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Disruptive behavior during adolescence is linked to severe problems for the youths later in life and poses challenges to the families, schools, and treatment systems these youths meet. This randomized controlled trial was conducted to examine the short- and long-term effectiveness of functional family therapy (FFT) for adolescents aged 11–17 referred for disruptive behavior to Child Welfare Services in Norway. One hundred sixty-one youths (Mage = 14.7, 45.9% female) were randomly assigned to FFT (n = 88) or treatment as usual (TAU, n = 73). Primary outcomes were parent- and teacher-reported youth aggressive behavior, rule-breaking behavior, internalizing problems, and social skills; youth self-reported delinquency (SRD) and negative peer involvement; and teacher-reported academic performance and adaptive functioning. Outcomes were collected before treatment (pretest), 6 months after pretest (posttest), and 18 months after pretest (follow-up). The results showed no intervention effect for FFT compared to TAU between pretest and posttest (p >.05). Significant improvements between pretest and posttest were found for youth receiving both FFT and TAU on parent-reported aggressive and rule-breaking behavior, internalizing problems, and social skills (ranging from d = 0.56 to −0.45) and youth SRD (d = 0.29). Between posttest and follow-up, however, a significant intervention effect in favor of TAU was found for parent-reported youth internalizing (d = 0.27). Significant improvements between posttest and follow-up were also found for youth receiving both FFT and TAU on parent- and teacher-reported aggressive behavior. Findings did not support the hypothesized superiority of FFT over TAU. [ABSTRACT FROM AUTHOR]

Objective: The present study tested the validity and clinical utility of adolescents' reports of two distinct modes of processing during the recall of a suicidal episode in the Suicide Narrative Interview (SNI). Recall Intensity (RI) items were designed to capture a tendency to become immersed in thoughts and feelings during the interview, while Meaning Making (MM) items were designed to assess more distant and reflective processing. Method: The construct and predictive validity of pretreatment MM and RI was tested in a 16-week randomized clinical trial (RCT) for depressed and suicidal adolescents (N = 113, Mage = 14.95, 84.1% female, 51.8% Black/African American). Adolescents rated MM and RI immediately following the SNI during a baseline assessment. Results: Baseline MM was associated with protective factors related to reduced suicidality, and RI was associated with several risk factors for suicidal symptoms. Adolescents who reported high MM and low RI reported greater reductions in both suicidal ideation and depressive symptoms during the RCT. Conclusions: The results support MM and RI as two distinct modes of how adolescents process memories of suicidal episodes and highlight the potential clinical utility of RI and MM in assessing and treating suicidal adolescents. What is the public health significance of this article?: Identifying both risk and protective factors for adolescent suicidality is imperative for effective assessment and treatment. The present study extends prior research by testing the validity of Meaning Making (MM) and Recall Intensity (RI) as two modes of processing while recalling a past suicidal episode. Results support MM as a protective factor and RI as a risk factor and demonstrate that attachment-based family therapy and family-enhanced nondirective supportive therapy were particularly effective in reducing suicidal ideation and depression in teens reporting high MM and low RI at the start of treatment. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Older adults typically receive rehabilitation services following an acute medical event within the context of declining health. Post-acute rehabilitation often serves as a "boiling point" for health needs and is met with numerous shared emotional stressors related to recovery, long-term care, and end-of-life considerations among older patients and their care-partners—referred to together as a dyad. Psychosocial intervention that targets patients and care-partners separately misses the opportunity to support dyads who typically navigate health-related emotional challenges together. In the context of chronic and serious illness, dyadic interventions (i.e., patient and informal care-partner, together) can successfully reduce emotional distress as well as improve communication and collaborative illness management. However, this approach has yet to be applied to older post-acute rehabilitation patients and their care-partners. Research Method/Design: In this commentary, we outline the need for dyadic psychosocial intervention approaches with older adults and their family care-partners in the context of post-acute rehabilitation. Results: First, we provide evidence for the potential benefits of a dyadic approach to psychosocial care. Next, we review theoretical models as well as clinically relevant confounding factors that can inform dyadic psychosocial case conceptualization and intervention. Finally, we offer a real-world clinical case example that demonstrates the opportunity for dyadic intervention to address common psychosocial challenges seen by psychologists in post-acute rehabilitation settings. Conclusions/Implications: Our goal is to encourage rehabilitation psychologists to view dyadic intervention as a first-line approach to psychosocial care with the growing population of older adults and their family care-partners in post-acute rehabilitation settings. Impact and Implications: Older adults receiving postacute rehabilitation care and their care-partners experience shared stressors related to recovery, long-term care, and end-of-life needs that create unique psychosocial challenges among patient–care-partner dyads. Dyadic approaches to psychosocial care are underexplored but could be the optimal approach for addressing psychosocial challenges that arise in postacute rehabilitation settings. [ABSTRACT FROM AUTHOR]

We tested the process of change in Alliance Empowerment Family Therapy (AEFT; Escudero, 2013), a systemic, team-based approach for treating child welfare involved families. Since building and balancing strong personal and within-family therapeutic alliances are crucial for motivating and sustaining change in these multistressed, overburdened families, we assessed alliance perceptions over time in relation to two indices of therapy outcome, youth functioning, and family-specific goal attainment. Specifically, we administered the self-report version of the System for Observing Family Therapy Alliances (Friedlander et al., 2006) following Sessions 3, 6, and 9 to 156 Spanish families seen by 20 therapists in six agencies whose mission is to serve child welfare referred maltreated youth. Results showed that AEFT delivered in M = 11.04 sessions (SD = 3.29) was effective in attaining family-specific goals and improving child functioning, d = 1.16, as rated by the therapist team in coordination with the referring caseworker. A unique aspect of the study was the modeling, at each time point, of the shared therapeutic system alliance, a latent variable consisting of the therapist's rating of the alliance as well as the alliance ratings of the youth and primary caregiver. As we hypothesized, shared alliance perceptions strengthened with time and positively predicted posttreatment outcomes. Moreover, a comparison of linear growth models with and without the therapist's perspective showed that inclusion of the therapist ratings in the shared alliance variables improved the predictability of child and family outcomes. Public Significance Statement: We studied the process and outcomes of Alliance Empowerment Family Therapy (AEFT), a treatment specifically developed for child welfare referred families that emphasizes the therapeutic alliance as the central component of change. As we predicted, the shared alliance perceptions of youth, caregivers and therapists increased in strength over time and positively predicted improved child and family functioning. [ABSTRACT FROM AUTHOR]

Despite increased emphasis on implementation science for empirically supported child mental health treatments, such as parent–child interaction therapy (PCIT), there continues to be limited understanding of optimal training methods and formats to disseminate protocols within community-based settings. The present study examined changes in trainee knowledge, attitudes, perceived competency, and coding skills after completion of an in-person 40-hr PCIT training workshop presented in two formats. Sixty-one mental health providers participated in either a consecutive or split 5-day workshop and completed written and behavioral measures pre- and posttraining. Results showed that trainees in either training format exhibited similar increases in PCIT knowledge, perceived competency, and behavior coding skills even for those with previous PCIT exposure. Trainee attitudes toward evidence-based practice did not change from pre- to posttraining; however, trainees reported high levels of satisfaction and clinical relevance for the workshop regardless of format. These findings validate the effectiveness of a 40-hr PCIT training workshop and support flexibility in training formats, which may reduce barriers and enhance access to evidence-based practice. They also offer insight into areas requiring increased emphasis within PCIT training, such as developing trainee behavior coding and coaching skills. Public Significance Statement: This study found that mental health clinicians who completed a 5-day training workshop, either in one long segment or two shorter segments, had increased knowledge of the treatment protocol, more confidence about using the treatment, and better behavior coding skills even when they had prior knowledge of the treatment. This study supports flexibility in training formats and highlights areas to emphasize in parent–child interaction therapy (PCIT) training. [ABSTRACT FROM AUTHOR]

Introduction: Interprofessional collaborative practice (ICP) is essential for optimizing patient outcomes in health care settings. Experiential learning (EL) is a method of modeling ICP to students during their education. No studies have evaluated the lasting impact of EL on self-reported clinical practice after students graduate. The aims of this study are to (a) examine what opportunities for ICP are available for alumni in current health care settings and (b) explore the early career impact of interprofessional EL on self-reported current clinical practice. Methods: This study utilized a mixed-methods design using descriptive statistics and a phenomenological approach. Participants included Doctor of Physical Therapy (DPT) and Master of Arts in Marriage and Family Therapy (MAMFT) alumni who previously participated as graduate students in Balanced Families (BF), an interprofessional EL program. Sixty-four alumni were contacted through e-mail, of which 17 (27%) agreed to be interviewed. Results: Quantitative data were analyzed utilizing descriptive statistics to describe demographics and summarize Likert scale responses. Qualitative data were analyzed using an interpretative phenomenological analysis approach. Five major themes were reflected in the transcripts: (a) The impact of interprofessional experiential learning on future clinical practice, (b) The value of holistic approaches, (c) The collaboration in holistic care, (d) The interconnected health care system and family system, and (e) The development of empathy for patients and their families. Discussion: Interprofessional EL positively impacted DPT and MAMFT alumni, improving interprofessional communication skills and leading to more holistic approaches to care. Study outcomes support continued implementation of interprofessional EL in health care graduate study programs. [ABSTRACT FROM AUTHOR]

Introduction: A growing recognition of the need for specialized training to prepare health care providers to work in integrated care (IC) settings requires innovative methods to educate learners. There is an opportunity to provide IC trainees with relevant experiential opportunities to practice these techniques using simulation-based learning, a well-established training approach in medical education. Method: This pilot study sought to examine the feasibility of using simulation-based learning in the interprofessional training of Marital and Family Therapy (MFT) and Family Nursing Practitioner (FNP) trainees in relevant integrated care competencies. Participants included 26 learners (21 MFT and five FNP). The case simulation event involved students completing a video telehealth clinical encounter involving a warm handoff. Clinical faculty observed trainees, completed a checklist designed specifically for the event, and provided feedback directly after the event. Results: Trainees reported high satisfaction with the use of simulation-based learning. Observational coding revealed that trainees successfully implemented many elements of a warm handoff, however, aspects involving interprofessional communication, brief intervention, and follow-up planning appeared more challenging. Discussion: Increased utilization of interprofessional case simulation training in masters and doctoral level behavioral health programs could help accelerate the development of a competent integrated care workforce. [ABSTRACT FROM AUTHOR]

Narrative language abilities are foundational to literacy development and are a culturally grounded measure of early literacy for Latino children. This study evaluates the impacts on narrative language abilities and the costs of a 4-week, strengths-based program that leverages two valued sociocultural practices with built-in benefits, personal narratives, and family food routines (e.g., grocery shopping), for improving Latino kindergarteners' learning outcomes in the United States. Two-hundred and 34 children (M age = 67 months; 51% girls; 13 schools) and their parents participated in a cluster randomized trial. Children produced personal narratives at three time points: pretest, end-of-treatment, and 5-month follow-up. Four narrative features were measured: narrative coherence, elaborations, word types, and literate language features. Large positive impacts were observed on all four narrative features at the end-of-treatment posttest (d = 1.21-1.76). There was suggestive evidence of moderate impacts on one narrative feature (i.e., narrative coherence) at the 5-month follow-up (d = .59). The costs required to implement the family program were relatively low. Findings highlight the potential value of implementing this strengths-based program in schools serving Latino kindergarteners using a rigorous evaluation of its effectiveness. [ABSTRACT FROM AUTHOR]

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

The purpose of this clinical practice guideline developed by the American Psychological Association (APA) is to provide recommendations concerning multicomponent behavioral treatment of obesity and overweight in children and adolescents. Intended users of the guideline include psychologists, other health and mental health professionals, patients, families, and policymakers. The guideline development panel (GDP) used a systematic review conducted by the Kaiser Permanente Research Affiliates Evidence-Based Practice Center as its primary evidence base (O'Connor, Burda, Eder, Walsh, & Evans, 2016). The GDP consisted of researchers and clinicians in psychology, medicine, nursing, and nutrition as well as adult community members who had childhood and adolescent experience with obesity. Critical outcomes used in rating evidence and formulating recommendations were change in body mass index (BMI or zBMI) and serious adverse events. For child and adolescent patients aged 2 to 18 years with obesity or overweight, the GDP strongly recommends the provision of family-based multicomponent behavioral interventions, with a minimum of 26 contact hours, initiated at the earliest age possible. Due to insufficient evidence, the GDP was not able to make recommendations about specific forms of family-based multicomponent behavioral interventions with respect to their comparative effectiveness; associations with adherence, engagement, or retention in treatment; or specific effectiveness with patients or families with particular characteristics. Considerations and challenges related to implementing the recommended interventions are discussed, and areas in which additional research is needed are identified. Public Significance Statement: The purpose of this article is to summarize the clinical practice guideline developed by the American Psychological Association to provide recommendations concerning multicomponent behavioral treatment of obesity and overweight in children and adolescents. Almost one third of youth aged 2 to 19 years in the United States are overweight or obese, which is concerning given the connection between obesity and multiple immediate as well as longer term health risks. The guideline recommends at least 26 contact hours of family-based multicomponent behavioral interventions for child and adolescent patients aged 2 to 18 with obesity or overweight, initiated at the earliest age possible. [ABSTRACT FROM AUTHOR]

Emerging adulthood is a unique developmental stage during which significant transitions in living environment, social networks, personal responsibilities, and identity development occur. Stress associated with these transitions relates to increases in health-risk behaviors, such as substance use and high-risk sexual behavior. This research examined health-risk behavior outcomes associated with the Young Adult Family Check-Up (YA-FCU). The YA-FCU comprises three sessions: an initial interview, an ecological assessment, and a feedback session that integrates motivational interviewing (MI) techniques. This study measured treatment fidelity of the YA-FCU and the extent to which therapists adhered to principles of MI during feedback sessions. Therapists included both licensed psychologists and trainees. The study also examined the relationship between therapists' MI fidelity and client change talk (CT), in order to determine if MI fidelity and client CT predicted postintervention health-risk behaviors among emerging adults who participated in the YA-FCU. Measures of health-risk behaviors were collected pre- and postintervention. Results indicated overall adequate treatment fidelity. MI fidelity was positively related to client CT. Several indicators of MI fidelity predicted decreases in emerging adults' health-risk behaviors. For example, therapist ratio of reflections to questions predicted a decline in emerging adults' alcohol use frequency and marijuana use quantity. These results have important implications for YA-FCU training and implementation and indicate that MI consistent skills might be a mechanism of change in the YA-FCU intervention. Public Significance Statement: This study suggests that the use of motivational interviewing in the Family Check-Up intervention might impact outcomes, particularly with regard to marijuana use. Therapists' use of MI related to changes in marijuana use one year after engagement in the FCU. [ABSTRACT FROM AUTHOR]

Objective: Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents' treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents' likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents' response to 2 treatment conditions. Method: The sample consisted of 129 depressed and suicidal adolescents (Mage = 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent–adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). Results: Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. Conclusions: Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent–adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed. Identification of factors that predict treatment response for depressed and suicidal adolescents holds important implications for treatment planning. The current study extends prior literature by testing multiple measures of family functioning as well as demographic factors as predictors and moderators of depressed and suicidal adolescents' response to attachment-based family therapy (ABFT) and family-enhanced nondirective supportive therapy (FE-NST). ABFT and FE-NST were particularly effective in reducing depressive symptoms in adolescents who engaged in less cooperative communication with their parent at the start of treatment and in reducing suicidal ideation in non-White adolescents and adolescents from lower income families. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in quality of life (QoL) in adolescents receiving family problem-solving therapy (F-PST) following traumatic brain injury (TBI). Method: Adolescents hospitalized for moderate-to-severe TBI were randomized to 1 of 3 ten-session, 6-month long treatments: face-to-face F-PST (n = 34), therapist-guided online F-PST (n = 56), and self-guided online F-PST (n = 60). Participants included 96 boys and 54 girls, of whom 124 were White and 6 were Hispanic. Outcomes were assessed pretreatment and 6 and 9 months later. Adolescents and parents rated adolescent QoL and TBI-related symptoms on the PedsQL and Health and Behavior Inventory (HBI), respectively. We used mixed modeling to examine changes over time and moderators of treatment efficacy. Results: Therapist- and self-guided online groups demonstrated improvements in parent-proxy QoL from baseline to 9 months, Cohen's d = 0.75; p =.004 and Cohen's d = 1.30; p <.001, respectively. The face-to-face group had poorer parent-proxy QoL at 6 months (M = 62, SE = 3.4) than either the therapist- (M = 70.9, SE = 2.8) or self-guided online group (M = 71.1, SE = 2.6). There were no changes or group differences in self-reported QoL over time. Similar findings were observed on the HBI. Differential treatment effects on parent-proxy outcomes were found in boys versus girls and in those from single versus 2-parent households. Improvements in parent-proxy HBI ratings mediated QoL improvements. Conclusions: Both online treatments, but not face-to-face F-PST, were associated with clinical improvements, raising questions about our current delivery paradigm. Individual and family moderators of treatment efficacy underscore the potential of personalized treatment. This study suggests that both self- and therapist-guided online family problem-solving treatment are effective in improving quality of life in adolescents following moderate to severe TBI. Sex differences in treatment response, with boys benefiting more from therapist-guided family problem solving than girls, highlight the need to personalize treatment choices. Lack of improvement following face-to-face treatment suggest a need to reevaluate the current treatment paradigm and give greater consideration to telehealth approaches. [ABSTRACT FROM AUTHOR]

This study examined the prospective associations among maternal substance use, depressive symptoms, and children's behavioral problems in a family systems therapy (ecologically based family therapy [EBFT]) condition and an individual treatment condition. Participants included 183 mothers with a substance use disorder who had at least 1 biological child in their care. Mothers were randomly assigned to the EBFT condition (n = 123) or an individual treatment condition (n = 60). Maternal substance use, depressive symptoms, and child behavioral problems were assessed at baseline and at 3, 6, and 12 months postbaseline. Autoregressive cross-lagged models were estimated to compare whether the cross-lagged paths among the 3 variables differed from zero in each treatment condition. Findings revealed that for individual treatment, strong reciprocal relationships were observed between maternal substance use and maternal depressive symptoms, and between maternal substance use and child behavioral problems. Conversely, in the EBFT group, fewer reciprocal relationships were observed, and instead, maternal depressive symptoms predicted more future child behavioral problems. These findings suggest an interruption in the dysfunctional reciprocal transmission of problem behaviors between mothers and children over time in the family therapy condition. The findings provide evidence for the effectiveness of family systems therapy, EBFT, in interrupting the dysfunctional family dynamics that contribute to maternal substance using behaviors and child behavioral problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

The Systemic Therapy Inventory of Change (STIC) is a multisystemic and multidimensional feedback system that provides therapists feedback about systemic domains of client change in individual, couple, and family therapy over time. The goal of the present study is to investigate the sensitivity to change of the scores of the STIC Initial Scales. In total, 583 clients who voluntarily sought individual, couple, or family therapy services and participated in a randomized controlled trial study were included in the study. Their pre- and posttherapy responses to the STIC Initial measures and corresponding validation measures for individual functioning, couple relationship, child adjustment, and family functioning were compared. The results support the sensitivity to change of the scores of the four STIC Initial Scales investigated: Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). Of particular note, the IPS demonstrated even greater change over time than the BDI-II, BAI, and OQ-45. The discriminant validity of measuring change with the CPS was not supported. Thus, the STIC Initial IPS, RWP, and FH can be usefully employed to measure multisystemic changes in both research and clinical work. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Couples form the foundation of military families. However, on average, couples become significantly less satisfied with their relationships and marriages across the deployment cycle. Reduced satisfaction places partners at risk for psychological distress and family problems. The present study examines the effects of a family based reintegration program aimed at enhancing reflective functioning in recently deployed service members and their home-front partners on relationship satisfaction. Results reveal that most dyads report being satisfied in their relationship at baseline. However, greater couple distress was related to more psychological distress in both partners. For spouses, intervention had a positive, significant effect on relationship satisfaction. Variations in relative risk for couple distress among service members and their spouses highlight the need to assess both partners to clarify risk factors and modifiable targets of intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether vocational supports for emerging adults with serious mental health conditions who are at high risk for rearrest are more effectively served within Multisystemic Therapy for Emerging Adults (MST-EA) through vocationally enhanced MST-EA Coaches or through referral to state vocational rehabilitation services. Method: A pilot randomized controlled trial examined two MST-EA Coaching approaches. In the Standard Coach + VR condition (n = 16), MST-EA Coaches delivered standard skills curricula to participants and referred them to state vocational rehabilitation (VR) services for vocational supports. In the Vocational Coach (VC) condition (n = 16), MST-EA Coaches delivered the standard skills curricula enhanced with extensive education/employment components. Analyses included pre- to posttreatment comparisons of vocational outcomes, and between groups comparisons of fidelity, satisfaction, and services utilization. Results: Those in the VC condition had a 12-fold increase in the odds of posttreatment vocational activity compared with those in the Standard Coach + VR condition (92.9 vs. 57.1% employed or in school, respectively). Subgroup analyses of those who engaged in Coaching showed that there was specifically an increase in the odds of posttreatment educational engagement among those in the VC condition compared with those in Standard Coach + VR. Conclusions and Implications for Practice: Based on the strength of the findings in this small pilot study the VC should be included in future clinical trials of MST-EA to maximize treatment impact for supporting emerging adult vocational functioning and thus reducing antisocial behavior. [ABSTRACT FROM AUTHOR]

Although preterm infants are at risk for social deficits, interventions to improve mother--infant interaction in the neonatal intensive care unit (NICU) are not part of standard care (SC). Study participants were a subset from a randomized controlled trial of a new intervention for premature infants, the Family Nurture Intervention (FNI), designed to help mothers and infants establish an emotional connection. At infants' 4 months corrected age, mother--infant face-to-face interaction was filmed and coded on a 1-s time base for mother touch, infant vocal affect, mother gaze, and infant gaze. Time-series models assessed self- and interactive contingency. Comparing FNI to SC dyads, FNI mothers showed more touch and calmer touch patterns, and FNI infants showed more angry-protest but less cry. In maternal touch self-contingency, FNI mothers were more likely to sustain positive touch and to repair moments of negative touch by transitioning to positive touch. In maternal touch interactive contingency, when infants looked at mothers, FNI mothers were likely to respond with more positive touch. In infant vocal affect self-contingency, FNI infants were more likely to sustain positive vocal affect and to transition from negative to positive vocal affect. In maternal gaze interactive contingency, following infants' looking at mother, FNI mothers of male infants were more likely to look at their sons. In maternal gaze self-contingency, following mothers' looking away, FNI mothers of male infants were more likely to look at their sons. Documentation of positive effects of the FNI for 4-month mother-infant face-to-face communication is useful clinically and has important implications for an improved developmental trajectory of these infants. [ABSTRACT FROM AUTHOR]

Perceived responsiveness has become one of the most important constructs in the relationship sciences. It is central to the development of a secure attachment style, the experience of social support, an internal locus of control, and the sense of control in close relationships. Conversely, an unresponsive environment is associated with learned helplessness and depression. Viewed through the lens of the social relations model (SRM), perceived responsiveness in family relationships could have multiple sources: the perceiver; the target or partner; the perceiver-target relationship; and the family group. This study used the SRM to determine the relative importance of these sources of perceived responsiveness in the relationships of 207 two-parent two-child families. Characteristics of the perceiver and the target each accounted for about 25% of the systematic variance in perceived responsiveness, whereas the perceiver-target relationship accounted for approximately 48%. At the individual level of analysis, reciprocity of perceived responsiveness was pervasive in the family relationships of the two children. Regardless of age, young people who generally perceived others as responsive were generally perceived by others as responsive. At the dyadic level of analysis, reciprocity was present in two dyads: mother-father and older child-younger child. Reliable target variances support the view that perceived responsiveness is not just "inside the head" of the perceiver, and reciprocity correlations suggest potentially useful systemic interventions. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Self-report scores on personality inventories predict important life outcomes, including health and longevity, marital outcomes, career success, and mental health problems, but the ways they predict mental health treatment have not been widely explored. Psychotherapy is sought for diverse problems, but about half of those who begin therapy drop out, and only about half who complete therapy experience lasting improvements. Several authors have argued that understanding how personality traits relate to treatment could lead to better targeted, more successful services. Here self-report scores on Big Five and Big Six personality dimensions are explored as predictors of therapy presentation, usage, and outcomes in a sample of community clinic clients (N = 306). Participants received evidence-based treatments in the context of individual-, couples-, or family-therapy sessions. One measure of initial functioning and three indicators of outcome were used. All personality trait scores except Openness associated with initial psychological functioning. Higher Conscientiousness scores predicted more sessions attended for family therapy but fewer for couples-therapy clients. Higher Honesty-Propriety and Extraversion scores predicted fewer sessions attended for family-therapy clients. Better termination outcome was predicted by higher Conscientiousness scores for family- and higher Extraversion scores for individual-therapy clients. Higher Honesty-Propriety and Neuroticism scores predicted more improvement in psychological functioning in terms of successive Outcome Questionnaire-45 administrations. Taken together, the results provide some support for the role of personality traits in predicting treatment usage and outcome and for the utility of a 6-factor model in this context. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Reviews the documentary film, UNSTUCK: An OCD Kids Movie by Kelly Anderson and Chris Baier (2017). In the film, Anderson and Baier interview six children diagnosed with obsessive-compulsive disorder (OCD), whom they refer to as "kid experts." It provides a new way of educating the public on a psychological disorder that is often casually referenced but frequently misunderstood. With its focus on children and their families, UNSTUCK offers families, educators, therapists, and researchers alike a viewpoint often overlooked in current film and literature regarding OCD: the viewpoints of the children and adolescents themselves. Individuals working in pediatrics or family therapy, thosewith personal or family experience with OCD, and those interested in learning more about the patient-child experience of psychiatric disorders and corresponding impact on family dynamics will be interested in this film. [ABSTRACT FROM AUTHOR]

The stress of multiple deployments and exposure to combat places service members at risk for posttraumatic stress disorder (PTSD), which may detrimentally affect parenting. Evidence-based parenting programs have been successful in promoting adaptive parenting practices among families exposed to stress. However, the effects of preventive interventions on parenting may vary by military parent's PTSD. The current study includes families who participated in a randomized controlled trial of a parenting intervention for military families known as After Deployment, Adaptive Parenting Tools (ADAPT). Families were randomized to either a 14-week, group-based parenting program or a comparison group. Participants included families with 4- to 12-year-old children in which at least 1 parent deployed to Iraq or Afghanistan (N = 336; 945 individuals). Structural equation modeling was used to examine parent self-reported PTSD as a potential moderator of the relationship between intent-to-treat status and effective parenting practices 12 months postbaseline while accounting for baseline effective parenting, length and number of deployments, and family demographics. Father PTSD was a significant moderator, such that the intervention was less effective for fathers who met clinical levels of PTSD. No significant moderation effects were found among mothers. These findings may have important implications for the development of future evidence-based parenting programs. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective: Although both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects. Method: Participants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion. Results: The CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (y = -1.72, 95% confidence interval [Cl] [--2.83, --0.60]), as well as individual DASS (y = -4.39, 95% Cl [-6.44, -2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (y = 0.93, 95% Cl [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (y = --0.87, 95% Cl [--1.47, --0.27]), but not patient symptoms. Conclusion: By integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health. [ABSTRACT FROM AUTHOR]

Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology's ability to facilitate, augment, or at times even substitute for face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka, telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations-such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches-are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Introduction: Lesbian, gay, bisexual, and transgender (LGBT) individuals experience more negative health outcomes compared with their heterosexual peers. The health disparities are often related to family and social rejection of the LGBT individuals. Integrated care, and Medical Family Therapy in particular, may aid in addressing the systemic nature of the negative health outcomes. Method: To better understand the current state of the integrated care literature on addressing the health needs of LGBT individuals, a systematic review of the research literature was conducted from January 2000 to January 2016 for articles including integrated health care interventions for LGBT populations. Independent reviewers coded identified articles. Results: Only 8 research articles met criteria for inclusion out of the 2,553 initially identified articles in the search. Results indicated a lack of integrated care research on health care and health needs of LGBT individuals, and none of the articles addressed the use of family or systemic-level interventions. Discussion: Implications for future research and the need for better education training are discussed. [ABSTRACT FROM AUTHOR]

Objective: Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, we used meta-analysis to summarize the findings of research on family-based treatments for serious juvenile offenders. Method: We conducted a multilevel meta-analysis that modeled dependencies between multiple effect sizes from the same study. The meta-analysis synthesized 324 effect sizes from 28 studies that met inclusion criteria. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model. Results: Across studies, family-based treatments produced modest, yet long-lasting, treatment effects (mean d = 0.25 for antisocial behavior, 0.24 overall) relative to comparison conditions. Furthermore, certain characteristics moderated the magnitude of treatment effects; for example, measures of substance use showed the largest effects and measures of peer relationships showed the smallest effects. Conclusions: Policymakers, administrators, and treatment providers may find it useful to consider the effects of family-based treatments for serious juvenile offenders in their selection of treatments for this population. In addition, investigators who seek to develop and study such treatments may wish to consider the current findings in their future research efforts. [ABSTRACT FROM AUTHOR]

Objective: Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method: RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinicbased FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results: Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. Conclusions: VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. [ABSTRACT FROM AUTHOR]

Urban families worldwide are often characterized by busy working lives which leave little time for family gatherings and communication. The Happy Family Kitchen project, which emphasized cooking and dining with family members, was conducted in a deprived district in Hong Kong. We hypothesized that the community-based family intervention, derived from a positive psychology framework, can improve family communication, family well-being, and subjective happiness. Twenty-three social service units organized and delivered the intervention programs for 1,419 individuals from 612 families. The core intervention was developed with emphasis on 1 of 5 positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at preintervention, immediate postintervention, and 6 weeks and 12 weeks postintervention. Results showed that family communication, family well-being, and subjective happiness improved with small effect sizes which were sustained up to 12 weeks. The gratitude intervention improved all of the outcome measures. Qualitative data provided additional evidence for effectiveness with in-depth insights into family dynamics. We concluded that this brief intervention was a low-cost and simple approach to improve family communication and well-being. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Using a randomized, intent-to-treat design, this pilot study examined the feasibility and short-term effects of Siblings Are Special (SIBS) with a sample of 54 low-income Latino families (91% Mexican-origin). Participants were older (M = 10.8 years; SD = .46) and younger siblings (M = 8.4 years; SD = 1.13), and their parents (94% biological mothers), who were randomly assigned within school to the intervention (n = 28) or no-attention control (n = 26) condition. The intervention condition included 12 weekly afterschool sessions (90 min each) for sibling pairs and 3 family nights for parents and siblings (2 hr each). SIBS was designed to enhance sibling relationships via 2 primary intervention targets: (a) children’s capacities that underlie positive sibling dynamics, including relationship skills, cognitions, and shared activities; and (b) parenting of siblings, specifically, enhancing positive guidance and involvement and discouraging authoritarian control. Pre- and posttest data were gathered from siblings and parents. Recruitment and implementation data revealed high rates of attendance and completion, and high ratings of parent satisfaction with the program. Further, analyses suggested the program had positive effects of small to modest magnitude on posttest measures of sibling and parent–child relationship quality, parenting of siblings, older siblings’ emotional efficacy, and parents’ depressive symptoms and parenting stress, controlling for pretest levels of all outcomes and family background characteristics. Discussion addresses the feasibility of sibling-focused programs with low-income Latino families and makes recommendations for future research. [ABSTRACT FROM AUTHOR]

Comments on the article, ""Stimulating Reflective Practice Using Collaborative Reflective Training in Breaking Bad News Simulations," by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). Kim et al. are applauded for engaging and supporting the development of simulation-based education, and for their efforts to create an interprofessional learning environment. However, we hope further work on alternate methods of debriefing leverage the already inherent activation of learners that builds on previous experience, fosters reflection and builds skills. What is needed is the transference of learning theories into our educational research efforts that measure the effectiveness, validation, and reliability of behavior based performance change. The majority of breaking bad news (BBN) curricula limit program evaluations to reports of learner satisfaction, confidence and self-efficacy, rather than determining the successful translation of effective and humanistic interpersonal skills into long-term clinical practice (Rosenbaum et al., 2004). Research is needed to investigate how educational programs affect provider-patient-family interaction, and ultimately patient and family understanding, to better inform our teaching BBN skills. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

This study tested whether individual executive function (EF) tasks were better characterized as formative or reflective indicators of the latent construct of EF. EF data that were collected as part of the Family Life Project (FLP), a prospective longitudinal study of families who were recruited at the birth of a new child (N = 1,292), when children were 3, 4, and 5 years old. Vanishing tetrad tests were used to test the relative fit of models in which EF tasks were used as either formative or reflective indicators of the latent construct of EF in the prediction of intellectual ability (at Age 3), attention-deficit hyperactivity disorder symptoms (at Ages 3 to 5 years), and academic achievement (at kindergarten). Results consistently indicated that EF tasks were better represented as formative indicators of the latent construct of EF. Next, individual tasks were combined to form an overall measure of EF ability in ways generally consistent with formative (i.e., creating a composite mean score) and reflective (i.e., creating an EF factor score) measurement. The test-retest reliability and developmental trajectories of EF differed substantially, depending on which overall measure of EF ability was used. In general, the across-time stability of EF was markedly higher when represented as a factor score versus composite score. Results are discussed with respect to the ways in which the statistical representation of EF tasks can exert a large impact on inferences regarding the developmental causes, course, and consequences of EF. [ABSTRACT FROM AUTHOR]

Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside. [ABSTRACT FROM AUTHOR]

Family-centered prevention programs are understudied for their effects on adolescent depression, despite considerable evidence that supports their effectiveness for preventing escalation in youth problem behavior and substance use. This study was conducted with 2 overarching goals: (a) replicate previous work that has implicated the Family Check-Up (FCU), a multilevel, gated intervention model embedded in public middle schools, as an effective strategy for preventing growth in adolescent depressive symptoms and (b) test whether changes in family conflict may be an explanatory mechanism for the long-term, protective effects of the FCU with respect to adolescent depression. This trial was conducted with 593 ethnically diverse families who were randomized to intervention (offered the FCU) or middle school as usual. Complier average causal effect (CACE) analysis revealed that engagers in the FCU evidenced less growth in depressive symptoms and family conflict from 6th through 9th grade, and post hoc analyses indicated that the FCU is related to lower rates of major depressive disorder. The second set of analyses examined family conflict as a mechanism of change for families who participated in the FCU. Families who reported short-term intervention benefits had significantly less escalation in family conflict over the middle school years; in turn, growth in family conflict explained risk for adolescent depressive symptoms. [ABSTRACT FROM AUTHOR]

Perceived criticism (PC) is a measure of how much criticism from 1 family member "gets through" to another. PC ratings have been found to predict the course of psychotic disorders, but questions remain regarding whether psychosocial treatment can effectively decrease PC, and whether reductions in PC predict symptom improvement. In a sample of individuals at high risk for psychosis, we examined a) whether Family Focused Therapy for Clinical High-Risk (FFT-CHR), an 18-session intervention that consists of psychoeducation and training in communication and problem solving, brought about greater reductions in perceived maternal criticism, compared to a 3-session family psychoeducational intervention; and b) whether reductions in PC from baseline to 6-month reassessment predicted decreases in subthreshold positive symptoms of psychosis at 12-month follow-up. This study was conducted within a randomized controlled trial across 8 sites. The perceived criticism scale was completed by 90 families prior to treatment and by 41 families at 6-month reassessment. Evaluators, blind to treatment condition, rated subthreshold symptoms of psychosis at baseline, 6- and 12-month assessments. Perceived maternal criticism decreased from pre- to posttreatment for both treatment groups, and this change in criticism predicted decreases in subthreshold positive symptoms at 12-month follow-up. This study offers evidence that participation in structured family treatment is associated with improvement in perceptions of the family environment. Further, a brief measure of perceived criticism may be useful in predicting the future course of attenuated symptoms of psychosis for CHR youth. [ABSTRACT FROM AUTHOR]

This study examined gender and ethnicity as moderators of Multidimensional Family Therapy (MDFT) effectiveness for adolescent drug abuse and illustrated the utility of integrative data analysis (IDA; Bauer & Hussong, 2009) for assessing moderation. By pooling participant data from 5 independent MDFT randomized clinical trials (RCTs), IDA increased power to test moderation. Participants were 646 adolescents receiving treatment for drug use, aged 11 to 17 years (M = 15.31, SD = 1.30), with 19% female (n = 126), 14% (n = 92) European American, 35% (n = 225) Hispanic, and 51% (n = 329) African American. Participants were randomized to MDFT or active comparison treatments, which varied by study. Drug use involvement (i.e., frequency and consequences) was measured at study entry, 6-, and 12-months by a 4-indicator latent variable. Growth curve change parameters from multiple calibration samples were regressed on treatment effects overall and by moderator subgroups. MDFT reduced drug use involvement (p < .05) for all participant groups. Pooled comparison groups reduced drug use involvement only for females and Hispanics (ps < .05). MDFT was more effective than comparisons for males, African Americans, and European Americans (ps <.05; Cohen's d = 1.17, 1.95, and 1.75, respectively). For females and Hispanics, there were no significant differences between MDFT and pooled comparison treatments, Cohen's d = 0.63 and 0.19, respectively. MDFT is an effective treatment for drug use among adolescents of both genders and varied ethnicity with males, African American, and European American non-Hispanic adolescents benefitting most from MDFT. [ABSTRACT FROM AUTHOR]

Introduction: Given the interdependent nature of relationships within the family system, the purpose of this study was to examine the potential role of child-parent psychotherapy (CPP) to extend its positive influence beyond the mother-child relationship within families challenged by maternal depression. Accordingly, we analyzed longitudinal associations between depressive symptoms and marital satisfaction over 3 years in order to evaluate if the benefits of CPP to mother-child attachment security might generalize within the family and indirectly benefit marital relationships.Method: We tested our hypotheses in a randomized control trial of CPP (N = 159 families) to examine the intervention's efficacy in families with mothers with histories of depression since the target child's birth (Mage = 20.4 months, SD = 2.5; 56% boys).Results: Using hierarchical linear modeling (HLM) with an actor-partner interdependence modeling (APIM) framework, the results supported our hypothesis as well as revealed significant associations between depressive symptoms and marital functioning. Specifically, shifts in mothers' depressive symptoms within specific waves of follow-up were associated with corresponding shifts in both their husbands' and their own relationship satisfaction in those same waves. After controlling for those effects, only mothers with a history of depression who received CPP demonstrated slight improvements in relationship satisfaction over the 3 years of the study, suggesting secondary benefits of CPP within the family system.Discussion: Results are discussed in terms of the importance of examining therapeutic processes within the larger family system. Concerning future research, we also suggest examining potential mechanisms through which CPP might influence marital satisfaction. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Presenting for a variety of reasons, a caregiver that exhibits behaviors that make them challenging to work with (e.g., stress, hostility, questioning, psychopathology) may prevent or impede gains when working within the context of a child-focused family therapy (i.e., therapy involving caregivers in the planning and implementation of child-centered treatments). Although some work has addressed the challenging patient, little research is available that has concisely translated such information into considerations, recommendations, and tips for preventatively facilitating strong rapport or managing any recognized challenging behaviors that the caregiver of the identified child patient may exhibit. For this reason, the current article aims to provide an integration of literature and clinician experience to provide practice-oriented considerations for those conducting child-focused behavioral or cognitive-behavioral family-based interventions. Discussion begins by outlining the initial contact and preparation with the family before reviewing techniques for ongoing treatment. Considerations for situations in which hostility, confrontation, or anger arises toward the clinician, as well as the patient (i.e., the child) are then discussed. Finally, clinician-focused factors to consider are examined. Effectively negotiating challenging caregiver behaviors within the context of a child treatment can enable clinicians to provide the often necessary and beneficial treatment that would otherwise not be possible. Through integration of proposed preventative and management considerations, a clinician may facilitate a strong relationship with the family, work to repair any ruptures in the relationship, and negotiate challenges brought forth by the challenging caregiver to avoid therapeutic disruptions or premature termination. [ABSTRACT FROM AUTHOR]

False beliefs about the genesis of parental alienation and about appropriate remedies shape opinions and decisions that fail to meet children's needs. This article examines 10 mistaken assumptions: (a) children never unreasonably reject the parent with whom they spend the most time, (b) children never unreasonably reject mothers, (c) each parent contributes equally to a child's alienation, (d) alienation is a child's transient, short-lived response to the parents' separation, (e) rejecting a parent is a short-term healthy coping mechanism, (f) young children living with an alienating parent need no intervention, (g) alienated adolescents' stated preferences should dominate custody decisions, (h) children who appear to function well outside the family need no intervention, (i) severely alienated children are best treated with traditional therapy techniques while living primarily with their favored parent, and (j) separating children from an alienating parent is traumatic. Reliance on false beliefs compromises investigations and undermines adequate consideration of alternative explanations for the causes of a child's alienation. Most critical, fallacies about parental alienation shortchange children and parents by supporting outcomes that fail to provide effective relief to those who experience this problem. [ABSTRACT FROM AUTHOR]

The author comments on an article by C. J. Peek that focuses on Don Bloch's vision of collaborative family health care and the evolution over the past 20 years of the field. He mentions the importance of family in Bloch's and the Wingspread workgroup's ecosystemic collaborative care model. The author thinks that the ability of the health care consumer and professionals to collaborate in a more egalitarian and less hierarchial manner hinders progress.

Background: Don Bloch is the central figure in the origin story for the field of collaborative family health care; the journal Families, Systems, & Health; and for the Collaborative Family Healthcare Association (CFHA). He exerted extraordinary intellectual and practical leadership for all 3. He convened a national working session in 1994 that took stock of the field and set out next steps, one of which was to create the interprofessional organization dedicated to collaborative family health care that is now CFHA. Purpose: As part of honoring Don Bloch's contributions to the field and this journal, this article sets out tenets of his original vision and traces next steps toward this vision generated by national groups between 1994 and 2014, showing what is the same or different over these 20 years, and especially what this means for the field going forward. Method: Precepts of Don Bloch's original vision are drawn from his writings, including the briefing papers he prepared for the national Wingspread group convened in 1994, which also set out next steps for the field. These steps are then compared with next developmental steps for the field generated by CFHA conference attendees in 2004 and again in 2014, after reviewing the history of the organization and the field. Conclusion: Much of Don Bloch's vision has remained relevant to health care transformation, with a number of areas showing significant accomplishment and acceptance, whereas others remain aspirational, and a few others arguably being more difficult to achieve now than when Don articulated them. [ABSTRACT FROM AUTHOR]

Objective: Building on an earlier study (Compas, Forehand. Thigpen, et al., 2011), tests of main effects and potential moderators of a family group cognitive-behavioral (FGCB) preventive intervention for children of parents with a history of depression are reported. Method: Assessed a sample of 180 families (242 children ages 9-15 years) in a randomized controlled trial assessed at 2, 6, 12, 18 and 24 months after baseline. Results: Significant effects favoring the FGCB intervention over a written information comparison condition were found on measures of children's symptoms of depression, mixed anxiety/ depression, internalizing problems, and externalizing problems, with multiple effects maintained at 18 and 24 months, and on incidence of child episodes of major depressive disorder over the 24 months. Effects were stronger for child self-reports than for parent reports. Minimal evidence was found for child age, child gender, parental education, parental depressive symptoms, or presence of a current parental depressive episode at baseline as moderators of the FGCB intervention. Conclusions: The findings provide support for sustained and robust effects of this preventive intervention. [ABSTRACT FROM AUTHOR]

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court--family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)-- on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n = 55) or group therapy (n = 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d = .51), externalizing symptoms (average d = 2.32), rearrests (average d = 1.22), and substance use (average d = 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d = 0.39), commission of serious crimes (d = .38), and felony arrests (d = .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Methods: Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes. Results: Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Conclusions and Implications for Practice: Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. [ABSTRACT FROM AUTHOR]

Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, we examined children's internalizing and externalizing behavior problems from age 5 to 15 years in relation to whether they had experienced a parental divorce. Children from divorced families had more behavior problems compared with a propensity-score-matched sample of children from intact families, according to both teachers and mothers. They exhibited more internalizing and externalizing problems at the first assessment after the parents' separation and at the last available assessment (age 11 years for teacher reports, or 15 years for mother reports). Divorce also predicted both short-term and long-term rank-order increases in behavior problems. Associations between divorce and child behavior problems were moderated by family income (assessed before the divorce) such that children from families with higher incomes prior to the separation had fewer internalizing problems than children from families with lower incomes prior to the separation. Higher levels of predivorce maternal sensitivity and child IQ also functioned as protective factors for children of divorce. Mediation analyses showed that children were more likely to exhibit behavior problems after the divorce if their postdivorce home environment was less supportive and stimulating, their mother was less sensitive and more depressed, and their household income was lower. We discuss avenues for intervention, particularly efforts to improve the quality of home environments in divorced families. [ABSTRACT FROM AUTHOR]

The negative effects of family instability on children and adults have captured the attention of legislators and policymakers wondering if something could be done to help at-risk couples form and sustain healthy relationships and marriages. For a decade now, public funds have supported grants to provide couple and relationship education (CRE) to lower income individuals and couples. This meta-analytic study reviewed 38 studies (with 47 independent samples) assessing the effectiveness of CRE for lower income couples (defined as more than two-thirds of the sample below twice the poverty level) in an attempt to inform current policy debates. Overall effect sizes for control-group studies suggest that CRE for diverse, lower income couples has small, positive relationship effects (overall d = .061), especially on self-reports of relationship quality, communication, and aggression. There were somewhat stronger effects for studies with more married couples (d = .091), mostly "near-poor" (vs. poor) participants (d = .074), and more (vs. fewer) participants in relationship distress (d = .072). In comparison to the effect sizes for control-group studies, the effects of one-group/prepost studies were larger (overall d = .352). Practitioners will need to continue to innovate curriculum design and pedagogy, improve other programmatic elements, and find ways to increase participant engagement to achieve greater success with the limited public funds that support CRE. [ABSTRACT FROM AUTHOR]

Objective: The "critical comments" dimension of the expressed emotion (EE) construct has been found to predict the illness course of patients with bipolar disorder, but less is known about the "emotional overinvolvement" component. The goal of this study was to evaluate whether relatives' observed appropriate and inappropriate emotional involvement (intrusiveness, self-sacrifice, and distress about patients' well-being) moderated the effectiveness of a family-based intervention for bipolar disorder. Method: 108 patients with bipolar disorder (mean age = 35.61 years, SD = 10.07; 57% female) and their relatives (62% spouses) from 2 clinical trials completed 10-min problem-solving interactions prior to being treated with pharmacotherapy plus family-based therapy (FBT) or brief psychoeducation (crisis management [CM]). Patients were interviewed every 3-6 months over 2 years to assess mood symptoms. Results: When relatives showed low levels of inappropriate self-sacrifice, CM and FBT were both associated with improvements in patients' manic symptoms over 2 years. When relatives showed high levels, patients in CM became more manic over time, whereas patients in FBT became less manic. Group differences in mania trajectories were also observed at high levels of inappropriate emotional response but not at low. When relatives showed high levels of appropriate self-sacrifice, patients in both groups became less depressed. At low levels of appropriate self-sacrifice, patients in CM did not improve, whereas patients in FBT became less depressed. Conclusions: Future studies of bipolar disorder should consider the prognostic value of the amount and appropriateness of relatives' emotional involvement with patients in addition to their critical behaviors. [ABSTRACT FROM AUTHOR]

Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research. [ABSTRACT FROM AUTHOR]

Objective: The current analysis demonstrates the use of empirical Bayes (EB) estimation methods with data-derived prior parameters for studying clinically intricate process-mechanism-outcome linkages using structural equation modeling (SEM) with small samples. Method: The data were obtained from a small subsample of 23 families receiving Functional Family Therapy (FFT) for adolescent substance abuse during a completed randomized clinical trial. Two or 3 video-recorded FFT sessions were randomly selected for each family. The middle 20-min portion of each session was observed and coded. An SEM examining the influence of a select set of observed therapist behaviors on pre- to posttreatment change in mother reports of family functioning and, in turn, pre- to posttreatment change in adolescent reports of adolescent marijuana use and delinquent behavior was specified. The SEM was implemented using EB estimation with data-derived maximum likelihood (ML) prior parameters and Markov Chain Monte Carlo (MCMC) estimation of the joint posterior distribution. Results: The EB SEM results indicated that a relatively high proportion of individually focused general interventions (i.e., seek information, acknowledge) as well as relationally focused meaning change interventions by therapists during sessions of FFT were predictive of pre- to posttreatment increases in levels of family functioning as reported by mothers in families of substance-abusing adolescents. In turn, increases in mother-reported family functioning were predictive of reductions in levels of adolescent-reported delinquent behavior. Conclusions: EB MCMC methods produced more stable results than did ML, especially regarding the variances on the change factors in the SEM. EB MCMC estimation is a viable alternative to ML estimation of SEMs in clinical research with prohibitively small samples. [ABSTRACT FROM AUTHOR]

Describes a modification of attachment-based family therapy for working with sexual minority young adults and their persistently nonaccepting parents. The goal of the treatment is to improve the quality of young-adult-parent relationships and promote connection and mutual acceptance. We provide a brief overview of the treatment tasks that comprise the model, describe the rationale behind each task and how it is implemented, offer clinical excerpts, and conclude with thoughts about the limits of the model and future challenges. [ABSTRACT FROM AUTHOR]

Objective: We evaluated 3 methods of integrating interventions for depression (Adolescent Coping With Depression Course; CWD) and substance use disorders (Functional Family Therapy; FFT), examining (a) treatment sequence effects on substance use and depression outcomes and (b) whether the presence of major depressive disorder (MDD) moderated effects. Method: Participants were 170 adolescents (ages 13-18; 22% female; 61% non-Hispanic White) with comorbid depressive disorder (54% MDD, 18% dysthymia) and substance use disorders who were randomized to (a) FFT followed by CWD (FFT/ CWD). (b) CWD followed by FFT (CWD/FFT). or (c) coordinated FFT and CWD (CT). Acute treatment (24 treatment sessions provided over 20 weeks) and 6- and 12-month follow-up effects are presented for substance use (percentage of days of substance use; Timeline Follow back) and depression (Children's Depression Rating Scale-Revised). Results: FFT/CWD achieved better substance use outcomes than CT at posttreatment. and 6- and 12-month follow-ups; substance use effects for CWD/FFT were intermediate. For participants with baseline MDD, the CWD/FFT sequence resulted in lower substance use than either FFT/CWD or CT. Depressive symptoms decreased significantly in all 3 treatment sequences with no evidence of differential effectiveness during or following treatment. Attendance was lower for the second of both sequenced interventions. A large proportion of the sample received treatment outside the study, which predicted better outcomes in the follow-up. Conclusions: Depression reductions occurred early in all 3 treatment sequences. Of the examined treatment sequences, FFT/CWD appeared most efficacious for substance use reductions but addressing depression early in treatment may improve substance use outcomes in the presence of MDD. [ABSTRACT FROM AUTHOR]