risk of out-of-home placement. The outcomes of the study provide initial empirical evidence that supports the effectiveness of I-FAST. Findings indicate that there were significant improvements in child behavior, significant increases in parental competency, and significant increases in the level of cohesion and adaptability in these families. All observed changes were significant from pre- to posttreatment with the families able to maintain these positive changes at 6-month follow-up. A more rigorous and robust research design, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.
Changes in family functioning and child behavior following intensive in-home therapy
Children and Youth …, 2007
Mechanisms by which intensive in-home therapy results in positive outcomes are little explored. This study tests the efficacy of standardized intake assessments to predict educational, correctional and placement outcomes for troubled youth after an intervention derived from MST (Intercept). Demographics, prior risk, and assessments of family functioning (FAM-Gen III), family structure (FACES-III) and child behavior (CBCL) were completed for 862 youth at intake who received intensive in-home therapy. Oneyear post-discharge outcomes including living situation, out-of-home placement, trouble with the law, and educational progress are described. Cox-Snell pseudo-R 2 is used to assess the contribution of the independent variables. Results show that risk and demographic factors explain as much or more variation in outcomes than the three assessment measures. More maltreatment types, and past partial hospitalization, residential treatment, or inpatient treatment predict less likelihood of living with family, and greater likelihood of out-of-home placement during the follow-up period. Age is a predictor of experiencing trouble with the law, with the probability of experiencing such trouble increasing by 1% for each one month increase in age at intake. These findings suggest that psychometric measures administered at intake contribute only moderate amounts to the explanatory value of demographics and risk factors. Policy and practice implications are forwarded.
This paper describes the Home-Based Crisis Intervention (HBCI) program in New York and the characteristics and outcomes of the families involved in a study that investigated the effectiveness of the program. The HBCI program provides short-term intensive in-home services to families with children who are at-risk of out-of-home placements. The intervention focuses on family strengths and needs using a multifaceted approach including skills building, counseling, and the provision of concrete services. The program effectiveness study included 221 children (ages 5-17) experiencing a psychiatric crisis that required immediate intensive intervention, hospitalization, or placement in another restrictive setting. Results indicate 63 percent of the families were Hispanic and 26 percent were African American. Eighty percent of the families had annual incomes of less than $20,000. Only 20 percent of the primary caretakers were employed. Seventy-two percent of the caretakers were single parents...
A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility in manual development. A preliminary integrative model termed Integrative Family and Systems Treatment is offered as one option in developing and testing a moderate common factors approach. Such a model might then be studied in eventual clinical trials with other well-developed evidence-based protocols to further address the common versus specific factor debate. Implications for further research and practice are offered.
A Pilot Evaluation of the Rapid Response Program: A Home Based Family Therapy
Community Mental Health Journal, 2018
A pilot evaluation study of the implementation of the Rapid Response Program, a program utilizing the ecosystemic structural family therapy model, in a rural area of Pennsylvania was conducted. This approach was implemented in children's mental health to supplant a costly model of care that had not proven to break the cycle of dependency for children with severe behavioral problems and their families. Initial results show that the Rapid Response Program appears to improve problematic family patterns and children's behavioral problems. The study results are limited by small sample size; however, the outcomes suggest that the program warrants further study using a more rigorous research design with a larger sample.
Objectives: This study examined the treatment outcomes of integrated families and systems treatment (I-FAST), a moderated common factors approach, in reference to multisystemic therapy (MST), an established specific factor approach, for treating atrisk children and adolescents and their families in an intensive community-based setting. Method: This study used a nonrandomized noninferiority trial design to compare the outcomes of 79 families who received I-FAST, the test intervention, to 47 families who have received MST, the reference intervention. Results: I-FAST was noninferior to MST in reducing problem severity and improving functioning based on youth, parents, and workers' assessments. Conclusions: While the nonrandomized design of this study precludes any definitive conclusions, implications of the study were discussed with respect to the debate regarding common factors and specific factor approaches to family treatment and implementation of evidence-based treatments.
Intensive home and community interventions
Child and Adolescent Psychiatric Clinics of North America, 2004
In the mid-1980s, Stroul and Friedman [1] articulated a set of guiding principles for a system of care for children's mental health. These principles built on ongoing work that incorporated an ecologic framework [2-4] to emphasize the need for a continuum and a system of care. These principles were disseminated throughout the United States via the Child and Adolescent Service System Program , so that by the mid-1990s, system of care demonstration projects and infrastructure development were spread throughout the nation .
American Journal of Orthopsychiatry, 1993
A short-term treatment program designed as an alternative to psychiatric hospitalization for children and adolescents is described. The program utilizes a multidisciplinary professional team and specially trained individuals (mentors) who work with the child and the child's biological family in the context of a mentor's home. Admission, discharge, and follow-up data on a group of patients are reported.
Group Dynamics-theory Research and Practice, 2010
Family dysfunction is unacceptably high nationally and internationally with high costs to society in adolescent problems. A number of evidence-based (EB) parenting and family interventions have been proven in research to improve children's outcome. The question remains whether these EB family programs are as effective in practice. This article summarizes research outcomes from a quasi-experimental, 5-year statewide study of the 14-session Strengthening Families Program (SFP) with over 1,600 high-risk families. The study compared outcomes including effect sizes for the four different age versions of SFP (SFP 3-5, 6 -11, 10 -14, and 12-16 years). Quality assurance and program fidelity were enhanced by standardized training workshops, site visits by evaluators, and online supervision. Outcomes were measured using the SFP Parent Retrospective testing battery containing self-report standardized clinical measures of 18 parent, family, and child outcomes. The 2 repeated measures by 4 group ANOVA compared the four different age versions of SFP. All of the outcome variables for the four programs were statistically significant at less than the p Ͻ .05 level except for reductions in Criminal Behavior and Hyperactivity in the older 10 to 16 year-olds. The effect sizes were larger than in prior randomized control design of SFP. The average effect sizes for both the Parenting and Family Cluster scores range from a high Cohen's d ϭ .77 for SFP 6Ϫ11 years to effect size of d ϭ .67 for SFP 3-5 and 10 -14. The largest effect sizes were for improvements for the SFP 6 -11 condition in Family Communication and Family Strengths and Resilience (d ϭ .76 for both), Family Organization (d ϭ .75), Parental Supervision (d ϭ .73), Parenting Efficacy (d ϭ .70), and Positive Parenting (d ϭ .67). Parental alcohol and drug use was reduced most in the SFP 12-16 year version (d ϭ .43).