Engaging high risk families in community based intervention services

Involving high risk families in community based intervention services constitutes a major challenge facing service delivery in the fields of mental health and substance abuse. Mental health and substance abuse programs typically experience high rates of failure to enroll families in services, as well as high rates of drop-outs from treatment. With family-based intervention programs, those involving all the members of the family or household participation by the entire family is a key to having a successful program. The NIDA funded Youth Support Project tests such a home and family based Family Empowerment Intervention in a randomized field trial which targets families of juvenile offenders. This intervention is delivered three times a week by paraprofessionals who are supervised by a licensed clinician. We discuss the guiding principles and success of our enrollment activities and discuss their implications for other family-based services.     

Prevention Programs to Augment Family and Child Resilience Can Have Lasting Effects on Suicidal Risk

In this commentary, the effects of four family‐based preventive interventions designed to augment parent and child resilience, originally designed to prevent mental health and substance abuse, on suicide ideation and attempts are reviewed. Three of the preventive interventions showed a beneficial effect either on child suicide ideation or attempts, and one found a beneficial effect on parental suicidal ideation. The duration of effects in two of these studies was well longer than a decade. These studies suggest that interventions to augment family and child resiliency originally designed to prevent mental health and substance abuse disorders can also have beneficial, often long‐term, effects on suicidal ideation and behavior.     

Intertransference: Transference Relationships between Members of the Psychotherapy Team

Abstract

There has been limited published research on the effectiveness of manualized psychoeducational approaches for the mental health and behavioral problems of child sexual abuse (CSA) survivors. The present study aims to add to the evidence base for the effectiveness and acceptability of such interventions. A total of 37 enrolled into a brief psychoeducation program (i.e., 10 sessions) aiming to help stabilize mental health and behavioral outcomes (e.g., self-harm), while on the waiting list for mental health services. Participants completed a set of self-rated measures at baseline, pre-intervention, post-intervention and 3-month follow-up. Although there was no change over time with regard to general distress, traumatic symptomatology, depression, anxiety, self-esteem, and life satisfaction, completers were less likely to report self-harm and presented with decreased rates of smoking, alcohol and substance misuse, and involvement in illegal and antisocial behaviors at post-treatment and follow-up. Qualitative data also suggested that overall the program is well tolerated by participants, despite the high attrition rate (43%). Although further research is required to establish the efficacy of this intervention, preliminary results indicate that the new intervention may be useful for stabilizing behavioral problems at post-treatment and follow-up. Strategies to improve attrition rates in future research and clinical practice are discussed.     

An evaluation of the short-term impact of a media-based substance abuse prevention programme

A state-wide substance abuse prevention programme, entitled KidsInTouch, incorporated a multifaceted approach involving: (a) media-based interventions; and (b) parent training workshops. KidsInTouch was targeted at parents and their children, ages five to 12 years. The media-based interventions attempted to increase children's and parents' awareness and knowledge about substance abuse and prevention. In addition, the intervention advertised and solicited audience participation in parent training workshops. Parents participating in the parent training workshops, in comparison to the control parents, evidenced significant improvement in both alcohol and other drug knowledge and parenting skills. The implications of using the media and involving children and their parents in substance abuse prevention programmes are discussed.     

The Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context

To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting‐list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3‐month follow‐up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community‐based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family‐defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context.     

A Balancing Act: Integrating Evidence‐Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence‐based prevention parent training (PT) interventions have been found to be efficacious with various Euro‐American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture‐specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community‐based prevention interventions that achieve a balance between evidence‐based knowledge and cultural relevance.     

Social Validity of a Training and Coaching Program for Parents of Children With Autism Spectrum Disorder on a Waiting List for Early Behavioral Intervention

Due to limited public resources, many children with autism spectrum disorder and their families must wait several months, if not years, to access early behavioral intervention (EBI) services. Service providers must thus develop alternative support models to assist families placed on waiting lists. The present study assessed the social validity of one such initiative, a training and coaching program for parents whose children had been put on a waiting list for EBI services. This program consisted of group training sessions on strategies to cope with their child’s disorder based on applied behavioral analysis and on one-hour, weekly follow-up meetings to support parents’ interventions with their child over the course of 12 months. Social validity was assessed through parental satisfaction with this program and their perception of its effects on themselves, the family, the child, and parental stress. The 94 participants were generally satisfied with the program overall, although they wished for more frequent and intensive interventions. They reported that the program had positive effects on their psychological well-being, their family’s quality of life, and their child’s behavior. However, parenting stress levels were found to have increased over the 12-month period. These results demonstrate that training and individually supporting parents can be beneficial for families of children with ASD who cannot have access to early behavioral intervention immediately upon receiving a diagnosis. Importantly, however, these lower-cost, parent-focused programs cannot be considered a substitute for more intensive and children-driven services.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program

Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self‐harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual‐level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi‐family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD). BEST MOOD is a manualized intervention that is designed to address both individual and family factors in the treatment of adolescent depression. BEST MOOD adopts a family systems approach that also incorporates psychoeducation and elements of attachment theories. The program consists of eight multifamily group therapy sessions delivered over 2 hours per week, where parents attend the first four sessions and young people and siblings join from week 5. The program design is specifically aimed to engage youth who are initially resistant to treatment and to optimize youth and family mental health outcomes. This article presents an overview of the theoretical model, session content, and evaluations to date, and provides a case study to illustrate the approach.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Mental Health Screening of Female Juvenile Offenders: Replication of a Subtyping Strategy

Recent research indicates that adjudicated female youth have higher rates of mental health problems and histories of trauma exposure and abuse relative to adjudicated male youth. These differences are important for gender-specific assessment, intervention, and management strategies. We replicated a subtyping strategy for adjudicated female youth based on mental health screening data from the Massachusetts Youth Screening Instrument-2 (MAYSI-2) by investigating subtype differences on trauma symptoms, abuse history, and other background variables. Cluster analysis of the standard MAYSI-2 scales revealed a three cluster solution replicating results from a prior study. Additionally, results indicated expected differences between female youth with mental health problems compared to those without mental health problems with co-occurring female youth (i.e., self-reported mental health and substance abuse problems) having have greater mental health problems and more extensive abuse histories compared to other subtypes.     

Predicting Behavioral Health Outcomes Among Low-Income Families: Testing a Socioecological Model of Family Resilience Determinants

Over the past decade, the concept of family resilience among impoverished families has increased as a main focus area for family scholars. Similarly, individual, family, and community-level factors that promote family resilience and their impact on behavioral health outcomes have particularly received increased amounts of attention. To date, however, few empirical studies have simultaneously validated the socioecological determinants of family resilience within multi-dimensional conceptual frameworks. In the current study, we test such a model using a cross-sectional design among 380 women and men with an average age of 35 experiencing poverty as a chronic stressor, the majority of whom are ethnic minorities. Individual, family and community determinants of family resilience are examined for their differential effect on outcomes of physical and mental health, as well as risks for substance abuse. Results from structural equation modeling provide support for the model. Findings suggest that community-level determinants impact health through indirect pathways. In this case, community factors predict family and individual-level determinants, and individual factors then directly predict health. Similarly, the relationship between family-level determinants and health was indirect through individual-level factors. Although, a strong positive relationship was found between individual-level determinants and health, the relationship between individual-level factors and substance abuse was also found to be indirect through health. Methodological limitations and implications for family life education, clinical interventions, policy, and future research that are socioecologically-informed are discussed.     

Mental health treatment need among pregnant and postpartum women/girls entering substance abuse treatment

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.     

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.     

The Relationship of Adverse Childhood Experiences to PTSD,Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation‐based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web‐based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) symptoms, depression symptoms, poly‐drug use, and suicide attempt. Seventy‐eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly‐drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation‐based populations must be developed, tested and evaluated longitudinally.     

Risk–need–responsivity and its application in behavioral health settings: A feasibility study of a treatment planning support tool

The risk–need–responsivity (RNR) model suggests several key practices for justice‐involved populations under correctional supervision. Behavioral health treatment planning aligned with RNR principles for offender populations with co‐occurring mental health and substance use disorders (CODs) could be one method for integrating RNR into clinical care. To explore a unique approach to working with behavioral health and RNR principles, the authors implemented a mixed‐methods feasibility study of the acceptability, usability, and utility of a newly developed RNR treatment planning support tool (RNR TST). The tool was implemented in a re‐entry program serving adults with co‐occurring mental health and opioid use disorders. Chart reviews of RNR TSTs (N = 55) and a focus group (N = 14 re‐entry clinical staff) were conducted. Ninety‐six percent of the RNR TSTs incorporated the use of a validated risk–need assessment and 70% of the RNR TSTs were semi‐complete to complete. Focus group interviews highlighted behavioral health staff perspectives on the acceptability, usability, and utility of the RNR TST. This novel RNR TST has the potential to assist behavioral health providers in integrating RNR principles into treatment planning. Further development and testing are needed to determine its impact on client care and outcomes.     

An Examination of Early Maladaptive Schemas among Substance Use Treatment Seekers and their Parents

Early maladaptive schemas, which are cognitive and behavioral patterns of viewing oneself and the world that result in substantial distress, are gradually being documented as important vulnerabilities for substance abuse. Unfortunately, there is limited research on early maladaptive schemas among substance abusers and their family members. Research on this topic may carry important implications for family-focused substance use interventions. The current study examined similarities and differences in early maladaptive schemas among a sample of substance abuse treatment seeking adults (n?=?47) and at least one parent (n?=?58). Results demonstrated that the substance abusers scored higher than their parents on 17 of 18 early maladaptive schemas, with most differences falling into the large effect size range. There were some similarities in the specific early maladaptive schemas endorsed by both groups despite substance abusers scoring higher on all schemas. Implications of these findings for future research and family-focused substance use treatment programs are discussed.     

Parenting contributors to early emerging problem behaviour in children of mothers in methadone maintenance treatment

This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behaviour problems in their young children and whether specific parenting practices are associated with specific types of behaviour problems. Mother‐reported and observational assessments were used to examine contributions of parenting behaviour and home environment to internalizing and externalizing behaviour problems in 150 preschool children of mothers receiving methadone‐maintenance treatment for heroin addiction. In multivariate analyses, mother‐reported child externalizing behaviour was related to greater maternal harshness and to mother history of illicit drug use during pregnancy but not other features of substance use and treatment history. Observer‐coded child internalizing behaviour was related to less maternal sensitivity and less provision of learning activities in the home. Additionally, mother report of her own psychopathology symptoms was related to mother‐reported, but not observer‐coded, child internalizing and externalizing problems. Findings suggest that women in substance abuse treatment should receive parenting interventions and that interventions should focus on increasing maternal sensitivity, reducing harshness, and providing children with cognitively stimulating environments. Findings also suggest that the need for attention to ongoing mental health problems of women in substance abuse treatment—both for their own well‐being and the well‐being of their children.

Highlights

• This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behavior problems in their young children.
• Maternal harshness was related to child externalizing behavior, low sensitivity, and low provision of learning opportunities to child internalizing problems.
• Findings suggest that women in substance abuse treatment should be provided access to parenting interventions.

     

A narrative evaluation of a psychoeducation and a therapeutic alliance intervention for parents of persons with a severe mental illness

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention.