Differential effects of the working alliance in family therapeutic home‐based treatment of multi‐problem families

et al. 2017

Front. Psychol.

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Objective: The present study validates the Multi-Problem Family (MPF)-Collaboration Scale), which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration) were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG), family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162) and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43), reaching ITG (d = 1.17; r = 0.50), family adversities (d = 0.55; r = 0.26), and severity of psychiatric symptoms (d = 0.31; r = 0.15). Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce psychological stress. For therapeutic interventions with multi-problem families it seems beneficial to maintain a stable high collaboration or help the collaboration, e.g., by fostering treatment expectation.

Section: Resultsmentioning

confidence: 99%

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study

Bachler¹,

Fruehmann²,

et al. 2017

Front. Psychol.

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“…SSE-TAF (social self-sufficiency) is a validated (interrater reliability 0.73) part of the TAF documentation (TAF-DOK) and tries to document the social self-preservation ability of the family with one item ( Bachler et al, 2014 ). The SSE TAF measures the ability to work and is a is based on a 5-tiered Likert scale.…”

Section: Methodsmentioning

confidence: 99%

“…Epidemiological data show that up to 20% of children and adolescents show mental disorders ( Belfer , 2008 ). The prevalence of neglect, maltreatment, deprivation in childhood in Germany is estimated with about 10–15% ( Reichl et al, 2014 ), higher rates were found in multi problem families (MPF; Belfer, 2008 ), which leads to an increased risk of vulnerability for children ( Egle et al, 2004 ; Bachler et al, 2014 ). High-risk families not only meet many criteria of family adversity indices, but also show low treatment compliance and low relational functioning of the families ( Bachler et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Childhood Adversities and Protective Factors on the Development of Child-Psychiatric Disorders and Their Treatment

Frühmann²,

et al. 2018

Front. Psychol.

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Context: Families with high rates of childhood adversities (CAs) (multi problem families, MPF) have an increasing importance in public health-policy.Objective: The present study addresses the relationship between risk- and protective factors and the severity and treatment-outcome of mental disorders.Setting: Family-therapeutic home-based treatment for MPF. We examined a clinical sample (N = 1031) of children between the age of 4 to 17, and a non-clinical sample of 148 children. We hypothesized that of all children of the clinical group have a predominance of risk factors and a higher number of psychopathological symptoms. Furthermore, we hypothesized that children with a predominance of protective factors benefit stronger from psychotherapy.Main Results: In the clinical sample, most children met the criteria of a psychopathological diagnosis (95.7%, as compared to 21.6% in the non-clinical sample) and showed significant higher rates of CAs and significant less protective factors as compared to the non-clinical sample. The clinical group showed a significant reduction of psychopathological symptoms and benefited equally well from treatment. The number of risk factors was a significant predictor for a child from the non-clinical sample to meet the criteria of a psychopathological diagnosis, while the number of protective factors significantly predicted the absence thereof.Conclusion: Children and adolescents with high scores of CAs show significant associations with child psychiatric symptoms (d = 0.35; including all ICD-diagnosis such as, e.g., Asperger Syndrome, ADHD etc. with a higher rate of genetic etiology). Early life stressors, however, do not trigger an irreversible fate, as psychotherapy with young people with high numbers of risk factors does help to reduce psychopathological symptoms significantly (range of five outcome parameters: d = 0.31–0.72).

“…This poses a serious challenge for the development of successful therapeutic principles in the treatment of MPFs (Bachler et al, 2017). For a long time, it was assumed that parents and adolescents in MPFs were unable or unwilling to collaborate in a goal-directed manner; they were referred to as "unwilling, involuntary or mandated clients" (Bachler et al, 2016). In the categorization of Friedlander et al (2011), who identified four groups of individuals or families in psychotherapy ("customers, " "plaintiffs, " "visitors, " and "hostages"), MPFs are found in the "plaintiffs, " "visitors, " and "hostages" categories.…”

Section: Treatment Of Mpfs Familiesmentioning

confidence: 99%

Long-Term Effects of Home-Based Family Therapy for Non-responding Adolescents With Psychiatric Disorders. A 3-Year Follow-Up

et al. 2020

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Objective: Home-based treatment of families with low socioeconomic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects. Methods: We examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables. Results: All variables showed significant improvement rates (pre-vs. post-treatment) with medium to high effect sizes (mean of Cohen's d = 1.04, range = 0.34-2.18). All variables showed a sustained or even further improvement at follow-up. Conclusion: This study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.