Multisystemic therapy decreases parental overestimation of adolescent responsibility for type 1 diabetes management in urban youth.

Abstract

The goal of the present study was to determine whether multisystemic therapy (MST) could decrease parental overestimation of adolescents' responsibility for completion of diabetes care. A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and their caregivers. Participants randomized to MST received treatment for approximately 6 months, and control participants received standard multidisciplinary care. Data were collected at baseline, posttreatment, and 12-month follow-up. In intent to treat analyses, participation in MST was associated with significant decreases in parental overestimation posttreatment and at 12-month follow-up. Tests for moderation found no significant effects of age, family composition, or ethnicity. Family delineation of responsibility for care is an important family process for diabetes management. An intensive homebased family therapy decreased parental overestimation of adolescent care completion among urban adolescents with chronically poorly controlled type 1 diabetes, a population often ignored in the research literature.

Predictors of Home-Based Obesity Treatment Efficacy for African American Youth

“…Regression imputation was used instead of omitting cases with incomplete follow-up data because this strategy can be used when the data can be assumed to be missing at random (Schafer & Graham, 2002). This assumption was confirmed by creating a variable that coded the participant as having either complete or missing follow-up data (NaarKing, Ellis, Idalski, Frey, & Cunningham, 2007). Whether participants completed follow up was not associated with parent or adolescent age, gender, education level, income, or marital status.…”

Multisystemic Therapy for Child Non-Externalizing Psychological and Health Problems: A Preliminary Review

“…Further, MST led to a statistically significant reduction in caregiver overestimation of youth responsibility for diabetes care by post-treatment, with continued decline by 12-month post-recruitment follow-up. On the other hand, control caregivers reported statistically significant increases in their overestimation of youth responsibility for diabetes care by post-treatment, though this effect remained stable by 12-month follow-up (Naar-King et al 2007). At 12-month follow-up, the decline in admissions remained statistically significant for MST youth, though the treatment effect for metabolic control disappeared; in addition, only two-parent families maintained improvements in blood glucose testing (Ellis et al 2007).…”

“…Two papers based on a single pilot study (Ellis et al 2004, 2005c), and four other papers (Ellis et al 2008, 2005b, 2007; Naar-King et al 2007) based on the subsequent larger clinical trial with community therapists in a university setting (Ellis et al 2005a) examined MST in comparison with a control treatment among youth with poorly controlled Type I diabetes. The control group received standard multidisciplinary medical care (endocrinologist, nurse, dietician, social worker, and psychologist) and met with the medical team once every three months (Ellis et al 2004).…”

“…Three studies examined the relative effects of MST and a comparison treatment as a function of demographic characteristics (Ellis et al 2005b; Naar-King et al 2007; Huey et al 2004). One study examined differences in self-reported diabetes stress as a function of treatment (MST, standard medical care) and possible moderating effects of age, gender, and ethnicity (Ellis et al 2005b).…”

Medication Adherence in Adolescents With Behaviorally-acquired HIV: Evidence for Using a Multimethod Assessment Protocol

“…Nonetheless, many adolescents with HIV are responsible for their own medical care for the first time in their lives, or otherwise are in the process of transitioning responsibility from their primary caregiver. Insufficient communication between adolescents and caregivers about relevant health care responsibilities combined with decreased daily contact and/or monitoring appears to have a negative effect on adherence [6,9,11,12]. Additional factors, such as housing stability, mood, medication regimen complexity, length of time on treatment, and delayed presentation of HIV-related symptoms have been cited as prominent influences affecting adolescent HIV medication adherence [6,13,14].…”