Preparation for residential treatment: An anticipatory mourning process

This paper discusses the intense emotional bonding between parent and adolescent as it interferes with the adolescent and family's ability to tolerate the physical separation inherent in long-term residential treatment. It describes the mourning process through which both adolescent and parent experience and partially relinquish their attachment to one another in anticipation of the separation. The process is completed when both parent and child accept the need for placement and are ready to accept the possibility of new relationships in the residential treatment setting.     

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.     

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.     

BUCKLEY'S SCHEME OF SCHEMES AS A FOUNDATION FOR TEACHING FAMILY SYSTEMS THEORY

In recent training literature, a consistent recommendation emerges concerning the need for an emphasis on the development of a strong system theory base upon which future practitioners and researchers can build. This paper advocates the use of Buckley's hierarchical scheme as a teaching tool to provide an understandable, yet broadly applicable, theory base for graduate students in an introductory family therapy course. A method of teaching Buckley's scheme is outlined that not only incorporates the recommendations of the literature, but also provides an umbrella model of systems for future application and theory building.     

Adolescent crisis and suicidal behavior: Dynamics and treatment

Suicide among adolescents is increasing. Three interacting factors—the crisis of adolescent development, family dysfunctioning, and social factors—create vulnerability to feelings of rejection and worthlessness among suicidal adolescents. Long-term family problems that are not openly acknowledged but for which the adolescent feels responsible are particularly relevant. The authors recommend a multiple approach to assessment and treatment in which crisis intervention is employed initially; and individual treatment for the adolescent and family therapy are utilized concurrently on a long-term basis.     

FAMILY STRUCTURE, CLOSENESS TO RESIDENTIAL AND NONRESIDENTIAL PARENTS, AND PSYCHOLOGICAL DISTRESS IN EARLY AND MIDDLE ADOLESCENCE

American adolescents currently live in a variety of different family structures, with the vast majority of adolescents living in intact, blended, divorced, and never-married families. Previous research shows that family structure correlates both with the quality of parent–adolescent relationships and adolescent psychological distress. The quality of parent–adolescent relationships also correlates with adolescent distress. This research hypothesizes that the observed differences in adolescent distress across family structure might result from differences in the quality of parent–adolescent relationships across family structure. Analyses, using data on 1,443 youth in early and middle adolescence from the National Longitudinal Survey of Youth (NLSY), indicate that when the variations in both the quality of parent–adolescent relationships and background characteristics across family structure are controlled, the association between family structure and adolescent psychological distress is significantly reduced. Further analyses revealed that the quality of residential parent–adolescent relationships explained the most variation in adolescent psychological distress. The quality of relationships with nonresidential fathers only had a significant association with adolescent psychological distress for adolescents in blended families.     

The Continued Importance of Quality Parent–Adolescent Relationships During Late Adolescence

The quality of adolescents' relationships with residential parents has been found to predict many different health and behavioral youth outcomes; strong associations have also been found between these outcomes and family processes, and between relationship quality and family processes. Data from Rounds 1–5 of the National Longitudinal Survey of Youth, 1997 were used to examine hypotheses about the influence of the parent–adolescent relationship on subsequent adolescent mental well‐being and delinquency, as mediated by family processes. Using structural equation modeling, we found that the influence of a positive residential parent–adolescent relationship on better mental well‐being and fewer delinquency was entirely mediated by family routines, parental monitoring, and parental supportiveness, net of sociodemographic controls.     

Parent-adolescent relationship quality as a link in adolescent and maternal depression

Guided by family systems theory and the depression-distortion hypothesis, the purpose of this study was to test the extent to which mother-adolescent relationship quality linked the known associations between maternal depression and adolescent depression. Data from the Longitudinal Study of Child and Adolescent Well-being were used to test hypotheses with a sample of 267 mother-adolescent dyads. Findings demonstrated the longitudinal associations between perceptions of mother-adolescent relationship quality and adolescent and maternal depression. Specifically, maternal depression symptoms were negatively correlated with adolescent perceptions of the relationship at age 12 and 14, which were positively correlated with adolescent depression at age 14. Additionally, youth depression at age 8 was positively correlated with maternal depression at adolescent ages 12 and 14. A significant association was found between youth depression and adolescent perception of the parent-adolescent relationship quality, such that higher youth depression scores were moderately linked with lower adolescent report of quality of the relationship at age 12. Further, higher levels of youth depressive symptoms were associated with lower maternal perception of the parent-adolescent relationship quality at youth age 12. Implications for clinical intervention and research are discussed.     

Neighborhood structural inequality, collective efficacy, and sexual risk behavior among urban youth

We draw on collective efficacy theory to extend a contextual model of early adolescent sexual behavior. Specifically, we hypothesize that neighborhood structural disadvantage--as measured by levels of concentrated poverty, residential instability, and aspects of immigrant concentration--and diminished collective efficacy have consequences for the prevalence of early adolescent multiple sexual partnering. Findings from random effects multinomial logistic regression models of the number of sexual partners among a sample of youth, age 11 to 16, from the Project on Human Development in Chicago Neighborhoods (N = 768) reveal evidence of neighborhood effects on adolescent higher-risk sexual activity. Collective efficacy is negatively associated with having two or more sexual partners versus one (but not zero versus one) sexual partner. The effect of collective efficacy is dependent upon age: The regulatory effect of collective efficacy increases for older adolescents.     

“I Deserve a Family”: The Evolution of an Adolescent’s Behavior and Beliefs About Himself and Others When Treated with Theraplay in Residential Care

This article chronicles a seriously disturbed adopted adolescent’s experience in an attachment focused residential program at which the primary treatment was Theraplay^®. Adopted at age four following significant abuse and neglect, Tom lived in institutions for 5 years before participating in Chaddock’s Developmental Trauma and Attachment Program (DTAP). He now resides successfully in the home of therapeutic foster parents. Theraplay treatment directly meets attachment needs through adult-guided, highly positive, engaging and nurturing interactions to change the child’s working models of attachment and to develop affect regulation. Theraplay was especially useful with this adolescent who was born addicted and who had little ability to participate in insight oriented therapy. Topics include adolescence and attachment, Theraplay theory, process and applications, and the DTAP milieu and treatment program. This case study demonstrates that it is possible to improve the outcome for adolescent development by directly meeting the adolescent’s attachment needs through the Theraplay model.     

Parental involvement in children's residential treatment: From preplacement to aftercare

Policy reforms and empirical evidence supporting family focused care for children have increased parental involvement in children's residential treatment. Reasons for encouraging family involvement in children's out-of-home care and factors that inhibit parents from participating in children's residential care are outlined. Methods used by treatment facilities to encourage family participation in children's preplacement, treatment, and aftercare stages of placement are reviewed. Important questions nd research necessary to increase parental involvement in children's residential treatment are identified.     

Examining the impact of gender, race/ethnicity, and family factors on mental health issues in a sample of court-involved youth

Faced with anywhere between one half and two thirds of its youth having a diagnosable mental illness, the identification and treatment of mental health concerns is a critically important endeavor for professionals working with youth who have contact with the juvenile justice system. In addition, the literature suggests that factors related to both the family and to the gender of the adolescent must be incorporated into any approach to assessment and intervention within this special population. Further, prior work that has documented the interaction of gender and family issues with adolescent race/ethnicity warrants further empirical attention, as does the intermediary role that the family may play in the development of both internalizing and externalizing behaviors. The present study extends this literature by examining factors related to gender, race/ethnicity, family factors, and mental health issues in a sample of 2,549 Caucasian and African American youth coming to the attention of juvenile courts. Multivariate analysis of variance results indicated significant main effects for gender and race/ethnicity, as well as a significant gender x race/ethnicity interaction for the family and externalizing variables. A multiple group structural equation modeling procedure was employed in order to test the hypothesis that family environment mediates the relationship between gender and mental health problems, as well as to test for potential differences in these relationships as a function of race/ethnicity. Results indicated support for the mediation model in the sample of African American youth but not in the sample of Caucasian youth.     

Fathers and youths’ delinquent behavior

This paper analyzes the relationship between having one or more father figures and the likelihood that young people engage in delinquent behavior. We pay particular attention to distinguishing the roles of residential and non-residential, biological fathers as well as stepfathers. Using data from the National Longitudinal Study of Adolescent Health, we find that adolescent boys engage in more delinquent behavior if there is no father figure in their lives. However, adolescent girls’ behavior is largely independent of the presence (or absence) of their fathers. The strong effect of family structure is not explained by the lack of paternal involvement that generally comes with fathers’ absence, even though adolescents, especially boys, who spend time doing things with their fathers usually have better outcomes. There is also a link between adult delinquent behavior and adolescent family structure that cannot be explained by fathers’ involvement with their adolescent sons and is only partially explained by fathers’ involvement with their adolescent daughters. Finally, the strong link between adolescent family structure and delinquent behavior is not accounted for by the income differentials associated with fathers’ absence. Our results suggest that the presence of a father figure during adolescence is likely to have protective effects, particularly for males, in both adolescence and young adulthood.     

Predictors of substance use and family therapy outcome among physically and sexually abused runaway adolescents

There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual. Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting fiamily systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions.     

Family reunification efforts that work: A three year follow-up study of children in residential treatment

A three year follow-up study of children discharged from a residential treatment program was conducted to determine long-term family reunification rates. The primary interest was a comparison of families which had received different types of parent involvement programs during their child's placement. Results indicated that families which had received a combination of experiential and didactic involvement programs reunified at a significantly higher rate than did those receiving either program separately. Results are discussed with regard to the difficulties of achieving successful reunification for families with children in placement.     

Multidimensional Family Therapy: A Science‐Based Treatment System

MDFT is a family‐based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research‐derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother; father or caregiver; (3) the family environment and family relationships, as manifested in day‐to‐day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one‐size‐fits‐all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).     

The McMaster Model of Family Functioning

The model of family functioning being presented is the product of over twenty years of research in clinical work with family units. A method of family therapy has been developed based upon this model and will be described in a future issue. The model utilizes a general systems theory approach in an attempt to describe the structure, organization, and transactional patterns of the family unit. It allows examination of families along the total spectrum ranging from healthy to severely pathological in their functioning. It is based upon a Judaeo-Christian value set, and allows attention to be paid to cultural differences and other issues of cultural relativity .     

Family Involvement in the Residential Treatment of Children: A Systemic Perspective

When children are placed in residential treatment, a number of underlying messages are often conveyed: the child is the problem, the child's parents are the problem, and the treatment centre has the answers. Consequently children may feel rejected and parents may feel blamed. These views reflect lineal perspectives which have not been adequately addressed in the literature on residential treatment. The aim of residential treatment is to change the child's behaviour in ways which parents are unable to achieve at home. This paper proposes that the child who is placed in residential care may be caught between the parents and the treatment setting: if the child positively responds to treatment, parents could easily feel inadequate or incompetent, a dynamic which is obviously counter productive to successful treatment. The paper argues from Milan and other systemic views, that family and treatment systems be taken into consideration in planning treatment strategies.     

Adolescents' Perceptions of Family Belonging in Stepfamilies

Prior research has established that adolescents' perceptions of family belonging are associated with a range of well‐being indicators and that adolescents in stepfamilies report lower levels of family belonging than adolescents in two‐biological‐parent families. Yet, we know little regarding what factors are associated with adolescents' perceptions of family belonging in stepfamilies. Guided by family systems theory, the authors addressed this issue by using nationally representative data (Add Health) to examine the associations between family characteristics and adolescents' perceptions of family belonging in stepfather families (N = 2,085). Results from structural equation models revealed that both the perceived quality of the stepfather–adolescent relationship and in particular the perceived quality of the mother–adolescent relationship were the factors most strongly associated with feelings of family belonging.