Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Enhancement of Emotional Intelligence,Family Communication,and Family Satisfaction Via a Parent Educational Program

In this study, 156 participants were tested before and after attending an 8- to 10-week parent educational program to check if their scores on general EI, perspective taking anger expression, family communication, and family satisfaction changed. Also, the study aimed to explore how individual factors (i.e., age, educational status, number of children, etc.) as well as general and specific EI skills are related to family communication and satisfaction and if the educational intervention modified their relationships. Results showed that on the completion of the educational intervention, parents had a modest improvement in family communication and satisfaction, and emotional intelligence, and a limited enhancement of perspective taking and anger expression. The main effects of parents’ age, educational level, and number of children were not significant for any of the variables tested. Also, no statistically significant differences were found between the group of parents attending the program for the first time and the group who had attended similar programs more than once. Finally, emotional intelligence was identified as a mediating variable, which partly explained the relationship of anger expression with family communication and family satisfaction, whereas it fully mediated the relationship of perspective taking with the two family-related variables.     

Examining the potential impact of a family session in therapeutic assessment: a single-case experiment

Most clinicians concede the benefits of conceptualizing children in systemic terms. Yet, many child assessments involve parents only on a limited basis. The Therapeutic Assessment model for children and families (TA-C) emphasizes parental involvement and family-driven collaboration throughout the intervention. Child TA has shown promise as an effective brief intervention (e.g., Smith, Handler, & Nash, 2010; Tharinger et al., 2009). Family intervention sessions (Finn, 2007; Tharinger, Finn, Austin, et al., 2008) are an integral component of the child TA model in facilitating familial changes. However, TA-C research has yet to empirically examine the potential impact of a family session on treatment trajectory. This case study includes an extended presentation of the development and execution of a family session. The authors use a daily measures time-series experiment to empirically examine the clinical effectiveness of the TA-C and the hypothesis that the family session was a tipping point in the trajectory of improvement.     

Using a Computer as an Environmental Facilitator to Promote Post-Head Injury Social Role Resumption

Abstract

The purpose of this case study was to determine if an adult man with traumatic brain injury could use a computer as an environmental facilitator to assume adult social roles post-injury. The participant received four months of intervention in which (a) modifications to the computer's internal system, monitor, and keyboard were made, (b) the participant received instruction in adapted word processing and e-mail packages, and (c) the participant was provided with computer-related activities that were designed to enhance his participation in desired social roles. Participant observation and qualitative interview methods were used as data collection and analysis processes. As a result of his participation in the intervention, the participant was able to (a) re-establish his roles as a brother and an adult son, (b) develop and maintain an extended family of others beyond his family of origin, and (c) create a more satisfying adult work role that has brought greater meaning to his post-injury life.     

Father Enrollment and Participation in a Parenting Intervention: Personal and Contextual Predictors

Fathers are an important, though often underrepresented, population in family interventions. Notably, the inclusion of ethnic minority fathers is particularly scarce. An understanding of factors that promote and hinder father participation may suggest strategies by which to increase fathers’ presence in studies designed to engage the family unit. The current research examined Mexican origin (MO) fathers’ involvement in a family‐focused intervention study. Participants included 495 fathers from eligible two‐parent MO families with an adolescent child. Individual, familial, and culturally relevant predictors based on father, mother, and/or child report data were collected through pretest interviews and included in two separate logistic regression analyses that predicted the following: (1) father enrollment in the study and (2) father participation in the intervention. Results indicated that higher levels of maternal education and lower levels of economic stress and interparental conflict were associated with increased father enrollment in the study. Rates of father participation in the intervention were higher among families characterized by lower levels of interparental conflict, economic stress, and Spanish language use. Results highlight the relevancy of the familial and environmental context to MO fathers’ research participation decisions. These findings as well as their implications for future research and practice are discussed.     

Home-based family intervention for low-income children with asthma: a randomized controlled pilot study

Low-income African American children have disproportionately higher asthma morbidity and mortality. Education alone may not address barriers to asthma management due to psychosocial stress. This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model. Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp. Caregivers with elevated scores on a stress measure were enrolled. Forty-three families were randomized to the 4- to 6-session Home Based Family Intervention (HBFI) or the single session of Enhanced Treatment as Usual (ETAU). All families received an asthma action plan and dust mite covers; children performed spirometry and demonstrated MDI/spacer technique at each home visit. The HBFI addressed family-selected goals targeting asthma management and stressors. Asthma management, morbidity, family functioning, and caregiver stress were assessed at baseline, postintervention, and 6 months after the intervention. ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion. Only one child (5%) in HBFI had an asthma-related hospitalization compared to 7 patients (35%) in ETAU in the year following intervention. Participants in both groups demonstrated improved asthma management and family functioning, and reduced ED visits, symptom days, missed school days, and caregiver stress, but there were no differential treatment effects. The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: results from a randomized pilot trial

The purpose of this study was to test the feasibility and short-term outcomes of Asthma: It's a Family Affair!, a school-based intervention for adolescents with asthma and their caregivers. Twenty-four ethnic minority families with a middle school student with asthma were randomized to immediate intervention or no-treatment control. Intervention students received six group sessions on prevention and management of asthma. Caregivers received five group sessions teaching child-rearing skills to support the youth's autonomy and asthma self-management. All students attended all sessions; caregivers attended an average of three. Two months post-intervention, relative to controls, intervention caregivers reported better problem-solving with children. Intervention students were more responsible for carrying medication, took more prevention steps, and woke fewer nights from asthma. The intervention resulted in positive short-term changes in family relations, asthma management by students, and health status.     

Family connectedness and women's sexual risk behaviors: implications for the prevention/intervention of STD/HIV infection

The present study explores the relationship between connectedness with the intergenerational family and women's sexual risk-taking as a guide to the development of family-focused prevention and intervention. Cross-sectional interview data from a pilot study were analyzed for correlations between a number of self-reported, risky sexual practices, the range of extended family members with whom the respondent was in contact, and awareness of stories pertaining to intergenerational family history. Structured interviews were administered by female interviewers to 56 women from two contexts: a STD (sexually transmitted disease) Clinic (N = 26), and an inner-city, Hispanic Community Organization (N = 30). Knowledge of stories about grandparents or great-grandparents was a robust predictor of lower sexual risk-taking in the STD Clinic sample. This relationship persisted, but only at the trend level in the Community Organization sample. In both the total sample and the STD subsample, the number of categories of extended family members with whom a respondent was in at least monthly contact was correlated with less sexual risk-taking. Given the fundamental importance of the family system as the primary social unit, these findings argue for further family theory-based research and for its potential application in the development of health prevention and intervention. Implications for practice and future research are discussed.     

Surviving cancer competently intervention program (SCCIP): a cognitive-behavioral and family therapy intervention for adolescent survivors of childhood cancer and their families.

Psychological reactions to having had childhood cancer often continue after treatment ends, for survivors and their parents. Based on our previous research, we developed an intervention program for adolescent survivors of childhood cancer, their parents, and siblings. Surviving Cancer Competently: An Intervention Program--SCCIP--is a one-day family group intervention that combines cognitive-behavioral and family therapy approaches. The goals of SCCIP are to reduce symptoms of distress and to improve family functioning and development. SCCIP is described and data from a pilot study of 19 families are presented. Program evaluation data indicated that all family members found SCCIP helpful. Standardized measures administered before the intervention and again at 6 months after SCCIP showed that symptoms of posttraumatic stress and anxiety decreased. Changes in family functioning were more difficult to discern. Overall, the results were promising with regard to the feasibility of the program and its potential for reducing symptoms of distress for all family members.     

Family Therapy After the Divorce: Developing a Strategy

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.     

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

Happy Family Kitchen: Behavioral Outcomes of a Brief Community-Based Family Intervention in Hong Kong

Positive psychology interventions commonly involve behavioral exercises to improve psychosocial well-being. Intervention effect on behavior is unclear. The Happy Family Kitchen project, one of the community-based brief intervention projects under The FAMILY: A Jockey Club Initiative for a Harmonious Society, was conducted in Hong Kong to develop and evaluate the effectiveness of a positive psychology family intervention. We have previously reported positive intervention effects on family communication, family well-being, and subjective happiness. This paper aims to explore the effectiveness of the intervention on behavioral outcomes and their associations with psychosocial well-being. A total of 23 social service units organized and conducted intervention programs for 1419 individuals from 612 families in Hong Kong. Each intervention was developed with emphasis on one of five positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at pre-intervention, immediate post-intervention, and 6 weeks and 12 weeks post-intervention. Results showed that family communication time and frequency of meal preparation with family members increased with sustainable small effects up to 12 weeks. Theme-specific behavior change was observed in the gratitude, flow, and happiness interventions, respectively. Family communication time, frequency of eating with family members, and theme-specific behaviors, including gratitude, flow, happiness behavior, health attitude, and health behavior, were positively associated with psychosocial well-being. Qualitative data provided additional evidence of effectiveness with in-depth insights into behavior change. The positive associations between target behaviors and well-being suggest that improvements in well-being as a function of the intervention may be associated with behavior change.     

Resilience in Families that have Experienced Heart-Related Trauma

The aim of this study was to identify resilience qualities in families in the wake of heart-related trauma of one of their members. The theoretical framework of this study was the Resiliency Model of Family Stress, Adjustment and Adaptation, which represents a paradigmatic shift from a pathological to a strength-based view of a family. Self-report questionnaires and an open-ended question were used to collect data from 22 family members who experienced the heart-related trauma. The results indicate that family time and routines, parent–child togetherness, family chores and affirming communication are key qualities for mediating family adaptation, while inflammatory communication was found to be negatively associated with family adaptation. Other relevant qualities were social support, family hardiness and a coping style where problem situations are reformulated. The identification of these qualities can serve as the focus for intervention and prevention, enhancing the quality of life for families with a cardiovascular patient.     

Using a Family History Intervention to Improve Cancer Risk Perception in a Black Community

Few studies examine the use of family history to influence risk perceptions in the African American population. This study examined the influence of a family health history (FHH) intervention on risk perceptions for breast (BRCA), colon (CRC), and prostate cancers (PRCA) among African Americans in Pittsburgh, PA. Participants (n = 665) completed pre- and post-surveys and FHHs. We compared their objective and perceived risks, classified as average, moderate, or high, and examined the accuracy of risk perceptions before and after the FHH intervention. The majority of participants had accurate risk perceptions post-FHH. Of those participants who were inaccurate pre-FHH, 43.3%, 43.8%, and 34.5% for BRCA, CRC, and PRCA, respectively, adopted accurate risk perceptions post-FHH intervention. The intervention was successful in a community setting. It has the potential to lead to healthy behavior modifications because participants adopted accurate risk perceptions. We identified a substantial number of at-risk individuals who could benefit from targeted prevention strategies, thus decreasing racial/ethnic cancer disparities.     

The Better Beginnings,Better Futures Project: Long‐term Parent,Family, and Community Outcomes of a Universal,Comprehensive, Community‐Based Prevention Approach for Primary School Children and their Families

Better Beginnings, Better Futures is a large‐scale, multi‐year, longitudinal research‐demonstration project designed to reduce children's problems, promote healthy child development, and enhance family and community environments in three economically disadvantaged communities in the province of Ontario, Canada. The initial intervention was implemented from 1993 to 1997 and focused on families with children from 4 to 8 years of age in their first 4 years of schooling (from Junior Kindergarten to Grade 2). This study examined the long‐term parent, family and community programme outcomes, 15 years after the start of the intervention, when the young people who had participated in the intervention as young children were 18 to 19 years of age. Comparison of intervention communities with matched non‐intervention communities showed a mix of outcomes. Although few significant differences between intervention and comparison communities were found with regard to parents' health and family outcomes, there was evidence that parents in the intervention communities were engaging in fewer risk behaviours, had lower levels of depression and had more community involvement than parents in the comparison communities. These results suggest that the intervention did have some positive long‐term effects on youths' parents and on their community environments. Results are discussed with respect to the importance of considering family and neighbourhood contexts in the development and evaluation of prevention programmes. Copyright © 2012 John Wiley & Sons, Ltd.     

An Application of the Complier Average Causal Effect Analysis to Examine the Effects of a Family Intervention in Reducing Illicit Drug Use among High‐Risk Hispanic Adolescents

The Complier Average Causal Effect (CACE) method has been increasingly used in prevention research to provide more accurate causal intervention effect estimates in the presence of noncompliance. The purpose of this study was to provide an applied demonstration of the CACE analytic approach to evaluate the relative effects of a family‐based prevention intervention, Familias Unidas, in preventing/reducing illicit drug use for those participants who received the intended dosage. This study is a secondary data analysis of a randomized controlled trial designed to evaluate the relative efficacy of Familias Unidas with high‐risk Hispanic youth. A total of 242 high‐risk Hispanic youth aged 12–17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at baseline, 6 months and 12 months postbaseline. CACE models were estimated with a finite growth mixture model. Predictors of engagement were included in the CACE model. Findings indicate that, relative to the intent‐to‐treat (ITT) analytic approach, the CACE analytic approach yielded stronger intervention effects among both initially engaged and overall engaged participants. The CACE analytic approach may be particularly helpful for studies involving parent/family‐centered interventions given that participants may not receive the intended dosage. Future studies should consider implementing the CACE analysis in addition to ITT analysis when examining the effects of family‐based prevention programs to determine whether, and the extent to which, the CACE analysis has more power to uncover intervention effects.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.