Adolescent depression and the family : a paradox

Discusses the role of the family in the development, treatment and prevention of adolescent depression. Studies have demonstrated that between 21–32% of adolescents report mild to severe symptoms of depression. The research points out the need for increased attention to adolescent depression because of its high prevalence, the risk factor for the development of other disorders and suicide, recurrence and tendency to endure into adulthood. Many studies have shown a strong relationship between depressive symptomatology and family factors. Therefore, family interventions should play an important role in the prevention and treatment of adolescent depression. However, there exists a paradox in that the research published to date fails to show that family-intervention programs add to the efficacy of treatments provided to the adolescents. Possible explanations for this paradox are discussed.

The treatment of recurrent abdominal pain in children : a controlled comparison of cognitive-behavioral family intervention and standard pediatric care

This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were randomly allocated to either cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of complete elimination of pain, lower levels of relapse at 6- and 12-month follow-up, and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC. After controlling for pretreatment levels of pain, children's active self-coping and mothers' caregiving strategies were significant independent predictors of pain behavior at posttreatment.

Family interventions in psychosis: a scale to measure therapist adherence

The efficacy of family interventions in psychosis is well documented. UK and USA schizophrenia treatment guidelines advocate the practice of family interventions within routine clinical services. However, less attention has been paid to the study of treatment fidelity and the tools used in its assessment. This study reports the inter-rater reliability of a new scale: Family Intervention in Psychosis-Adherence Scale (FIPAS). This measure is designed to assess therapist adherence to the Kuipers et al. (2002) family intervention in psychosis treatment manual. Reliability ratings were based on a sample of thirteen audiotapes drawn from a randomized controlled trial of family intervention. The results indicated that the majority of items of the FIPAS had acceptable levels of inter-rater reliability. The findings are discussed in terms of their implications for the training and monitoring of the effectiveness of practitioners for family interventions in psychosis.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Working with family to promote health adolescent development

In recent years a sea change has occurred in thinking about interventions for families with adolescent children. A range of intervention strategies has been proposed, including parent education, adolescent education, family therapy, and community change. These associations arise, in part, from a higher likelihood sole-parent families will experience traumatic conflict around family breakdown, lack of supervision due to the parent's work pressures, and limited family income resulting in higher exposure to community risk factors, which demonstrated reduced parental drug use and improved family management, and the Strengthening Families Program, which demonstrated increased children's protective factors, reduced substance use in both adolescents and parents, and improved parenting behaviours are currently investigating the impact of an integrated multi-level secondary school intervention, resilient families, which incorporates communication training for students, an information night for parents, sequenced parent education groups, and brief family therapy.

Change for the BEST: family changes for parents coping with youth substance abuse

This paper reports family changes for participants in a program for parents coping with youth substance abuse. The Behavioural Exchange Systems Training (BEST) program is a professionally-led, parent training intervention. During 1996 and 1997, six groups of parents participated in the program. High levels of depression were observed at intake and symptoms demonstrated a stable reduction in association with exposure to the program. Parents tended to achieve success in developing common strategies for assertively managing family problems, though couples from more complex blended families found this more difficult. Adolescent improvements were noted during the weeks observed. A two year follow up conducted with a subset of families revealed that parents continued to report that the intervention had helped them cope with youth drug abuse.

Family recovery from youth substance use related problems : a pilot study of the BEST plus program

Youth substance use related problems are increasingly common, and families experience considerable stress in attempting to cope with these problems. A pilot study of 34 Australian parents from 21 families (38% sole parent families) participating in an 8-week group program, designed to assist families recover from youth substance use related problems, provided the context to explore family change processes. Participants reported a number of significant improvements over the course of the four groups that ran from late 2003 and through 2004. Regression analyses found general support for the program logic model in identifying significant associations between program-targeted parent changes and post-program improvements in stress symptoms and cohesive family behaviors. The study's limitations are noted.

Family in transition: parents, children and grandparents in lesbian families give meaning to 'doing family'

Lesbian parents, their children and grandparents ‘do family’ in rich and diverse ways. This article draws on innovative grounded theory research using qualitative, multi-generational family interviews with twenty lesbian- parented families living in Victoria, Australia. The intersection between the public and the private in lesbian family life has been seriously neglected by family researchers, and in particular the perspectives of family members other than the lesbian parents themselves. This article addresses the question of ‘How members of lesbian-parented families define and describe their family’, and the results reported here focus on children’s and grandparents’ views, because they are the voices less well represented in the literature. Children and grandparents straddle both mainstream and marginalized spaces as they negotiate contemporary family life. We examine the interface and tensions between the traditional and the transformative, and the implications of these findings for family therapists are briefly discussed.

Investigation of consumer satisfaction with cognitive-behaviour therapy and sertraline in the treatment of adolescent depression

Objective: A new instrument, the Adolescent Depression Treatment Satisfaction Questionnaire (ADTSQ) was devised to measure the consumer satisfaction of depressed adolescents and their parents. The objectives of the paper were to present the psychometric proper ties ofthe ADTSQ and to investigate the relative consumer satisfaction with cognitive-behavioural therapy (CBT), sertraline (SRT) and a combined treatment of CBT and SRT (COMBINED) for the treatment of adolescent depression. In addition, participants were asked to rank their most preferred treatment from the following approaches: medication, individual counselling, group program and family therapy.Method: Thirty-eight adolescents with a unipolar depressive disorder and 37 parents who participated in a randomized clinical trial of CBT versus SRT versus COMBINED completed the ADTSQ following the completion of acute treatment.Results: The ADTSQ was found to have high internal consistency and exploratory factor analysis detected three underlying factors. High levels of consumer satisfaction were reported by both adolescents and parents in all three treatments. Those treated with CBT treatments reported higher levels of skill acquisition than those treated with SRT. Of the four treatment approaches, most parents and adolescentsrated individual counsellingas their first preference.Conclusions: The ADTSQ is a useful measure of consumer satisfaction for depressed adolescents and their parents. CBT, SRT and COMBINED were shown to have high consumer satisfaction with CBT's higher skills training content reflected in the participants' reports. Individual counselling was perceived as the most favourable choice of treatment for adolescent depression. Although limitations associated with the measurement of consumer satisfaction and of the study are acknowledged, it is recommended that the inclusion of consumer satisfaction measures be considered in clinical trials that examine treatment efficacy.

Psychological wellbeing among same-sex attracted and heterosexual parents: Role of connectedness to family and friendship networks

© 2015 Australian Association of Family Therapy. Increasing numbers of lesbian, gay and bisexual (LGB) adults are entering into parenthood. Previous studies indicate many of these parents receive little or no support from their families of origin due to family members' negative attitudes toward homosexuality. This study looks at the extent to which LGB parents report a lower sense of connectedness to family of origin and friendship networks than heterosexual parents and whether this has an impact on psychological wellbeing in either of these groups. Data were derived from two studies of parents: Work, Love, Play, a study of Australian and New Zealand LGB parents (n=324); and the Longitudinal Study of Australian Children, a population-based study of young children and parents (n=6460). Structural equation modelling was used to explore the relationships between: parent sexuality and family/friendship connectedness, family/friendship connectedness and psychological wellbeing, parent sexuality and psychological wellbeing. LGB parents reported feeling less connected to their families of origin but more connected to their friendship groups than heterosexual parents. Counter to previous studies, we found no difference in the psychological wellbeing of LGB parents compared to heterosexual parents when examining the direct effect of sexuality on psychological wellbeing. Clinical implications for counsellors and family therapists are discussed.

2013 Massachusetts Family Impact Seminar: Youth at Risk, Part 2

The youth of Massachusetts are of primary concern to legislators and citizens. This briefing report features three essays by experts — Fern Johnson, Deborah Frank, and Donna Haig Friedman — who focus on three aspects of children in need: children in foster care who need adoption, children who are hungry, and children who are homeless. Each report has further and more detailed suggestions for helping these children in need; below is a summary of the problems we face.

That Wall is Around My Heart: Family Centered Practice

The author uses a clinical case study, in which he works with a teenager and his adoptive parents to illustrate how placement and adoption decisions can provide physical safety while at the same time exacerbating and extending overlooked and destructive effects of child abuse. The case study highlights the continuing impact of childhood trauma on the interpersonal patterns of behavior within the family, whether biological, kinship, foster or adoptive. The tendency for patterns of aggression and reactivity to be repeated by the victim and his or her caregivers in a foster or adoptive home, and then to extend into the next generation, is an integral aspect of the cycle of child abuse and underscores a critical challenge for skilled and patient staff in family-based service programs.

Using Emotion to Foster Acceptance: A Treatment Approach for Family Therapists Working with Transgender Adolescents and their Families

Currently, there is limited research and clinical focus on family therapy with transgender adolescents. When an adolescent discloses his/her transgender identity to his/her family, the family can experience an array of emotions, such as fear, distrust, anger, and sadness, along with confusion and invalidating behavior that can threaten secure attachment among family members. The purpose of this paper is to present a family therapy treatment approach for therapists working with transgender adolescents that is both culturally sensitive to the needs of these families as well as based on a systemic family therapy model. Emotionally Focused Family Therapy (EFFT) is a systemic model that is grounded in attachment theory and focuses on using emotion as a key tool in restructuring problematic relational patterns and fostering more secure family bonds. Through the use of a hypothetical case study, this paper aims at illustrating how EFFT can help family members process feelings related to the transgender identity of an adolescent family member and restore their attachment in a manner that strengthens family relationships and bonds.