Trauma adapted family connections: reducing developmental and complex trauma symptomatology to prevent child abuse and neglect

Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and prevent child abuse and neglect. Trauma Adapted Family Connections (TA-FC) is a manualized trauma-focused practice rooted in the principles of Family Connections (FC), an evidence supported preventive intervention developed to address the glaring gap in services for this specific, growing, and underserved population. This paper describes the science based development of TA-FC, its phases and essential components, which are based on theories of attachment, neglect, trauma, and family interaction within a comprehensive community-based family focused intervention framework.     

Methods of Engagement in Family-Based Preventive Intervention

Family-based prevention programs have shown promise in preventing drug use and antisocial behavior in high-risk youth. Multidimensional family prevention (MDFP) is an intensive, family-based counseling program in which a family-specific prevention agenda is crafted with each family. This collaborative, individualized approach to intervention requires a high degree of engagement on the part of families. The main challenges of engagement are discussed, and the main features of an engagement strategy are described: capturing the interest of the family and assessing risk and protective factors within the specific ecological context of the family in order to create a working agenda for preventive intervention.     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.     

Creating pathways to participation: a community-based developmental prevention project in Australia

Pathways to Prevention is a developmental prevention project focused on the transition to school in a disadvantaged multicultural urban area in Queensland. The project incorporates two elements: The Preschool Intervention Program (PIP) promotes communication and social skills related to school success; and the Family Independence Program (FIP) (parent training, facilitated playgroups, support groups, etc) promotes family capacity to foster child development. Using a quasi-experimental design (N= 597), improvements in boys' but not girls' behaviours over the preschool year were found. FIP reached more than a quarter of the target population, including many difficult-to-reach families experiencing high stress. Case studies and other qualitative data suggest positive outcomes.     

Buffering Effects of a Family-Based Intervention for African American Emerging Adults

This study focused on the buffering effects of Adults in the Making (AIM), a family-centered preventive intervention, on the link between life stress and increases in risk behaviors among 347 rural, southern African Americans as they left high school. Of the families, 174 were assigned to the prevention condition and 173 to a control condition. Emerging adults reported risk behaviors at pretest, posttest (7 months after pretest), and long-term follow-up (10 months after posttest). A significant Life stress × Prevention condition interaction emerged: Increases in risk behaviors were significantly greater among emerging adults in the control condition who experienced high stress levels than among those in the prevention condition who experienced equally high stress levels.     

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.     

Adolescents' Prosocial Behavior Toward Family,Friends, and Strangers: A Person‐Centered Approach

This study examined longitudinal change in adolescents' prosocial behavior toward family, friends, and strangers. Participants included 491 mother–child dyads (average age of child at Time 1 = 11.5, 67% European American). Growth mixture modeling suggested that prosocial behavior toward family was generally stable or decreased over time, while prosocial behavior toward friends increased over time. However, findings highlighted unique developmental trajectories within subgroups of adolescents for prosocial behavior toward family and friends and found that maternal warmth and adolescent sympathy, self‐regulation, and gender consistently distinguished between groups. Discussion focuses on the need for a more multidimensional approach to prosocial development.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

Drug abuse and eating disorders: prevention implications.

This article explores the relationship between drug and alcohol abuse and eating disorders in a sample of adolescent females using a self-report methodology. An Eating Disorders Risk (EDR) Scale is adopted and correlated with drug and alcohol use, other forms of deviance, family and peer relationships, and depression. The findings support the concept of a generalized theory of addictions based on psychosocial, family, and peer factors. Family and peer prevention applications and a need for further research on the correlates of depression are discussed.     

Measuring risk and protective factors for substance use,delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.     

The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.     

BOOK REVIEWS

Book reviewed in this article:
Bentovim, Arnon, Barnes, Gill Gorell, and Cooklin, Alan (Eds.). Family therapy: Complementary frameworks of theory and practice (Vols. 1&2).
Leff, Julian and Vaughn, Christine. Expressed emotion in families: Its significance for mental illness.
Gurman, Alan S. (Ed.). Casebook of marital therapy.
Kaufman, Edward (Ed.). Power to change: Family case studies in the treatment of alcoholism.
Vincent, John P. (Ed.). Advances in family intervention, assessment and theory (Vol. 2).
Minuchin, Salvador. Family kaleidoscope.
Coleman, Sandra B. (Ed.). Failures in family therapy.     

Cybersex and the E‐teen: What Marriage and Family Therapists Should Know

Adolescents who use the Internet regularly (the “e‐teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk‐taking behaviors and critical decision‐making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.     

The role of crisis in family crisis intervention: Do crisis experience and crisis change matter?

Evaluation studies of crisis intervention have focused on prevention of out-of-home placement of children or family functioning, but largely neglected the aspect of crisis. The present study examined crisis in 183 families receiving Family Crisis Intervention (FCI), addressing crisis characteristics and crisis change. In questionnaires children and parents were asked about their definition and experience of crisis and about their need for help. Results show that all families but one were in crisis at the beginning of the intervention, although the perception and extent of crisis differed among respondents. Crisis decreased from baseline to posttest according to clients and crisis intervention workers, but was not absent after the intervention. Combined with an unexpected pattern of reported family balance in the months before FCI, this result challenges the 4-6 weeks time span assumption of a crisis period. Variations in perception of crisis, clients' need for help, and possible crisis patterns are discussed, addressing theoretical and practical implications for family crisis intervention.     

In Defence of a Modern Medical Model: Purism and Eclecticism in Family Therapy*

Family therapists criticise the ‘medical model’ for relying on linear causality, focusing on pathology rather than health processes and tending to coerce the family into preconceived models. These criticisms might be legitimately levelled at 19th Century models but not at modern medical models which include the circularity of general systems theory, attention to ecological field, and understanding of reciprocal influences of many factors such as emotions, antibodies, genetic endowment, nutrition, interpersonal relations, environmental stress, and symbiotic micro-organisms. This modernised medical model is consistent with modern family therapy theory which integrates general systems theory, ecological theory, communication theory, small group process, role theory and metaphoric communications. Family therapy purists define themselves by contrasting their differences with ‘the medical model’. Eclecticists tend to be practitioners who use broad theoretical frames of reference and commonsense, straight-forward, direct intervention where it is likely to work but will resort to indirect, metaphoric or paradoxical intervention for the more complex and resistant family.     

THE FAMILY CRISIS INTERVENTION LITERATURE: WHAT IS MEANT BY “FAMILY”?*

Family crisis intervention is a rapidly growing area of clinical care in family therapy which lacks clear conceptualization, especially with respect to how “family” fits into crisis intervention theory. This paper integrates recent concepts from the family therapy literature into three views: family as background, family as context, and family as a unit. The family crisis intervention literature (56 publications) is reviewed and categorized according to these three views. Clarity in how “family” is viewed and consistency between theory and practice are examined. Recommendations for improving the conceptualization of “family” in family crisis intervention theory and practice are made.     

Empathy and Self‐Regulation as Mediators Between Parenting and Adolescents' Prosocial Behavior Toward Strangers,Friends, and Family

The current study examined the role of empathy and self‐regulation as mediators between positive parenting (mothering and fathering) and early adolescents' prosocial behavior toward 3 targets (strangers, friends, and family). Data were taken from Time 1 and Time 2 of the Flourishing Families Project, and included reports from 500 families with an early adolescent child (mean age of child at Time 1=11.29). Analyses suggested that predictors of prosocial behavior toward the 3 targets differed, with empathy (as reported by mothers only) and self‐regulation mediating the relation between positive parenting and prosocial behavior toward strangers and friends, but not toward family. Positive mothering was the only variable that was significantly related to prosocial behavior toward family. The discussion focuses on the need for continued research examining a relational approach to prosocial development.     

Evaluating the use of assessment paradigms for preventive interventions: A review of the Triple P — Positive Parenting Program

Public interest and research literature on preventive interventions have grown exponentially in the last three decades (O'Connell, Boat, & Warner, 2009), and the accountability of preventive interventions has come to the forefront of research as stakeholders and consumers increasingly require evidence to support prevention practices (Biglan, Mrazek, Carnine, & Flay, 2003; Flay et al., 2005; Wandersman & Florin, 2003; Weissberg, Kumpfer, & Seligman, 2003). A major goal for preventive interventions is to provide evidence that observed individual and community-level outcomes are a result of the intervention (Glass et al., 2013; Gottfredson et al., 2015). However, preventive interventions require the use of unique assessment methodology to establish evidence supporting the intervention. The present paper seeks to: 1) identify measurement issues within preventive models, 2) examine the interface of theory and practice in evaluating outcomes, and 3) review the implementation of an assessment paradigm in establishing support for a leading preventive intervention.The scope of the paper is limited to preventive interventions for children at risk for psychosocial problems and child maltreatment. A selected parent training model, the Triple P — Positive Parenting Program (Triple P; Sanders, 1999) is highlighted because it has emerged as a leader in the use of a rigorous, multi-level, prevention-focused assessment methodology. This paper adds to the extant literature by providing a theoretical review of assessment within preventive interventions and reviewing the Triple P approach to implementing this methodology successfully. Future directions are discussed.     

Harnessing the strength of families to prevent social problems and promote adolescent well-being

The family context exerts notable influence on many domains of adolescent development and well-being. Recent research indicates that the family has the power not only to help youth get back on course after problems emerge, but that the family can also play a critical role in preventing problems for youth by reducing the severity of a problem or mitigating its occurrence. The purpose of this paper is to outline the promise and challenges of family-based approaches to prevention in social work practice. Research and theory have identified numerous risk and protective factors in the family. Prevention programs that address these risk and protective factors have shown strong evidence of reducing youth risky behavior. Program effects vary based on the strength of program implementation. Agencies often face barriers to implementation including maintaining model fidelity, engaging families, and sustaining funding. Implications for practice and policy are discussed.     

Promoting responsible gambling via prevention messages: insights from the evaluation of actual European messages

Prevention messages are short sentences supposed to broadcast preventive intentions. Three types of messages are noticeable: messages correcting erroneous beliefs, messages informing about the risks and messages promoting responsible gambling. While the results in the literature about messages promoting results are alerting, they are frequently used in European prevention campaigns. The present study relied on language and semantics models to evaluate the communicative and preventive values of 14 messages: 7 were actual European prevention messages and 7 messages were created for the study. Overall, 339 participants answered an online questionnaire in which they evaluated the communicative value of one of the messages and then ranked all the messages according to their preventive level. Results showed that messages informing about the risks and messages correcting erroneous beliefs have a higher level of communicative value than messages promoting responsible gambling. Indeed, the latter are judged as more ambiguous and as less preventive than the two other types of messages. As models of conversational pragmatics suggest that ambiguous messages convey at least two interpretations, the article discusses the possibility that individuals comprehend these messages as incentives to control their impulses (prevention) and incentives to control the game (promotion).