Review of outcome research on marital and family therapy in treatment for alcoholism

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Conduct disorder and delinquency

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed.     

Strengthening Supervision in Systems of Care: Exemplary Practices in Empirically Supported Treatments

The last few decades have witnessed major growth in the evidence base on effective client interventions used by social workers and other health and social service professionals. As the pressure for service agencies to offer empirically supported treatments has been increasing, financial and time constraints have driven a decline in the frequency and amount of supervision provided within many of these organizations. While the reduction in staff supervision presents a challenge for effective implementation of all treatments, there are comprehensive empirically supported treatment models for clients that serve as exemplars of supervisory practice through their explicit requirements, processes and tools for supervision and supervisor development. After a review of the current status of supervision nationally, an implementation science-based approach is described, which builds organizational support for supervision and promotes optimal supervisory practice through training and consultation of supervisors and supervisees. The elements of this comprehensive approach, developed by the Yale Program on Supervision, are detailed. Supervisory policies, practices, and tools created by the developers of empirically supported treatments and similarly grounded in the principles of implementation science are offered as further examples of strategies for ensuring effective supervision.     

Integrative module-based family therapy: application and training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.     

Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.     

The Marriage and Family Therapy Practice Research Network (MFT‐PRN): Creating a More Perfect Union Between Practice and Research

This article describes the Marriage and Family Therapy Practice Research Network (MFT‐PRN). The MFT‐PRN is designed to build a professional community based on practice‐informed research and research‐informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT‐PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical‐research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article .     

Integrative module-based family therapy: a model for training and treatment in a multidisciplinary mental health setting

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.     

Social Workers' Postgraduate Use of the IFD Interpersonal Communication Model

Interpersonal communication assessment models have become very popular as a means of quickly establishing rapport in many settings across the United States. Despite their popularity and possible utility, there has been minimal research into the impact of these models, especially over time and in educational settings (more than 6 months after the training is over). In the master's of social work (MSW) program at Brigham Young University (BYU), the interpersonal family dynamics (IFD) model is used as a tool to better understand human behavior and strengthen relationships in the social work practice environment. This training is provided to first-year students in the foundation human behavior in the social environment course and to field supervisors in their field training conferences. BYU's MSW program graduates were surveyed to find out their perceptions of the utility of IFD. With a relatively high level of accuracy, the graduates reported IFD was a useful approach to better understanding human behavior in their daily practice. Graduates used the model as much in their personal lives as in their professional lives.     

Stepping Down and Stepping In: Youth's Perspectives on Making the Transition from Residential Treatment to Treatment Foster Care

Older youth preparing to emancipate from the foster care system are often served in residential treatment settings where they have limited opportunities to practice skills for independent living in a community setting. Stepping these youth down to less restrictive environments such as treatment foster care is a growing trend, especially for youth with mental health issues. Yet, few studies have explored the youth's perspective on making this transition. This study utilized qualitative interviews with youths who were participating in a treatment foster care intervention study (n = 8) to gain their perspectives on the process of transitioning from residential care. Youths were interviewed right before they exited residential care and two months after placement in the new foster home. Youths reported hopes for gaining family in the new home as well as fears of placement disruption. Findings point to the need to enlist youths in discussion and problem solving about difficulties they anticipate in the new home and expectations for their relationship with the new foster parents. In addition, the struggles described after two months in the home point to the need for youths to build specific skills to better manage ongoing relationships with foster parents and for foster parent training on how to help build these skills.     

Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques

Suicide is the second leading cause of death among youth, and as many as one in five youth report having had at least one serious thought of suicide in the past year. Despite the enormous emotional pain and suffering associated with suicidal thoughts and behaviors, up to 40 % of suicidal youth never receive treatment. Given that social workers are employed in multiple settings where suicidal children and adolescents are encountered (e.g. schools, homeless shelters, emergency departments, outpatient mental health agencies, private practice), they play a critical role in the identification and treatment of suicidal youth. In the past decade, evidence has emerged that attachment-based family therapy, integrated cognitive behavioral therapy, and dialectical behavior therapy can reduce suicidal ideation and/or suicide attempt in youth. The purpose of this article is to review the theoretical assumptions, conceptual frameworks and key intervention techniques for these three interventions so that clinicians can integrate these approaches into their practice with suicidal youth and families. Implications for practice are integrated throughout the review.     

Social Work Practice and Education in México

Social work education and practice in Mexico has emphasized need for social change, family, and community involvement. Education includes casework, group work, and community organization with extensive field work experience that is community based. Education programs rely heavily on literature from South American countries including liberation theory such as that espoused by Paolo Friere. Social work education at the college level prepares graduates for practice, with a licencia. Social Workers in Mexico work in medical settings, children's services, rehabilitation, family services, work settings and a variety of community based programs. Mexico has begun to develop graduate education. Education in the US, Canada, Mexico and other countries could be enhanced with further exchanges of faculty, students and literature.     

The relationship of theory to clinical practice

This paper, based on the results of a national study of experienced clinical social workers, focuses on the nature of theoretical perspectives, practice models, and modes of clinical intervention. The majority of respondents identified ego psychology as being most instrumental to their approach with socio-cultural, cognitive/behavioral and family systems theories having an important secondary influence. Most identified with the psychosocial model of practice with problem-solving and family therapy being instrumental secondary models. Specific modes of clinical work were examined in relation to these theories and models.     

Good Country Living? Exploring Four Housing Outcomes Among Poor Appalachians

In the wake of welfare reform, many poor people have exhausted their benefits and must now live with less government support. While all of these former welfare recipients are struggling, some are experiencing housing problems that are quite severe. This article uses survey data on former welfare recipients who have used up the maximum time limits for receiving welfare to better understand three core explanations for rural housing problems among the poor: community, individual, and family factors. We estimate models to weigh the relative effects of these factors on the likelihood of experiencing several housing outcomes, finding that rural location is the most consistent predictor of housing outcomes, predicting home ownership, and whether families reside in low‐quality housing. We also find that individual and family factors affect the type of housing one has. We conclude that housing policies must be tailored to improve specific housing outcomes.     

Implementing Single Session Therapy

In recent decades, discussion about clinical practice has been dominated by a focus on evidence‐based treatments, whilst the translation of evidence‐based treatments into practice has been neglected or avoided. The single session therapy (SST) field reflects this general trend. As a result, the community has not benefited from available service improvements simply because they have not found their way into core practice or been translated across state‐wide services. This article draws on a range of implementation projects managed by The Bouverie Centre, in particular a successful state‐wide SST implementation project conducted in collaboration with Victorian community health counselling services, to raise implementation dilemmas and suggest practical ideas about the translation of SST ideas into mainstream clinical practice. It is hoped this discussion will be of interest to those wanting to translate any new idea into practice.     

Sense of community: Issues and considerations from a cross-cultural perspective

Behaviour settings such as work, family, church and community are primary settings in which we participate, they provide us with meaningful roles, relationships, and social identities. In fact, these are settings that provide us with a sense of community (SOC). SOC has been heralded as the guiding value for community research and action. It reflects the integration of people into networks and structures that provide feelings of belonging, identification and meaning. The concept has received much attention since the introduction of McMillan and Chavis' initial formulation. It is argued that research into SOC has been hampered by relying on the Sense of Community Index at the expense of the SOC model. Insights are drawn from cross-cultural psychology and research to highlight conceptual issues and to encourage exploration and the utilisation of alternative modes of investigation. Contex-tualist approaches including substantive theorising and narrative psychology, which have their roots in pragmatism, are promoted as frameworks for bringing community and SOC into focus as central to social and community development.     

Overcoming Barriers to Using Empirically Supported Therapies to Treat Childhood Anxiety Disorders in Social Work Practice

Anxiety disorders are among the most common psychiatric disorders in children and adolescents. Most empirically supported treatments (ESTs) for pediatric anxiety disorders include various cognitive-behavioral methods. Although demonstrated efficacious in controlled and clinic settings, there are barriers to implementing these types of therapies in social work settings due to beliefs about the usefulness of ESTs in community settings; limitations of treatment manuals; time constraints of implementing ESTs; fidelity and flexibility of implementing ESTs; and limited training opportunities. This article provides an overview of ESTs for childhood anxiety disorders, highlighting options for overcoming common barriers to implementing ESTs. Collaborative multi-method approaches to advance implementation of ESTs in social work practice are suggested.