Multiple-family group treatment as an effective intervention for children with psychological disorders

Preliminary Impact of Group-Based Interventions on Stigma and the Mental Health of Caregivers of Adolescents Living with HIV in Uganda

This study examined the preliminary impact of group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family groups (MFG-FS) on HIV stigma, parenting stress, and the mental health of caregivers of adolescents living with HIV. We analyzed data from the Suubi4Stigma study (2020-2022), a two-year pilot randomized clinical trial for adolescents and their caregivers (N = 89 dyads), recruited from nine health clinics in Uganda. Adolescent-caregiver dyads were randomized to three intervention conditions delivered over three months, with data collected at baseline, three and six-months follow-up. We fitted mixed-effects linear regression models to test the effect of the interventions on caregiver outcomes over time. At six months, caregivers randomized to the MFG-FS condition reported lower levels of stigma by association (mean difference = -1.45, 95% CI = -2.52 - -0.38, p = 0.008), and stigma and discrimination attitudes (mean difference = -3.84, 95% CI = -4.63 - -3.05, p < 0.001), compared to Usual care condition. In addition, caregivers of adolescents randomized to the G-CBT condition reported lower levels of stigma and discrimination attitudes at three months (mean difference = -5.18, 95% CI = -9.13 - -1.22, p = 0.010), and at six months (mean difference = -6.70, 95% CI = -9.28 - -4.12, p < 0.001). Caregiver mental health and parenting stress significantly reduced over time regardless of intervention condition. Findings point to the importance of incorporating stigma reduction components within psychosocial interventions targeting adolescents and families impacted by HIV.

Family functioning and problematic usage of the internet in youth: A cross-sectional investigation

BACKGROUND

Problematic usage of the internet (PUI) refers to maladaptive use of the Internet linked to functional impairment as a growing concern in many countries. Youths are often considered more vulnerable to PUI than other age groups. The relationship between PUI and family dynamics is likely bidirectional and complex, warranting further research. Using a cross-sectional study design, we aimed to determine the rate of PUI and the association between PUI and family functioning in a South African sample between the ages of 18 and 30 years.

METHODS

South African youths were recruited via email and social media. Respondents completed an online survey as part of a cross-sectional study to assess the extent and the types of activities for which they use the internet, as well as the quality of their family relationships and functioning, employing standardised questionnaires (including the IAT-10) and the General Functioning Scale of the Family Assessment Device (GF-FAD). The sample included 814 participants (65% female; aged 21 years; SD 3 years).

RESULTS

15.5% of our sample presented with PUI. There was a significant, moderate positive correlation between totals on the IAT-10 and GF-FAD (r = 0.33, p < .001). An independent samples t-test found that individuals with self-reported PUI (GF-FAD: M = 2.57, SD = 0.51) had significantly poorer quality family functioning than individuals without PUI (GF-FAD: M = 2.13, SD = 0.61; t (812) = -7.52, p < .001; Cohen's d = -0.73, 95% CI [-0.92, -0.54]). Correlations were found between increased time spent on various online activities, including pornography (r = 0.20, p < 0.001), cyberbullying (r = 0.17, p < 0.001), social networking (r = 0.11, p = 0.003), and streaming media (r = 0.11, p = 0.003), and poorer quality family functioning.

CONCLUSION

PUI is common in South African youth. Presence of PUI and increased PUI severity were associated with worse family functioning in this sample. We recommend using family-based approaches in promoting a healthy family environment, and in the prevention of PUI and mitigation of its effects, with the goal of striking a balance between the benefits of the internet and its potential role in compromising aspects of family relationships.

Interfamily Therapy, a multifamily therapy model settled in infant-juvenile mental health services of Havana (Cuba): A qualitative study from participants' perspectives

Interfamily therapy (IFT) is a specific model for multifamily therapy (MFT) of recent expansion in Latin American and European countries. In IFT a multifamily group becomes a community of learning where professionals and family members establish collaborative relationships and participate in dialogues. This study used a qualitative phenomenological approach to explore the participants' perspective of 14 members and ex-members of two IFT groups conducted in Infant-Juvenile Mental Health Centers in Havana (Cuba). In this study IFT was well accepted and effective, and it was perceived as beneficial due to its positive influence for participants, with benefits on a personal, family and social level. In addition, participants articulated a series of therapeutic elements of IFT that were essential to promote these benefits. In conclusion, IFT seems to be a useful therapeutic model in the treatment of children, adolescents and their families in a Cuban psychiatric setting.

Perceived Benefits of a Multiple Family Group for Children with Behavior Problems and their Families

Multiple family groups (MFG) have shown to have promising results for children with behavioral difficulties. The 4Rs and 2Ss is a curriculum-based multiple family group model for families of children with disruptive behavior disorders, who live in poverty-impacted communities. This study aimed to explore group processes and caregiver perceptions of the benefits of participating in the 4Rs and 2Ss MFG. Caregivers participating in the MFG were asked to complete a 29- item questionnaire which collected information about the perceived benefits of the MFG upon Yalom's therapeutic factors, including group cohesion, universality, interpersonal learning, guidance, catharsis- and self-understanding. Data were analyzed using SPSS 25, and descriptive statistics were performed for each sub-scale. Responses of open-ended questions were reviewed and coded by two of the authors. Thirty-two caregivers completed the survey. Results indicated that the MFG offered multiple benefits that alignwith Yalom's therapeutic factors, such as creating a sense of universality, catharsis, group cohesion, and interpersonal learning. Future research is needed to determine whether such therapeutic factors are associated with changes in child outcomes and family functioning.

Treatment Efficacy of Multiple Family Therapy for Chinese Families of Children with Attention Deficit Hyperactivity Disorder

The treatment efficacy of multiple family therapy (MFT) for Chinese families of children with attention deficit hyperactivity disorder (ADHD) has not been studied in the past. In this paper, the effect of MFT on different aspects of the lives of the parents in the experimental group (n = 61) was compared with the effect of only the psychoeducational talks on parents in the control group (n = 53). The results of a MANOVA have shown that by the time they reached the posttreatment phase, the parents who had completed the full 42 hours of the MFT program perceived their children's ADHD symptoms as being less serious and less pathological than they had originally thought compared to the parents in the control group. The effect of MFT on parent-child relationships, parenting stress, parental efficacy, hope, and perceived social support was statistically insignificant. Contributions and limitations of our study are discussed.

Wirksamkeitsüberprüfung einer kinderpsychiatrischen Eltern-Kind-Station unter klinischen Routinebedingungen

Zusammenfassung. Vor dem Hintergrund der komplexen Wechselwirkung zwischen der Entstehung und Aufrechterhaltung psychischer Störungen im Kindesalter einerseits und familiären Kontextbedingungen andererseits, bieten Eltern-Kind-Stationen die vielversprechende Möglichkeit das familiäre Umfeld intensiv in die kinderpsychiatrische Behandlung mit einzubeziehen. Um die Wirksamkeit dieser speziellen Therapieform zu untersuchen, wurden im Rahmen einer monozentrischen Fragebogenstudie unter klinischen Routinebedingungen im Ein-Gruppen-Prä-Post-Design anhand einer Stichprobe von 60 Familien die kindliche Symptombelastung (CBCL) und das elterliche Stresserleben (ESF) zu drei Zeitpunkten (Diagnostikblock, Beginn Therapieblock, Therapieende) erhoben. Während sich in der Wartezeit bis Therapiebeginn keine bedeutsamen Veränderungen zeigten, reduzierten sich im Verlauf der Behandlung sowohl die kindlichen Verhaltensauffälligkeiten als auch das elterliche Stresserleben signifikant. Damit liefern die vorliegenden Ergebnisse nicht nur einen Hinweis auf die therapeutische Effektivität kinderpsychiatrischer Eltern-Kind-Stationen, sondern untermauern bisherige Untersuchungen zur engen Verzahnung von kindlichen Verhaltensauffälligkeiten und elterlichen Stresserleben.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.

Effectiveness of online versus live multi-family psychoeducation group therapy for children and adolescents with mood or anxiety disorders: a pilot study

OBJECTIVE

[1] To highlight the effectiveness of multi-family psychoeducation group therapy (MFPGT) in children with mood or anxiety disorders; [2] to measure change in knowledge and awareness of mood and anxiety disorders in families and children; and [3] to compare the relative effectiveness of online compared to live MFPGT.

METHOD

Participants included families of children (12 years or younger) referred with a mood or anxiety disorder to the Division of Child and Adolescent Psychiatry at Queen's University (n=16) who were on a waitlist to see a psychiatrist. Change was measured through questionnaires for all parents before and after the program. Using SPSS v22, comparisons between the online (n=6) and live (n=10) groups were made using the Mann-Whitney U test and within group comparisons were made using Wilcoxon signed-rank test.

RESULTS

The online and live education groups showed similar overall improvements in knowledge acquisition and expressed emotion in participating families. However, statistical significance must be interpreted with caution due to the small sample size.

CONCLUSIONS

Online MFPGT may be an effective way to increase knowledge, provide resources and support and build on skills thus giving individuals more control and confidence when dealing with a mood or anxiety disorder while on a waitlist. MFPGT showed equal efficacy in live and online groups, indicating that the online program has the potential to be a more convenient and accessible program for families. More research is needed with a greater sample size.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review

Multiple family therapy (MFT) is a therapeutic method that brings together several families affected by the same pathology. Although from an ideological and conceptual point of view, MFT is often linked to family therapy and group therapy, it is difficult to define it with precision, a weakness which may in turn hinder research on therapeutic effectiveness. This is most notable in the field of eating disorders (ED) where, in spite of MFT's great popularity, research evidence remains limited. Within the context of a systematic review of the literature on MFT in the treatment of anorexia nervosa, the purpose of this article is to provide a theoretical and clinical framework for describing two MFT models, in an attempt to explore their common and distinct concepts, principles, techniques, and factors of change. The first program is a day treatment adaptation of the Maudsley family-based MFT approach, developed in Belgium at the Therapeutic Centre for Adolescents suffering from Eating Disorders: it focuses on the management of ED symptoms, using a strong cognitive behavioral orientation. The second is an integrated systemic MFT outpatient and inpatient program carried out on the ED unit of a pediatric hospital in Paris, France: it emphasizes intra- and inter-family relationships within a systemic framework. Our effort to describe and compare these two models constitutes a first step toward determining the relative value of different models of MFT. Indeed, each model presents specific characteristics that may make it best suited for specific ED populations and/or types of families.

The effects of a multiple family therapy on adolescents with eating disorders: an outcome study

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty-two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI-2), the Outcome Questionnaire 45 (OQ-45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ-45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions.

Multi-family group therapy for adolescent Internet addiction: exploring the underlying mechanisms

OBJECTIVE

Internet addiction is one of the most common problems among adolescents and effective treatment is needed. This research aims to test the effectiveness and underlying mechanism of multi-family group therapy (MFGT) to reduce Internet addiction among adolescents.

METHOD

A total of 92 participants consisting of 46 adolescents with Internet addiction, aged 12-18years, and 46 their parents, aged 35-46years, were assigned to the experimental group (six-session MFGT intervention) or a waiting-list control. Structured questionnaires were administered at pre-intervention (T1), post-intervention (T2) and a three-month follow-up (T3).

RESULTS

There was a significant difference in the decline both in the average score and proportion of adolescents with Internet addiction in MFGT group at post-intervention (MT1=3.40, MT2=2.46, p<0.001; 100 versus 4.8%, p<0.001) maintained for three months (MT3=2.06, p<0.001; 100 versus 11.1%, p<0.001). Reports from both adolescents and parents were significantly better than those in the control group. Further explorations of the underlying mechanisms of effectiveness based on the changed values of measured variables showed that the improvement in adolescent Internet use was partially explained by the satisfaction of their psychological needs and improved parent-adolescent communication and closeness.

CONCLUSIONS

The six-session multi-family group therapy was effective in reducing Internet addiction behaviors among adolescents and could be implemented as part of routine primary care clinic services in similar populations. As family support system is critical in maintaining the intervention effect, fostering positive parent-adolescent interaction and addressing adolescents' psychological needs should be included in preventive programs for Internet addiction in the future.

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.

Recent developments in family psychoeducation as an evidence-based practice

Among potential resources for people with serious mental illnesses (SMI) and their families, professionally delivered family psychoeducation (FPE) is designed to engage, inform, and educate family members, so that they can assist the person with SMI in managing their illness. In this article, we review research regarding FPE outcomes and implementation since 2001, updating the previous review in this journal (McFarlane, Dixon, Lukens, & Lucksted, Journal of Marital and Family Therapy 2003; 29, 223). Research on a range of FPE variations continues to return mostly positive effects for adults with schizophrenia and increasingly, bipolar disorder. More recent studies include functional outcomes as well as the more common relapse and hospitalization. FPE research involving adults with other diagnoses is increasing, as is FPE research outside the United States In both cases, uneven methodologies and multiple FPE variations make drawing conclusions difficult, although the core utility of access to information, skill building, problem solving, and social support often shines though. Since the previous review, several FPE programs for parents of children or youth with mood disorders have also been developed, with limited research showing more positive than null results. Similarly, we review the developing inquiry into early intervention and FPE, short-form FPE, and cost studies involving FPE. The second half of the article updates the paradox of FPE's evidence base versus its persistently low use, via recent implementation efforts. Multiple challenges and facilitating factors across healthcare systems and financing, individual programs and providers, family members, and consumers shape this issue, and we conclude with discussion of the need for empirical evaluation of implementation strategies and models.

[Multifamily therapy in children with learning disabilities]

Multifamily therapy is an evidence-based method used in the treatment and prevention of severe psychiatric disorders, behavioral problems and physical illnesses in children, adolescents and adults. For preventive family-oriented work with children with learning disorders there is a lack of therapeutic models. This article presents results from an innovative pilot project--multiple family groups for families with a learning disabled child of primary school age (six to eleven years old). Based on a systemic approach, this resource-oriented program integrates creative, activity-based interventions and group therapy techniques and conveys a comprehensive understanding of the challenges associated with learning disorders. Because of the pilot character of the study and the small sample size, the results have to be interpreted with care. The results do however clearly support the wider implementation and evaluation of the program in child guidance clinics, social-pediatric centers, as well as child and adolescent clinics and schools.