Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

Family Functioning and the Course of Adolescent Bipolar Disorder

The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning data were collected from 58 families of adolescents with bipolar disorder (mean age = 14.48 ± 1.60; 33 female, 25 male) who participated in a 2-year randomized trial of family-focused treatment for adolescents (FFT-A). Cohesion and adaptability scores did not significantly change over the course of the study. Parent-reported conflict prior to psychosocial treatment moderated the treatment responses of families, such that high-conflict families participating in FFT-A demonstrated greater reductions in conflict over time than low-conflict families. Moreover, adolescent mania symptoms improved more rapidly in low-conflict than in high-conflict families. For all respondents, cohesion, adaptability, and conflict were longitudinally correlated with adolescents’ depression scores. Finally, decreases in parent-reported conflict also predicted decreases in adolescents’ manic symptoms over the 2-year study. Findings suggest that family cohesion, adaptability, and conflict may be useful predictors of the course of adolescent mood symptoms. Family conflict may be an important target for family intervention in early onset bipolar disorder.     

Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence‐based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time‐limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother‐, teacher‐, and child‐reports of mental health, school experiences, and psychosocial well‐being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool‐aged children and externalizing for adolescents 11–16. The intervention led to declines in self‐reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.     

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.     

The psychological effects of parental mental health on children experiencing disaster: the experience of Bolu earthquake in Turkey

Disasters affect families as a whole, and symptoms displayed by a family member may lead to secondary traumatizations for other members of the family, especially the children. This study examines the effects of parental psychopathology and family functioning on children's psychological problems six months after the earthquake in Bolu, Turkey. Forty-nine children aged between 7 and 14 and their parents were randomly chosen from among 800 families living in a survivor camp in Bolu. Both the children and parents were assessed by trained psychiatrists and psychologists using self-report measures for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms six months after the earthquake. Family functioning in survivor families was also assessed using the Family Assessment Device (FAD). The results showed that the severity of PTSD in children was mainly affected by the presence of PTSD and the severity of depression in the father. State and trait anxiety scores of children were related to general family functioning. The constellation of PTSD symptomatology was different in fathers than in mothers: the most common type of symptoms was "externalizing" in fathers with PTSD. This study supports the notion that the mere presence of PTSD in parents may not be enough to explain the relational process in families experiencing trauma. Our findings with earthquake survivors suggest that when fathers become more irritable and detached because of PTSD symptoms, their symptoms may affect children more significantly.     

The Oregon Model of Behavior Family Therapy: From Intervention Design to Promoting Large-Scale System Change

This paper reviews the evolution of the Oregon model of family behavior therapy over the past four decades. Inspired by basic research on family interaction and innovation in behavior change theory, a set of intervention strategies were developed that were effective for reducing multiple forms of problem behavior in children (e.g., Patterson, Chamberlain, & Reid, 1982). Over the ensuing decades, the behavior family therapy principles were applied and adapted to promote children’s adjustment to address family formation and adaptation (Family Check-Up model), family disruption and maladaptation (Parent Management Training–Oregon model), and family attenuation and dissolution (Treatment Foster Care–Oregon model). We provide a brief overview of each intervention model and summarize randomized trials of intervention effectiveness. We review evidence on the viability of effective implementation, as well as barriers and solutions to adopting these evidence-based practices. We conclude by proposing an integrated family support system for the three models applied to the goal of reducing the prevalence of severe problem behavior, addiction, and mental problems for children and families, as well as reducing the need for costly and largely ineffective residential placements.     

Factors Impacting the Mental Health of the Caregivers of Children with Asthma in China: Effects of Family Socioeconomic Status,Symptoms Control,Proneness to Shame,and Family Functioning

Caregiver mental health is widely considered to be an important factor influencing children's asthma symptoms. The present study aimed to examine key factors that contribute to caregiver mental health in pediatric asthma with a Chinese sample. Two hundred participants reported their family socioeconomic status (SES), proneness to shame, asthma symptoms control of their child, family functioning, and their depression and anxiety symptoms. Results suggested that low family SES, low family functioning, and a high level of shame proneness were associated with high levels of anxiety and depression for caregivers. Family functioning mediated the effects of SES and shame on caregiver mental health and also moderated the effects of SES and shame on caregiver depression. This study highlights the importance of reducing experience of shame and enhancing family functioning in families affected by pediatric asthma.     

Chinese adolescents' perceptions of family functioning: personal,school-related,and family correlates

The author used two translated measures (Self-Report Family Inventory; D. T. L. Shek, 1998); and Family Assessment Device; N. B. Epstein, L. M. Baldwin, & D. S. Bishop, 1983) and a locally developed scale (Chinese Family Assessment Instrument; D. T. L. Shek, in press-a) to assess 3,649 Chinese adolescents' perceptions of how well their families function. He found that boys perceived their families to function worse than did girls and that younger adolescents perceived their families to function better than did older adolescents. Perceived family functioning was negatively related to grade level; students attending schools with higher academic standards perceived their families to function better than did students attending schools with lower academic standards; and students attending government and aided schools had higher levels of family functioning than did students attending private schools. Family types (intact vs. nonintact families) and the duration of parents' stay in Hong Kong were also related to the adolescents' perceptions of family functioning. Findings for the personal, school-related, and family correlates of perceived family functioning were statistically significant and stable across different measures of family functioning, but the practical significance of the findings was not high.     

Family structure and family processes in Mexican-American families

Despite increases in single-parent families among Mexican Americans, few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican-American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single-parent families reported greater school misconduct, conduct disorder/oppositional deviant disorder, and major depressive disorder symptoms, and greater parent-child conflict than their counterparts in 2-parent families. Single-parent mothers reported greater economic hardship, depression, and family stress. Family stress and parent-child conflict emerged as significant mediators of the association between family structure and early adolescent outcomes, suggesting important processes linking Mexican-American single-parent families and adolescent adjustment.     

The Role of Stress Exposure and Family Functioning in Internalizing Outcomes of Urban Families

Although research suggests that stress exposure and family functioning are associated with internalizing problems in adolescents and caregivers, surprisingly few studies have investigated the mechanisms that underlie this association. To determine whether family functioning buffers the development of internalizing problems in stress-exposed families, we assessed the relation between stress exposure, family functioning, and internalizing symptoms among a large sample of inner-city male youth and their caregivers living in poverty across five waves of data collection. We hypothesized that stress exposure and family functioning would predict development of subsequent youth and caregiver internalizing problems and that family functioning would moderate this relation, with higher functioning families demonstrating greater resiliency to stress exposure. We used a longitudinal, prospective design to evaluate whether family functioning (assessed at waves one through four) activated or buffered the effects of stress exposure (assessed at wave one) on subsequent internalizing symptoms (assessed at waves four and five). Stress from Developmental Transitions and family functioning were significant predictors of depressive symptoms and anxiety in youth; however, family functioning did not moderate the relation. Family functioning mediated the relation between stress from Daily Hassles and internalizing outcomes suggesting that poor parenting practices, low structure, and low emotional cohesion activate depression and anxiety in youth exposed to chronic and frequent everyday stressors. Surprisingly, only family functioning predicted depressive symptoms in caregivers. Results validate the use of a comprehensive, multi-informant assessment of stress when investigating internalizing outcomes in youth and support using family-based interventions in the treatment and prevention of internalizing.     

Family-based physical activity interventions and family functioning: A systematic review

Family physical activity (PA) can confer multiple health benefits, yet whether PA interventions affect general family functioning has not been appraised. The purpose of this review was to evaluate studies that have examined the effect of family PA interventions, where child PA was the focus of the intervention, on constructs of family functioning. Literature searches were concluded on January 11, 2022 using seven common databases. Eligible studies were in English, utilized a family PA intervention, and assessed a measure of family functioning as a study outcome. The initial search yielded 8413 hits, which was reduced to 20 independent PA interventions of mixed quality after screening for eligibility criteria. There was mixed evidence for whether family PA interventions affected overall family functioning; however, analyses of subdomains indicated that family cohesion is improved by PA interventions when children are in the early school years (aged 5–12). High-quality studies also showed an impact of family PA interventions on family organization. Targeted interventions at specific family subsystems (e.g., father–son, mother–daughter), characteristics (low-income, clinical populations, girls), and broad multibehavioral interventions may have the most reliable effects. Overall, the findings show that family PA interventions can promote family cohesion and organization, particularly among families with children in the early school years. Higher quality research, employing randomized trial designs and targeting specific intervention and sample characteristics (e.g., different clinical conditions, specific parent–child dyads), is recommended in order to better ascertain the effectiveness of these approaches.     

Family Intervention Effects on Co-occurring Early Childhood Behavioral and Emotional Problems: A Latent Transition Analysis Approach

This study used latent transition analysis (LTA) to examine changes in early emotional and behavioral problems in children age 2 to 4 years resulting from participation in a family-centered intervention. A sample of 731 economically disadvantaged families was recruited from among participants in a national food supplement and nutrition program. Families with toddlers between age 2 and 3 were randomized either to the Family Check-Up (FCU) or to a nonintervention control group. The FCU’s linked interventions were tailored to each family’s needs. Assessments occurred at age 2, 3, and 4. The FCU followed age 2 and age 3 assessments. Latent class analyses were conducted on mother reports of behavior and emotional problems from age 2 to 4 to study transitions among the following four groups: (a) externalizing only, (b) internalizing only, (c) comorbid internalizing and externalizing, and (d) normative. LTA results revealed that participation in the FCU increased the likelihood of transitioning from either the comorbid or the internalizing class into the normative class by age 4. These results suggest family interventions in early childhood can potentially disrupt the early emergence of both emotional and behavioral problems.     

Effectiveness of a Multiple Family Group Intervention for Juvenile First Offenders in Reducing Parent Stress

Parenting practices are major influences on incidents of juvenile delinquency. Stress experienced by parents of children with behavioral problems is a leading contributor to parenting practices. We investigated the extent to which parental stress was reduced by participation in an established multiple group family intervention, the Family Solutions Program, developed to reduce recidivism among juvenile offenders. We also examined parent stress by gender, ethnicity, dropout rates, intervention benefits at 3-month follow-up, single- versus two-parent households, and across dimensions of family functioning and parent-adolescent communication. Parents reported greater levels of parent stress than non-clinical parents prior to intervention. Parental stress did diminish in response to intervention, but not until follow-up to intervention completion. No differences were found on initial parent stress level between completers and non-completers of the intervention or between parent stress and gender or ethnicity of the parent; however, single-parent household was associated with significantly higher levels of parent stress. Family functioning was significantly negatively correlated with parental stress. Finally, open communication between juvenile first offenders and their parents improved significantly in response to the intervention both at post-intervention and at follow-up.     

Children growing up in a violent community: The role of the family

This review evaluates empirical reports of relations among exposure to violence in the community, dimensions that characterize families and parenting, and the distress and maladjustment of children and adolescents. Family functioning variables that have been examined in relation to community violence exposure include family conflict and violence, social support, structure and cohesion, parenting practices, maternal distress, and sociodemographic characteristics. Evidence is reviewed for three hypotheses regarding family dimensions: (1) that they are associated with children's community violence exposure in bivariate relations, (2) that they moderate relations between community violence exposure and child outcomes, and (3) that they mediate relations between community violence exposure and child outcomes. Following the empirical review, theoretical and methodological gaps in the literature are identified; guidelines are proposed for ecologically valid family-based research on community violence.     

Therapy with greek families living in Australia

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasize the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict will be given.Originally published inThe Australian Journal of Family Therapy, Vol. 1, No. 2 (January 1980) pp. 62–68. Reprinted here with permission. Title slightly changed from original.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Intensive family therapy: a way to change family functioning in multi-problem families

TA single group treatment outcome study of intensive family therapy (IFT) is presented. One hundred and nine families from five Swedish units participated and results on family measures for eighty-six of these families are reported. This multi-centre study is the largest so far of this treatment model. The units offered a full-day multi-impact treatment programme for families during an intensive period of approximately one month preceded by a period of extensive planning. Measures used were the self-rating 'Family Climate' and Family Relation Scale and observer-rated CRS-Turbo and the Beavers' System Scales. Significant changes in the direction towards a better family climate and a higher family functioning occurred. Given the very difficult circumstances of these multi-problem families the results are considered promising.     

Severe traumatic brain injury: some effects on family caregivers

This study assesses the effects of severe traumatic brain injuries on family members and functioning-a topic of interest for those working with survivors and their families. This issue is receiving increased attention as recent findings suggest that family adjustment influences outcome for brain-injured persons. The Family Environment Scale and the Profile of Mood States were completed by 25 individuals who had a family member with a severe traumatic brain injury. These scales were also completed by a comparison group of 32 individuals who had no brain-injured family member. In terms of family functioning, the findings suggest that, when a family member suffers a severe traumatic brain injury, depression may be elevated, along with a decreased ability to express feelings, decreased time and energy for social and recreational activities, and increased control in comparison to families without a brain-injured member. While this might contribute to family isolation which could last for many years, the overall finding of the present study was that caregiver families were coping adequately.     

Randomized controlled trial of a prenatal focused coparenting consultation for unmarried black fathers and mothers: One-year infant and family outcomes

In the infant mental health field, scant conceptual attention has been given to coparenting and family adaptations of non-white family systems, with no evidence-based, community-informed coparenting interventions responsive to unmarried Black mothers’ and fathers’ life circumstances. This study examined 1-year post-partum child and family outcomes of a novel, modest dosage (six sessions) prenatal focused coparenting consultation (FCC) using randomized controlled trial methodology. One-hundred-thirty-eight expectant families (one or both parents identified as Black/African American) were randomized to an intervention (N = 70) or treatment-as-usual (TAU; control) condition (N = 68). TAU families received navigational support in accessing existing community services for pregnant families. Intervention families received TAU plus 6 dyadic FCC sessions led by a Black male-female Community Mentor team. When infants were three and 12 months old, parents reported on coparenting, father engagement, interparental aggression, depressive symptoms, and infant social and emotional adjustment. Intent-to-treat analyses focusing on 12-month post-partum data indicated significant intervention effects on coparenting, interparental psychological aggression, and infants’ emotional adjustment. Improvement was also seen in depression and father engagement, with gains for both groups. Results suggest FCC delivered by same-race Community Mentors to unmarried Black coparents transitioning to parenthood supports infant and family adaptation during the first year of life.     

A cross-cultural study of family functioning

The Family Assessment Device (FAD) was used to compare patterns of family functioning in two cultural settings, North America and Hungary. The sample size consisted of 95 nonclinical North American families and 58 nonclinical Hungarian families. No cross-cultural differences were found in the families' general functioning nor in their affective involvement or affective responsiveness as measured by the FAD. Hungarian families, however, perceived their functioning as significantly better than the North American families in problem-solving and in communication. North American families rated themselves significantly better than the Hungarians in setting family rules and boundaries and in meeting their family responsibilities. Results from this study suggest that cultural values can affect a family's functioning and that differences in areas of family functioning can be captured using the FAD. A discussion of broad societal values of the two cultures was used to interpret the contrasting patterns of family functioning.Cross-cultural studies serve many purposes. In general they provide knowledge about the different cultures under investigation. As such, they broaden and enrich our perspectives of ourselves and the world around us. More specifically they highlight similarities and differences across cultures, information that can be helpful in further refining our understanding of the impact of diverse and varying socio-political forces.A topic of particular interest to family therapists and researchers is family functioning in different cultural settings. In spite of continuing research in this area, few studies examine cross-cultural patterns of family interactions and even fewer do so with instruments specifically designed to assess family functioning.From a family perspective, particularly looking at pathology in family functioning, cross-cultural comparisons can be used to highlight areas of dysfunction common to families irrespective of the cultural context. From a cross-cultural perspective, family comparisons can be used to point out the cultural effects and emphases given to different dimensions of functioning within a common system (i.e., the family unit).Both conceptual and methodological problems have contributed to shortcomings in previous cross-cultural studies (Fabrega, 1974; Kleinman, 1987; Flaherty et al., 1988; Rogler, 1989). A basic criticism of such studies has been the assumption that meanings and values in one culture are equivalent to those in another.Another issue, which is particularly pertinent to our study, is the use of an instrument which is developed in one culture and administered in another cultural setting. A potential problem this raises is inferring cultural differences between groups when the translated and the original instruments are not actually comparable in meaning. In fact, one objective of the study was to see whether our own self-report measure of family functioning, the Family Assessment Device (FAD, Epstein et al., 1978, 1983), could be successfully used in another cultural setting.The following report is part of a larger research project, conducted in 1986–87, that compared depressed and nonclinical families across two cultures. The findings presented here are comparisons between nonclinical Hungarian and nonclinical North American families. In our earlier study differences in family interactions between clinically depressed and nonclinical families were evident in both cultural settings (Keitner et al., in press). It was not clear, however, if significant cross-cultural differences in family functioning would be found for the normal group of families and, if so, how these would differ from their ill counterparts. Inclusion of the normal families thus served two purposes, as controls in the larger study to test within cultural differences and as comparison groups in a separate analysis to test between cultural differences.A specific objective of this study was to contrast patterns of perceived family functioning in nonclinical Hungarian families and North American families. Another objective was to determine if the Family Assessment Device (FAD), a self-report measure of family functioning, could be successfully used in different cultural contexts. Hungary was chosen as an appropriate country of study for several reasons. It is at the crossroads of East and West, sharing enough similarities with western culture to validate comparisons, yet different enough in both its cultural and sociopolitical system that some differences could be expected to emerge. Because it is likely that the Hungarian social system is less familiar to readers than that of North American, the results are discussed with particular reference to Hungary.We would like to thank Drs. J. Furedi and T. Kurimay for help in translating the Family Assessment Device and Professors J. Szilard and Muszong-Kovacs for their support of this study. This work was supported in part by the Firan Foundation.