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Background: Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically address both SUDs and IDs are less effective., Objective: This pilot treatment development study aims to develop and test a modular treatment protocol for addressing cooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurring adolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and family psychoeducation and safety planning., Methods: This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicit provider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6 cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverse adolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receive TAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapist and client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. For aim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and on adolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups., Results: Study recruitment will begin in April 2025., Conclusions: We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent's ID symptoms; functional analysis of the adolescent's ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent's ID symptoms and functional needs, featuring 3 core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients., Trial Registration: ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979., International Registered Report Identifier (irrid): PRR1-10.2196/64332., (©Aaron Hogue, Molly Bobek, Nicole P Porter, Alexandra MacLean, Craig E Henderson, Amanda Jensen-Doss, Gary M Diamond, Michael A Southam-Gerow, Jill Ehrenreich-May. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.09.2024.)

Avoidant/Restrictive Food Intake Disorder (ARFID) and food neophobia present significant challenges in pediatric healthcare, particularly among children with food allergies (FAs). These eating disorders, characterized by the persistent avoidance or restriction of food, can lead to severe nutritional deficiencies and psychosocial impairments. The presence of FAs further complicates these eating behaviors, as the fear of allergic reactions exacerbates avoidance and restrictive patterns. This comprehensive review synthesizes current knowledge on ARFID and food neophobia, focusing on their definitions, characteristics, and the unique challenges they present in the context of FAs. The review explores the critical role of healthcare professionals, especially nurses, in integrating psychological and clinical care to improve outcomes for affected children. A multidisciplinary approach, including Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT), is emphasized as essential in addressing the complex needs of these patients. The review also highlights the need for standardized treatment protocols and further research on the long-term outcomes of these disorders, aiming to enhance therapeutic strategies and family support systems. Effective management of ARFID and food neophobia in the context of FAs requires a holistic and integrated approach to mitigate the profound impacts on a child's growth, development, and overall well-being.

Introduction: Maternal stress and trauma during pregnancy have been shown to influence cortisol levels and epigenetic patterns, including DNA methylation, in the offspring. This study aimed to determine whether a tailor-made family intervention could help reduce cortisol levels in children born to traumatized mothers, and to determine whether it effected offspring DNA methylation. The secondary aim was to determine whether the family intervention influenced DNA methylation aging, a marker of biological aging., Methods: A needs-based family intervention was designed to help address relational difficulties and family functioning, and included a focus on family strengths and problem-solving patterns. Women survivors of sexual violence during the Kosovar war in 1998-1999, and their families (children with or without partners) were randomly assigned to 10 sessions of a family therapy over a 3-5-month period, or to a waitlist control group. Both mothers and children completed assessments prior to and after the intervention phase. Children's blood samples collected at these two time points were used to measure cortisol and epigenome-wide DNA methylation patterns (Illumina EPIC array). Cortisol levels, and genome-wide DNA methylation changes pre-/postintervention were compared between children in the intervention and the waitlist groups. DNA methylation age and accelerated biological aging were calculated., Results: Sixty-two women-child dyads completed the study, 30 were assigned first to the intervention group, and 32 to the waitlist control group. In adjusted linear regression, the family intervention was associated with a significant decline in cortisol levels compared to the waitlist control (β = -124.72, 95% confidence interval [CI]: -197.4 to -52.1, p = .001). Children in the intervention group, compared to the waitlist control group, showed >1% differential methylation degree at 5819 CpG (5'-C-phosphate-G-3') sites across the genome (p < .01), with the largest methylation difference being 21%. However, none of these differences reached genome-wide significant levels. There was no significant difference in DNA methylation aging between the two groups., Conclusion: We find evidence that a tailored family-based intervention reduced stress levels in the children (based on cortisol levels), and modified DNA methylation levels at a number of sites across the genome. This study provides some preliminary evidence to suggest the potential for tailored interventions to help break the intergenerational transmission of trauma, however, large studies powered to detect associations at genome-wide significant levels are needed., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background: In Germany 1.5-2.75 million children live in families affected by substance use disorders. Substance abuse can impact on family interactions in many ways. If a dependent parental drug use continues over a longer period of time, this can have pronounced psychological and social consequences for the (co)affected children. Nevertheless, family-focused treatment approaches are not yet widely used in the context of addiction treatment., Aim: This review article aims to provide an overview of the prevalence of parenthood among dependent drug users in Germany, the impact of dependent drug use on families and family-focused treatment approaches., Methods and Results: Recording parenthood is particularly difficult in the case of dependent drug users as they often do not openly discuss it with their therapists because of the fear of consequences from youth welfare services. In order to change this, a structured recording of parenthood by the treatment providers is required. This is the prerequisite for being able to offer family-focused treatment to those affected. In Germany, three evidence-based therapy programs are available for this purpose: SHIFT, SHIFT Plus and MAMADAM. Additionally, a number of programs developed in the Anglo-American region can also be used. In contrast, the evidence for web-based programs is much weaker., Discussion: In order to establish family-focused treatment approaches for drug-using parents across the board, long-term, secure funding is required. The necessary framework conditions must be created at a political level., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The aim of this pre-registered (NCT05051462), randomized controlled trial was to investigate the efficacy and safety of a pandemic-adjusted version of family/systemic constellation therapy in the general population. Altogether, 80 individuals were randomized (85% retained; 67.6% women, M age  = 41.9 ± 9.2 years) and followed up 1- and 6 months after participation in the single-day intervention. Numerous indicators of psychopathology and addiction as well as wellbeing were assessed. Members of the intervention group improved significantly in terms of the a priori primary outcome (overall psychopathology: d 1-month  = 0.41, p 1-month  = 0.003; d 6-month  = 0.31, p 6-month  = 0.028) as well as numerous secondary outcomes (obsession-compulsion, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and paranoid ideation). However, the magnitude of improvements was small and mostly disappeared by 6-months. Further, no significant treatment benefit emerged considering time x group interactions regarding any of the outcomes (although statistical power was low). Due to the significant, pandemic-related deviations from the protocol of the intervention, these results may not be generalizable to systemic constellation interventions in general; instead - considering the previous, more favorable data regarding efficacy/effectiveness and tolerability - they rather call attention to the importance of process-related factors regarding this intervention specifically as well as the potential disadvantages of pandemic-related treatment modifications of in-person (non-virtual) group interventions in general., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Family-centered substance use treatment (FCSUT) approaches for pregnant and postpartum people have the potential to prevent intergenerational transmission of adverse childhood experiences (ACEs). Guided by two theoretical frameworks drawn from implementation science (the Consolidated Framework for Implementation Research [CFIR] and the Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] framework), this study used a mixed methods approach to answer: (1) What is the extent to which FCSUT approaches are offered for pregnant and postpartum people seeking substance use disorder (SUD) treatment? and (2) How are FCSUT approaches for pregnant and postpartum people implemented?, Methods: This study utilized a sequential mixed methods design that began with quantitative data collection followed by qualitative data collection. The quantitative component consisted of service provision surveys of facilities that provided FCSUT to pregnant and postpartum people (n = 118). The qualitative component consisted of semi-structured in-depth interviews with administrators and providers working at FCSUT facilities (n = 26) and pregnant and postpartum people who were currently receiving or had previously received services in the last two years from FCSUT facilities (n = 27). The qualitative findings were used to deepen understanding of the quantitative findings., Results: Findings from the quantitative survey of treatment facilities' FCSUT provision revealed that while most facilities offered services related to substance use treatment, behavioral health, and parenting skills development or parent training, a smaller proportion offered services related to prenatal and postpartum health, sexual and reproductive health, and family-related services. Qualitative in-depth interviews with program administrators and providers and pregnant and postpartum people who had participated in FCSUT programs revealed major themes around expanding reach of facilities by maintaining participants' familial connections, resources for implementation and maintenance of FCSUT, the importance of program adaptation, and gaps in service delivery., Conclusions: Results indicated there is a wide range of FCSUT services offered at treatment facilities across the United States. Furthermore, while many pregnant and postpartum people expressed positive experiences with FCSUT, there are some areas that should be considered for future progress to be made., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose. Funding support for this project was provided by the National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention (CDC) through a contract to Fors Marsh Group, LLC, Contract Number 47QRAD21DU200, OMB Control Numbers 0920-1154 and 0990-0421. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To explore families' experiences of participating in a family intervention, targeting families living with the consequences of acquired brain injury (ABI) or spinal cord injury (SCI)., Materials and Methods: Individuals with ABI or SCI and their family members were recruited from a randomised controlled trial investigating the effectiveness of the manual-based family intervention, which consisted of eight weekly sessions. Semi-structured interviews were conducted with 16 families ( n  = 33). The data were analyzed through reflexive thematic analysis., Results: One central theme was developed " A sense of belonging together again ", describing the value of the reciprocal format of the family intervention, where individuals with ABI or SCI and their family members gained new insights into each other while building up their relationship. The central theme was supported by three additional themes: " Strengthened communication and emotional control" , "Acknowledging the changed life situation" and "Being seen as a whole person" ., Conclusions: The family intervention supported the families to strengthen family cohesion and to be capable to manage the changed life situation. The findings emphasize the importance of a family-centered approach in neurorehabilitation, and how healthcare professionals play a significant role in facilitating families to achieve a balanced level of family cohesion.

Background: The leading evidence-based treatment for anorexia nervosa (AN) in adolescents is Family-based Treatment (FBT). However, due to the intensive training requirements and lack of practitioners, it is often difficult for families to access FBT. Thus, innovations that improve access to care are needed. A pilot randomized study of a guided self-help version of Family-based Treatment (GSH-FBT) that utilized approximately 1/4 the amount of therapist time compared to FBT found that the approach was acceptable and appeared to achieve similar outcomes. The study protocol detailed in this manuscript compares the efficiency (clinician time) of GSH-FBT to Family-based Treatment via Videoconferencing (FBT-V) in a fully powered study in achieving clinical outcomes through a multi-site randomized clinical trial across the US and Ontario, Canada., Methods: This study will randomize the families of adolescents ages 12-18 (n = 200) who meet DSM-5 criteria for AN to receive either GSH-FBT or FBT-V. Participants will be randomized to 15 sixty-minute sessions of FBT-V or to 10 twenty-minute sessions of online GSH-FBT. Major assessments will be conducted by a masked assessor at baseline, within treatment, at the end of treatment (EOT), and 6 and 12 months after the end of treatment (EOT). The primary outcomes of this study are changes to body weight and eating disorder cognitions relative to clinician time used (relative efficiency of treatment modality)., Conclusions: The findings of this study may help increase access to care by providing a time efficient, affordable, more scalable intervention for adolescent AN compared to standard FBT., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients., Objective: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy., Methods: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment., Results: This study started in March 2022 and the recruitment is expected to close in August 2024., Conclusions: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity., Trial Registration: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922., International Registered Report Identifier (irrid): DERR1-10.2196/56315., (©Per Bore, Sara Nilsson, Mitchell Andersson, Kajsa Oehm, Joel Attvall, Anders Håkansson, Emma Claesdotter-Knutsson. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.08.2024.)

Current Approaches and Methods of Systemic Therapy and Counselling: KIKOSR Combines Techniques and Systems Therapy with children and teens could often be more effective and sustainable if the therapeutic process included not only the family environment, but also the more distant environment, such as teachers and pedagogues from school and leisure activities. It is important to take a look at the principles of hypnotherapeutic and systemic therapy approaches and perhaps even beyond. Whenever working according to guidelines or manuals no longer shows success, it can be extremely helpful to interrupt those patterns by making use of a combination of different therapeutic techniques, such as PEP®, impact and embodiment techniques, as well as resource and solution-oriented approaches. KIKOS® is an approach that promotes tolerance of ambiguity in all systems, regardless of the basic therapeutic orientation, by combining techniques and systems while taking into account the individuality of client and practitioner.

Purpose: Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder., Methods: Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235). Patient exposure to treatment varied given individualized length of treatment. Outcomes include eating disorder symptoms, depression, anxiety, suicidality, caregiver burden, and parental confidence in supervising treatment. Treatment outcomes for cisgender boys and TGE youth were compared with cisgender girls., Results: Patients included n = 975 cisgender girls, n = 152 cisgender boys, and n = 108 TGE youth. Anorexia nervosa was the most common diagnosis. Cisgender boys reported significantly lower eating disorder (b = -2.7 [-4.1, -1.3]), anxiety (b = -1.6 [-2.2, -0.9]), and depression (b = -1.7 [-2.4, -0.9]) symptoms at admission compared with cisgender girls. TGE patients had significantly higher anxiety (b = 1.08 [0.28, 1.91]) and depression (b = 1.72 [0.78, 2.65]) symptoms compared with cisgender girls. Cisgender boys started with significantly lower suicidal ideation (b = -1.28 [-2.19, -0.43]) and TGE patients with significantly higher suicidal ideation (b = 1.63 [0.76, 2.51]) than cisgender girls. All symptoms improved during treatment and improved at similar rates over time in treatment regardless of gender identity., Discussion: Early evidence from this study supports the use of family-based treatment for cisgender boys and TGE youth with eating disorders. Further research is needed on the long-term outcomes of this approach for youth of all genders., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Latinx youth who have experienced caregiver deportation show higher rates of posttraumatic stress disorder (PTSD) and internalizing symptoms compared to Latinx youth who have not. Thus, there is a need for culturally and linguistically appropriate therapeutic approaches to address psychiatric needs related to caregiver deportation. Positive Adaptations for Trauma and Healing (PATH) is a manualized 10-week group therapy for Latinx youth and their caregivers that integrates trauma-informed interventions with positive psychology and resilience interventions. The present study examined PATH for reducing trauma symptomatology for Latinx youth who endured at least three traumatic experiences in their caregiving system as well as differences for Latinx youth who experienced their caregiver's deportation., Method: Self-identified Latinx youth ( N = 31) and their Spanish-speaking caregivers were recruited from two urban hospitals. All youth experienced three or more traumatic events. Pre- to postintervention mean change was measured with t tests; mixed-effects analysis of variance assessed whether the program was feasible for youth who had experienced a caregiver deportation versus Latinx youth who did not., Results: Assessment with the Trauma Symptom Checklist and the UCLA PTSD Index for Youth showed statistically significant reductions on Anxiety, Depression, Anger, and PTSD subscales. Latinx youth who experienced a caregiver's deportation exhibited larger reductions in anger symptoms and PTSD symptoms., Conclusion: Study results suggest that the novel group therapy intervention was feasible and acceptable for Latinx youth and their caregivers. Despite a small sample size, the intervention proved feasible for Latinx youth who experienced caregiver deportation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

WHAT IS KNOWN ON THE SUBJECT?: Open Dialogue was developed in Finland in the 1980s by clinical psychologist, Jaakko Seikkula. It is a development of family therapy, recognises previous trauma and has proven to be very effective in situations of acute mental illness, and in particular psychosis. Trauma Informed Care is a practice based on the understanding of and responsiveness to the impact of trauma. When people have experienced trauma, they may have difficulties in their everyday life and experience negative physical health outcomes as well as the risk of developing mental ill health. Open Dialogue is aligned to mental health care which aims to be trauma-informed, person-centred and rights-based. Examples exist of the use of both approaches for service delivery with limited evaluation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, no formal evaluation has been made of the use of open dialogue as a Trauma Informed therapy approach to support individuals and their family networks. Although both approaches recognise the impact of trauma on individuals, no study has explored the effectiveness of this treatment combination for use by mental health nurses. This review is timely as it provides insights into contemporary services that are trauma informed and have used Open Dialogue to extend therapy work with individuals and their family/networks. This scoping review was able to determine whether recommendations for clinical practice and training in Open Dialogue with Trauma Informed Care approaches could be identified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review provided a broad overview on the current types of trauma-informed care services incorporating Open Dialogue approaches into their practice. The literature, though sparce, identifies that Trauma Informed Care recognises multiple origins for mental ill health. Open dialogue has an affinity with the common values of mental health nurses. As combined therapies, they are demonstrating usefulness in engaging families and people in their journey towards recovery. Rigid adherence to Open Dialogue focus and delivery as well as training practices could be revised to make them more open to what people and their families wish to discuss. The person with mental ill health and previous trauma should be able to direct the narrative. Trauma Informed Practice principles could be adapted to improve consumer satisfaction with Open Dialogue approaches., Abstract: INTRODUCTION: A large proportion of people who access mental health services have a lived experienced of trauma and are more likely to have a history of complex trauma. Open Dialogue and Trauma Informed Care practices identify previous trauma as a factor related to later psychosis. This scoping review has identified similarities and contrasts in how an Open Dialogue and Trauma Informed Care approach have been combined to complement one another for clinical work with people presenting with psychosis and previous trauma., Aim: We aimed to answer the following research question in this scoping review: What is known of the combined use of Open Dialogue and Trauma Informed Care practice when working with consumers and their family networks? As such, the purpose of this paper was to explore the application to practice and identify if any training existed and been evaluated., Method: This scoping review was based on the Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Grey literature was also searched through Psyche Info and Google Scholar for books, Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2013 to January 2023., Results: Five distinct themes were identified from the literature: (1) Linking open dialogue with trauma, (2) Response to treatment, (3) Empowerment and information sharing, (4) Interpretation by clinical services, (5) Staff training outcomes., Discussion: Some tentative recommendations for practice recognised the individuals' unique story and perspective, suggested that trauma is an important concept to assess. Services practising as Trauma Informed Services that have incorporated an Open Dialogue approach have mixed experiences. The use of Open Dialogue may have some benefits for family work and exploring consumer narratives while building a network of support. However, consumers identified similar frustrations with service delivery as with the family therapy literature. For example, it was difficult to bring family members together and difficult to discuss previous traumatic events in front of family. People experiencing training in Open Dialogue reported it taking a slow pace and not what they were familiar with., Implications for Practice: Open Dialogue can facilitate engagement of consumers and their family networks and greater recognition of the peer workforce to promote collaboration in therapy is needed. Future research should also focus on evaluating the effectiveness of such services and comparing their outcomes across regions., (© 2024 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Objective: Family-based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). A parent-only guided self-help version of FBT (GSH-FBT) demonstrated preliminary efficacy in pilot investigations. To address challenges in access to care, we adapted GSH-FBT into a parent-only multi-family group format (MF-GSH-FBT) delivered via videoconferencing., Method: This report details the feasibility and acceptability of a parent-only group-based multi-family GSH-FBT (MF-GSH-FBT) for adolescent AN delivered virtually. The MF-GSH-FBT intervention consisted of 12 weekly 60-min sessions facilitated by a clinician in addition to online FBT video content and recommended readings. Adolescents and parents completed assessments at baseline and post-treatment. Parents reported their child's weight each week., Results: A total of 13 adolescents (15.57 + 1.63 years; 92% female; 23% Hispanic) with AN and their parents enrolled and initiated treatment. Four consecutive cohorts of groups of 3-4 families were completed from April 2022 to April 2023. Across cohorts, parents attended 85% of sessions. Most parents rated the treatment sessions as helpful (79%; agree/strongly agree) and felt supported by the other group members (84%). All parents (100%) reported MF-GSH-FBT helped their child, and most (90%) reported their child had improved by end-of-treatment. On average, adolescents gained 3.53 kg (SD: 3.76) from pre- to post-treatment, with percent estimated mean body weight increasing 5% on average. Parental self-efficacy also increased from baseline to end-of-treatment., Discussion: MF-GSH-FBT for AN appears feasible and acceptable to parents participating in this pilot study. Challenges with recruitment and adolescent data collection remain questions for future investigation., Public Significance: This study describes initial pilot testing of a virtual guided self-help family-based treatment for adolescents with anorexia nervosa delivered in a multi-family group format. This treatment aims to enhance access to family-based treatment for anorexia nervosa whilst providing additional support to parents., (© 2024 Wiley Periodicals LLC.)

There is increasing evidence that therapy and intervention services delivered by telehealth are effective at reducing a variety of mental health symptoms. Limited studies have indicated online services can reduce intimate partner violence (IPV), but none have tested in-person compared to telehealth-delivered interventions for men who have used IPV. Clinical outcome data from 311 parents (192 fathers and 119 linked coparent mothers) engaged in the Fathers for Change (F4C) intervention following referral by child protective services for IPV were examined to determine if in-person delivery of the intervention differed in terms of client treatment engagement and retention or outcomes. Parents who enrolled during a 1-year period prior to the COVID pandemic received their F4C therapy in person, while those who enrolled during the pandemic received their intake and most of their sessions via telehealth delivery. Parents reported significantly greater symptoms of depression, anxiety, and stress prior to treatment if they enrolled prior to COVID than if they enrolled during the pandemic. There were few differences in completion rates or outcomes based on in-person compared to telehealth delivery. Fathers were slightly more likely to complete treatment and attended a significantly higher percentage of their sessions when it was delivered by telehealth during COVID. Fathers reported significantly lower stress scores posttreatment when they received COVID telehealth delivery compared to prior to COVID in-person delivery of F4C. These findings suggest that telehealth may be an appropriate and viable option for the delivery of IPV interventions for families., (© 2024 John Wiley & Sons Ltd.)

Background: Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential., Method: This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0-24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes., Main Findings: We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs., Preliminary Conclusions: Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024. Published by Elsevier Inc.)

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: The global burden of mental health difficulties among children underscores the importance of early prevention. This study aims to assess the efficacy, feasibility and acceptability of the Strong Families programme in enhancing child behaviour and family functioning in low-resource settings in Gilgit-Baltistan, Pakistan., Methods and Analysis: This is a two-arm, multisite feasibility randomised controlled trial with an embedded process evaluation in three districts of Gilgit-Baltistan, namely Gilgit, Hunza and Skardu. 90 families living in these challenged settings, comprising a female primary caregiver aged 18 or above, and at least one child aged 8-15 years, will participate. Participants will be randomly assigned to either receive the Strong Families programme or to the waitlist group. Strong Families is a 7-hour family skills group intervention programme attended by children and their primary caregivers over 3 weeks. The waitlist group will be offered the intervention after their outcome assessment. Three raters will conduct blind assessments at baseline, 2 and 6 weeks postintervention. The primary outcome measures include the feasibility of Strong Families, as determined by families' recruitment and attendance rates, and programme completeness (mean number of sessions attended, attrition rates). The secondary outcomes include assessment of child behaviour, parenting practices, parental adjustment and child resilience. Purposefully selected participants, including up to five caregivers from each site, researchers and facilitators delivering the intervention, will be interviewed. Descriptive statistics will be used to analyse primary and secondary outcomes. The process evaluation will be conducted in terms of programme context, reach, fidelity, dose delivered and received, implementation, and recruitment., Ethics and Dissemination: This study has been approved by the UNODC Drug Prevention and Health Branch in the Headquarters office of Vienna and the National Bioethics Committee of Pakistan. Findings will be disseminated through publication in reputable journals, newsletters and presentations at conferences., Trial Registration Number: NCT05933850., Competing Interests: Competing interests: IBC, NC and NH have disclosed engagements encompassing presentations and consultancy roles with Eli Lilly, Bristol Myers Squibb, Lundbeck, AstraZeneca and Janssen Pharmaceuticals. These interactions led to reimbursements for them or their respective employing institutions. NH and IBC have held positions as trustees at the PILL in the past. NH has also held roles as a trustee for organisations including Manchester Global Foundation, Lancashire Mind and Abaseen Foundation, UK. Additionally, NH is an NIHR senior investigator and serves as the Director of Research and Innovation at Mersey Care NHS Foundation Trust. Importantly, none of the aforementioned companies maintains any financial stake in this research., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Women who have experienced conflict-related sexual violence report significant long-term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict-related sexual violence in 1998-1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty-four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow-up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child-rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict-related sexual violence. Future research should evaluate the long-term effects of family therapy to assess if immediate effects were maintained., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms., (© 2024 American Association for Marriage and Family Therapy.)

Background: Systemic family interventions for adolescents with problems of substance use and/or delinquency are increasingly focused subject of economic evaluations. Treatment effects go beyond improvements in commonly measured health-related quality of life (HRQOL). The Teen-Addiction Severity Index (T-ASI) was identified as capable of capturing these broad outcomes. However, it lacks preference-based scores. An abbreviated self-completion version (ASC T-ASI) was created and validated, covering the T-ASI domains substance use, school, work, family, social relationships, justice, and mental health. This study aimed to obtain societal preference scores for the ASC T-ASI., Methods: Preferences were elicited in a sample of the Dutch general adult population (n = 1500), using a web-based Discrete Choice Experiment. Choice tasks included two unlabeled alternatives with attributes and levels corresponding to the domains and levels of the ASC T-ASI. A pilot study (n = 106) informed priors, optimal presentation, and number of choice tasks applied in the main study. Data were analyzed using a mixed multinomial logit model., Results: Preference scores were logically ordered, with lower scores for worse ASC T-ASI states. Scores were most influenced by reductions in problems concerning the domains substance use, mental health, justice, and family. Tariffs were calculated for each ASC T-ASI state, ranging from 0 (worst situation) to 1 (best situation)., Conclusions: The tariffs enable preference-based assessments of the broad effects of systemic family interventions for adolescents with problems of substance use and/or delinquency. The outcome reflects addiction-related rather than health-related utility and can be used next to generic HRQOL instruments in relevant economic evaluations. Given the source used for the preferences, interpretations and valuation of scores require attention., (© 2023. The Author(s).)

Background: To evaluate the effects of different interventions on adolescent internet addiction, a meta-analysis and network meta-analysis were performed to determine the possible intervention effects of these interventions., Methods: Computer searches of the China National Knowledge Network, Wanfang, VIP, EMBASE, PubMed, Web of Science, EBSCO, and Cochrane Library databases were performed. The relevant randomized controlled trials were designed to assess the effects of interventions on adolescent internet addiction. The retrieval period ranged from the establishment of the database to January 31, 2024. Literature screening, data extraction, and bias risk assessment were carried out independently by two researchers. CMA 3.3, Stata 17.0 software and Review Manager 5.3 were used for the data analysis., Results: A total of 89 studies with 6876 samples were included. A traditional meta-analysis of 51 single interventions and controlled studies revealed that sports intervention, cognitive behavior therapy, family therapy, mindfulness intervention, attention bias training and group counseling significantly improved adolescent Internet addiction [standardized mean difference (SMD) = -1.75, 95 % CI (-2.07, -1.44), p < 0.01; I 2  = 94 %] compared to no-treatment groups. A network meta-analysis showed that combined intervention (Sucra = 93.5) had the highest probability of being the best intervention for adolescent Internet addiction, and acupuncture interventions showed the most promise as a single intervention modality; however, due to the limited number of studies, we believe that sports intervention could be the most appropriate single intervention., Discussion: The evidence provided by existing studies shows that compared with other single interventions, combined interventions have the greatest effect on adolescent IA, and sports may be the best single intervention. However, because of the limitations of sample size and quality of individual studies, the strength of the evidence still needs to be further verified by additional standardized and high-quality studies., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This meta-analysis evaluated the effectiveness of Parent-Child Interaction Therapy (PCIT) for maltreated families and examined potential moderators associated with the intervention. Seven English electronic databases (PubMed, PsycINFO, Web of Science, MEDLINE, Scopus, Cochrane Library, and ProQuest Dissertations and Theses Global) were systematically searched to identify randomized controlled trials (RCTs) published before January 20, 2023. Eleven studies involving 1,069 maltreated or high-risk families were included in the meta-analysis. Our results showed that PCIT significantly reduced child externalizing behaviors, improved parenting skills, and decreased parenting stress and child abuse potential in maltreated families. Additionally, families with confirmed maltreatment history reported larger effect sizes across all outcomes than those at high risk of maltreatment; parenting skills outcomes were more effective in adapted PCIT versions, using per-protocol analysis, and American caregivers, whereas none of the outcomes were related to the number of sessions. These findings provide encouraging evidence for the use of PCIT as an intervention for families with a history of maltreatment, although more high-quality RCTs are required to confirm its effects., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents. We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). Primary outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. CLINICAL TRIALS: # NCT03674944., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Miller receives royalties from Dialectical Behavior Therapy books and Dialectical Behavior Therapy Psychwire training videos. No other competing interests are declared by the other authors., (Copyright © 2024. Published by Elsevier Inc.)

Family Based Mental Health Services (FBMHS) with an embedded clinical model, Ecosystemic Structural Family Therapy, is an intervention designed for youth with a serious emotional disturbance (SED) who are at risk of out-of-home placement. The current evaluation examines the association between receipt of FBMHS and rates of out-of-home and community-based care during and after an episode of FBMHS. We identified 25,016 Medicaid-enrolled youth ages 3 to 17 years with receipt of a new FBMHS episode from 1/1/2015 to 6/30/2021. 14% of youth received out-of-home services. Rates of out-of-home service decreased during receipt of FBMHS (14.25-6.98%, p < .0001) and remained lower 6 months following discharge (to 6.95%, p < .0001). Short and longer doses of service were both associated with decreased rates of out-of-home services. FBMHS has been scaled across a large geographic area and is associated with lower rates of out-of-home placement for youth with SED., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The prevalence of hazardous substance use is highest in the age between 18 and 25, but few young adults enter treatment. Community Reinforcement and Family Training (CRAFT) is a support program for concerned significant others (CSOs) of individuals with diverse substance use disorders and is proven efficacious in promoting treatment entry. The aim of the current study was to investigate the experiences of CRAFT among parents of substance using young adults., Methods: We used a qualitative design conducting semi-structured interviews with 10 parents of young adults (18-24 years) with hazardous substance use. The participants were recruited from a randomized controlled trial of the CRAFT program. The transcribed interviews were analyzed using thematic analysis., Results: We divided the results into three overall domains-Reasons for entering the CRAFT program, Strengths of the CRAFT program and Limitations of the CRAFT program - with three to four themes under each domain. The parents appreciated the accessible support at a time when they needed it due to feelings of shock and powerlessness, and they described communication strategies together with positive reinforcement as the two most helpful CRAFT-sessions. Regarding limitations of CRAFT in the current population, the parents wanted more accessible support for the young adults when they were ready to enter treatment, and described difficulties to practice CRAFT-components due to changing life-circumstances and fear of aggravated health for their young adults., Conclusion: The results provide arguments for the health care system to implement support programs to parents of young adults with hazardous substance use. The results show that CRAFT is suitable for the current population, but with some possible additions due to changing circumstances that are common in the young adult developmental phase emerging adulthood., Trial Registration: The trial was pre-registered at isrctn.com, reference number ISRCTN12212515 date: November 7, 2018., (© 2024. The Author(s).)

Objective: Anorexia nervosa (AN) is a serious psychiatric disorder with high morbidity and mortality. The current evidence supports the use of family-based treatment (FBT), but recovery rates are only about 40%. Improving treatment outcomes among adolescents with AN will save lives, improve health, and prevent chronicity. This study examined the relative efficacy of adding intensive parental coaching (IPC) to standard FBT for patients who do not respond by weight gain of 2.4 kg by session 4, a clinical predictor of outcome at the end of treatment, to improve remission rates (>94% of expected mean body mass index)., Method: The study recruited 107 participants and their families from across the United States; 69 participants failed to respond early and were randomly assigned to continue with standard FBT or to receive 3 sessions of IPC. Participants were adolescents (ages 12-18) meeting DSM-5 criteria for AN; 6.5% were male, and 11% were Hispanic., Results: Main outcomes were mean body mass index >94% expected for age, height, and sex. Secondary outcomes included change in eating-related cognitions. Adding IPC to early nonresponders did not improve outcomes except for participants whose parents demonstrated low parental self-efficacy at baseline (moderator). Early weight gain of 2.4 kg by session 4 was replicated as a predictor of end of treatment remission., Conclusion: Parental self-efficacy moderates IPC as an adaptive treatment for adolescents with AN. Baseline parental self-efficacy assessment can be used to identify families most likely to benefit from adding IPC to FBT. Future studies should consider earlier interventions to improve early response rates., Plain Language Summary: Anorexia nervosa is a serious psychiatric disorder. While family-based treatment (FBT) has the largest evidence base for adolescents with anorexia, recovery rates are only about 40%. This study investigated the addition of 3 sessions of intensive parental coaching intervention (IPC) to FBT among youth with anorexia who did not gain adequate weight early in treatment, a predictor of recovery by the end of treatment. Youth with inadequate weight gain were randomized to either receive FBT with IPC or FBT as usual. Overall, adding IPC did not improve outcomes among youth with anorexia. However among those whose parents demonstrated low parental self-efficacy at baseline, youth who received FBT with IPC had higher remission rates than youth who received FBT alone., Clinical Guidance: Intensive parental coaching shows promise for improving outcomes among youth with anorexia whose parents report low parental self-efficacy., Clinical Trial Registration Information: Adaptive Treatment for Adolescent Anorexia Nervosa; https://clinicaltrials.gov/; NCT03097874., (Copyright © 2023 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Family Mediated Intervention (FMI) and Early Intensive Behavioural Intervention (EIBI) are found to be standard of care for children with Autism Spectrum Disorder (ASD). Comparison of their efficacy were assessed using ISAA as primary outcome measure., Methods: This study was a parallel arm, open label, randomized active- controlled non-inferiority clinical trial. 50 Children diagnosed with ASD were randomized into FMI and EIBI groups. Clinical status was checked by using Indian scale for assessment of autism (ISAA), Oro- motor and sensory profile at baseline, after three and six months., Results: Difference between change in mean ISAA score between FMI and EIBI group at the end of 6 months as per protocol (PP) analysis was -7.23 (CI=-18.41, 3.94), which was within pre-defined clinically relevant non-inferiority (NI) margin of - 24. FMI was found to be non-inferior to EIBI at the end of 6 months as the lower bound of 95% CI (-18.41) for ISAA score was higher than NI margin. ISAA scores were found to be statistically lower in both FMI and EIBI groups at the end point compared to baseline which indicated improvement in symptom severity., Conclusion: FMI was non-inferior to EIBI as therapy for children with ASD at the end of six months. Finding also indicated longer duration of treatment is required for FMI to be superior. FMI can be recommended for children with ASD in view of improved ISAA scores reported in our study., Clinical Trial Registration Number: CTRI/2020/08/027099 (Registered with Clinical Trials Registry- India)., Competing Interests: Declaration of Competing Interest All the authors have contributed substantially and there is no conflict of interest in reporting this study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Previous studies have suggested the negative impacts of attention deficit hyperactivity disorder (ADHD) on parent-adolescent interactions. Yet engaging parents, particularly the fathers, to participate in family-based interventions has been challenging in Chinese contexts given the traditional concerns about keeping the family's "face" and the influence of affiliate stigma. Empirical evidence supports multifamily therapy as an effective modality for parental engagement. This study explores the role of mutual support in promoting parental engagement and family communication quality of Chinese families of adolescents with ADHD. Inclusion criteria of the study were (a) Chinese family of at least one adolescent child having an ADHD diagnosis, (b) the adolescent child was aged between 11 and 15 years, and (c) the family participated in a multifamily therapy program. Families who had not completed a multifamily therapy program were excluded. Fourteen Chinese families of adolescents with ADHD who participated in a pilot multifamily therapy program from June 2017 to September 2018 were recruited for this qualitative study. Photo-elicited parent focus groups and photo-elicited individual interviews with adolescents were conducted. The thematic analysis revealed that a low level of hierarchy in the therapist-client relationship contributed to the building of mutual support among the families in the therapy process. The mutual support was found to play a key role in promoting acceptance, father involvement, and open communication within families of adolescents with ADHD. Discussion was conducted on the importance of the nonexpert stance of the therapist for promoting mutual support among Chinese families in a multifamily therapy process., (© 2023 The Authors. Family Process published by Wiley Periodicals LLC on behalf of Family Process Institute.)

Anti-Black racism including structural racism and racism-related disparities have come to the foreground in recent years with the increasingly frequent and brutal police killings of innocent African Americans, the disproportionate impacts of the pandemic on the Black community, and the effectiveness of the Black Lives Matter movement. There have been calls to action to ensure cultural effectiveness of couples and family therapy for African Americans. As one response to these calls, this article provides recommendations for culturally humble and anti-racist couple and family interventions. These best practices focus on the necessity of embracing a systemic stance and a strengths-based culturally responsive lens when assessing and intervening with African American couples and families. They focus on the need for therapists to be intentional about and consistent in engaging in self-exploration and taking the necessary steps to be not just competent but also capable. The final set of best practices detailed relate to assessing and intervening using a strengths-based approach in a culturally responsive, anti-racist, and socially attuned fashion. The article concludes with recommendations for couple/family therapists to develop a critical consciousness, engage in anti-racist practices, and address oppression while advancing healing and liberation, all of which are essential to ensuring the resilience and well-being of African American couples and families., (© 2023 Family Process Institute.)

This study explores the experience of promoting inclusion and anti-racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance-based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self-reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti-racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health-related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti-racism work in family science and family mental health-related fields. It is essential to promote inclusion and anti-racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health-related professionals are taking in the relationship to inclusion and anti-racism work., (© 2024 Family Process Institute.)

Disruptive behavior during adolescence is linked to severe problems for the youths later in life and poses challenges to the families, schools, and treatment systems these youths meet. This randomized controlled trial was conducted to examine the short- and long-term effectiveness of functional family therapy (FFT) for adolescents aged 11-17 referred for disruptive behavior to Child Welfare Services in Norway. One hundred sixty-one youths ( M age = 14.7, 45.9% female) were randomly assigned to FFT ( n = 88) or treatment as usual (TAU, n = 73). Primary outcomes were parent- and teacher-reported youth aggressive behavior, rule-breaking behavior, internalizing problems, and social skills; youth self-reported delinquency (SRD) and negative peer involvement; and teacher-reported academic performance and adaptive functioning. Outcomes were collected before treatment (pretest), 6 months after pretest (posttest), and 18 months after pretest (follow-up). The results showed no intervention effect for FFT compared to TAU between pretest and posttest ( p > .05). Significant improvements between pretest and posttest were found for youth receiving both FFT and TAU on parent-reported aggressive and rule-breaking behavior, internalizing problems, and social skills (ranging from d = 0.56 to -0.45) and youth SRD ( d = 0.29). Between posttest and follow-up, however, a significant intervention effect in favor of TAU was found for parent-reported youth internalizing ( d = 0.27). Significant improvements between posttest and follow-up were also found for youth receiving both FFT and TAU on parent- and teacher-reported aggressive behavior. Findings did not support the hypothesized superiority of FFT over TAU. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes , limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT)., Method: Children ages 3-5 years, and their caregiver(s) ( N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress)., Results: iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT., Conclusions: This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relational savoring (RS) is a brief, strengths-based approach to heightening attentional focus to moments of positive connectedness within relationships. RS can be administered preventatively or within an intervention context when a therapist aspires to foster more optimal relational functioning. Typically administered within a one-on-one therapy setting, RS has demonstrated efficacy in enhancing intra- and interpersonal outcomes. To increase access to mental health services, the developers of RS are committed to engaging in an iterative approach of enhancing the cultural congruence and accessibility of this intervention within various cultural contexts, beginning with Latine groups in Southern California. In this article, we describe relational savoring and its theoretical and empirical support, including the process of culturally adapting the intervention within the context of three major studies, each with a distinct focus on Latine groups, a community that is underserved in mental health care settings. We then provide a vision for future research to improve upon the intervention's compatibility for Latine families and other populations., (© 2024 The Authors. Family Process published by Wiley Periodicals LLC on behalf of Family Process Institute.)

The twenty-first century has seen the development and delivery of online programs of behavioral family intervention for disruptive child behavior. Typically, programs evaluate outcomes in terms of change in child functioning and change in parenting ability. Existing research has also articulated the importance of parent-child relational capacity and its role in facilitating change in child functioning, and the importance of parent emotion regulation in the interests of ensuring optimal child development. These factors were explored in a meta-analysis of k = 14 prospective longitudinal research studies of online parenting interventions for disruptive child behavior. Peer reviewed randomized controlled trials with inactive control groups that were published in English between 2000 and 2022 were included in the review if they were delivered online; offered parent self-directed treatment; included as participants families who were screened as having child behavioral difficulties on validated psychometric assessment measures; and assessed child treatment outcomes, parenting ability and parent treatment outcomes. The protocol for this study was pre-registered with PROSPERO (CRD42020215947). Statistical analyses employed random effects models and reported pooled effect sizes (Hedge's g) within and between groups. Results emphasize the importance of child outcomes and parenting ability in program assessment, however, suggest that parents' capacity to develop optimal parent-child relationships and regulate emotion may not be sufficiently reflected in program content. Identified continuous and categorical moderators of treatment outcome were also assessed. Results of the review are discussed in terms of their potential to influence the future development of online programs of behavioral family intervention and, therefore, child development., (© 2024. The Author(s).)

Positive Family Connections is a coproduced, positively oriented, family-systems program for families of children with a developmental disability aged 8-13 years. The study was a feasibility cluster randomized-controlled trial which was registered prospectively (International Standard Randomised Controlled Trial Number 14809884). Families (clusters) were randomized 1:1 to take part in Positive Family Connections immediately or to a waitlist condition and were followed up 4 months and 9 months after randomization. Feasibility outcomes included participant and facilitator recruitment rates, retention, intervention adherence, and fidelity. The proposed primary outcome measure was the family APGAR, a measure of family functioning. Quantitative data were analyzed using multilevel modeling. Sixty families (60 primary parental carers and 13 second carers) were randomized. 73.33% of primary parental carers and 71.43% of second carers in the intervention group attended ≥ 4 intervention sessions, and fidelity of delivery was high ( M = 94.02% intervention components delivered). Retention for the proposed primary outcome was 97.26% at 4-month follow-up and 98.63% at 9-month follow-up. Intervention condition was not associated with family APGAR scores at 9-month follow-up (estimate = 0.06, 95% CI [-0.49, 0.61], p = .86, Hedges' g = 0.03, 95% CI [-0.43, 0.49]). However, meaningful improvements were observed for other secondary outcomes related to parental well-being and family relationships. A definitive randomized-controlled trial of Positive Family Connections is feasible. Preliminary evaluation of outcomes shows that Positive Family Connections may be beneficial for parental psychological well-being and family relationships. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The COVID-19 pandemic and widely depicted incidents of racial injustice in the United States caused marked stress and shifts in society in 2020, leading to an acceleration of discussions related to promoting diversity, equity, inclusion, and justice (DEIJ) in family-oriented mental health professions, including through training. Despite the consequential role leaders of academic programs play in overseeing didactic and clinical training, little research has examined approaches for supporting academic leaders in promoting DEIJ in family science-related academic training programs. In this collaborative autoethnography, we, six participants in a diversity and anti-racism peer consultation group for leaders of couple/marriage and family therapy (C/MFT) programs, present our experiences participating in the group over the past two years. At the start of the group, many of us were experiencing profound isolation and stress due to intensified responsibilities subsequent to the COVID-19 pandemic and broadcast depictions of racial injustice. We experienced the group as a safe, inclusive space to grow personally and professionally, which subsequently inspired us to make changes in our programs. We also recognized the need for greater infrastructure to support program directors in developing DEIJ leadership skills. Future directions for research include examining experiences and outcomes of director-initiated DEIJ change, as well examination of DEIJ-focused peer consultation groups among family systems-oriented academic leaders of diverse disciplines and nations., (© 2023 Family Process Institute.)

Purpose of Review: This review aims to report on recent evidence for multi-family therapy for eating disorders (MFT) across the lifespan. It is a narrative update of recent systematic, scoping and meta-analytic reviews., Recent Findings: There has been a recent increase in published theoretical, quantitative and qualitative reports on MFT in the past few years. Recent and emerging data continues to confirm MFT can support eating disorder symptom improvement and weight gain, for those who may need to, for people across the lifespan. It has also been associated with improved comorbid psychiatric symptoms, self-esteem and quality of life. Data are also emerging regarding possible predictors, moderators and mediators of MFT outcomes, as well as qualitative data on perceived change processes. These data suggest families with fewer positive caregiving experiences at the start of treatment may particularly benefit from the MFT context. Additionally, early change in family functioning within MFT may lead to improved outcomes at end of treatment. MFT is a useful adjunctive treatment across the lifespan for people with eating disorders. It helps to promote change in eating disorder and related difficulties. It has also been shown to support and promote broader family and caregiver functioning., (© 2024. The Author(s).)

Objective: This study explored the impact of a family intervention on the relapse rate of Chinese patients with alcohol dependence., Methods: A total of 151 male patients with alcohol dependence who were discharged from the Substance Dependence Department of the Wenzhou Seventh People's Hospital from January to December 2020 were selected. They were divided into the control ( n  = 73) and experimental ( n  = 78) groups. Patients in both groups received routine alcohol cessation treatment. Moreover, patients in the experimental group were followed up by a professional psychiatrist to carry out individual family intervention. The Family Function Rating Scale (FAD), a Self-made general information questionnaire, and the Chinese version of the Family Intimacy and Adaptability Scale (FACESI-CV) were performed. Re-drinking rate and readmission rate were assessed., Results: Family intervention could reduce relapse rate (31, 39.74%) and rehospitalization (27, 34.62%) compared with the control group. After family training, FAD factor scores were improved in the experiment group in comparison with the control group. Family training improved communication (18.2 ± 3.7), role (20.8 ± 2.5), emotional response (10.8 ± 1.8), emotional involvement (13.7 ± 1.2), behavioral control (19.8 ± 1.2), and overall functionality (23.5 ± 2.1) in the experiment group in comparison with the control group. After family training, intimacy (70.5 ± 8.7) and adaptability (64.1 ± 6.9) in the experiment group was higher than in the control group. After family intervention, Michigan Alcohol Dependence Scale (MAST) (9.21 ± 0.68) and Short-Form 36 (SF-36) (80.32 ± 4.47) in the experiment group were higher than the control group., Conclusion: Family intervention for families of patients with alcohol dependence can improve their family function, increase their family intimacy and adaptability, and reduce the rate of relapse., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Tang, Chen, Xia, Wang and Zhang.)

This pilot feasibility study examined the effects of a new trauma-informed parenting program, Family Life Skills Triple P (FLSTP), in an open uncontrolled trial conducted in a regular service delivery context via video conferencing. FLSTP was trialed as a group-delivered 10-session intervention. Program modules target positive parenting skills (4 sessions) and adult life skills including coping with emotions, taking care of relationships, self-care, dealing with the past, healthy living, and planning for the future. Participants were 50 parents with multiple vulnerabilities, due to social disadvantage or adverse childhood experiences, who had children aged 3-9 with early onset behavior problems. Outcomes were assessed across four data collection points: baseline, mid-intervention (after Session 4), post-intervention, and 3-month follow up. Findings show moderate to large intra-group effect sizes for changes in child behavior problems, parenting practices and risk of child maltreatment, and medium effect sizes for parental distress, emotion regulation and self-compassion. Parents and practitioners reported high levels of consumer satisfaction with the program. Parents with lower levels of parental self-efficacy, lower personal agency and higher baseline scores on a measure of child abuse potential were at greater risk of not completing the program. The strength of these preliminary findings indicates that a more rigorous evaluation using a randomized clinical trial is warranted., (Copyright © 2023 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Empirical evidence is unequivocal in illustrating that the majority of patients with eating disorders will not fully recover during treatment. To that end, the need for optimized treatment approaches and improved patient outcomes cannot be overstated. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Preventi on during 2023. Importantly, this review encapsulates research addressing (i) between-session patient behaviors, (ii) the integration of technology into treatment approaches, (iii) methods to augment emotional regulation in the context of eating disorder treatment, (iv) methods to measure progress, and potentially risk markers for patient dropout, during treatment, (v) optimizing treatment approaches for inpatient settings, and (vi) augmenting family therapy-based approaches. Incorporating novel technological advances may be critical in enhancing the scalability of eating disorder treatments, since treatment uptake remains an ongoing challenge for the field. Moreover, expanding the scope of non-outpatient eating disorder treatment settings, while ensuring fidelity to theoretical models developed in outpatient settings, is critical as treatment is effectively administer across the spectrum of levels of patient care.

Objective: The aim of this study is to identify the main processes and outcomes related to family-centred care (FCC) in neuromotor and functional rehabilitation of preschool children with cerebral palsy (CP)., Background: FCC is considered a reference for best practices in child rehabilitation. CP is the most common cause of physical disability in childhood with repercussions on functionality. There is a gap in knowledge of the practical principles of FCC, and it is necessary to develop a reference model for the practice of child rehabilitation professionals., Methods: In this scoping review, the main databases selected were as follows: LILACS; Pubmed; Embase; The Cochrane Library; CINAHL (EBSCO); Scopus; Web of Science; PEDro (Physiotherapy Evidence Database); Open Gray and other banks of thesis. The terms combined in the search strategy were as follows: 'Family-centered', 'Family-centred' and 'CP'. Inclusion criteria are as follows: studies on preschool-aged children with CP, undergoing family-centred functional therapeutic interventions (FCFTI) with outcomes on bodily structures and functions and/or activities and/or participation., Results: The main participatory care methods identified were home intervention, environmental enrichment, collaborative realistic goal setting, planning of home-based activities and routine, child assessment feedback, family education/training, family coaching, encouraging discussion, observation of therapist and supervised practice. The main relational care qualities identified were as follows: respect, active listening, treat parents as equals, clear language, respect parents' ability to collaborate, demonstrate genuine care for the family, appreciate parents' knowledge and skills, demonstrate competence, experience and commitment. The main outcomes identified in children were improvement in motor and cognitive function and the child's functional ability. The main parentaloutcomes identified were empowerment, feeling of competence, self-confidence, motivation and engagement., Conclusion: The main differences in FCFTI programs refer to the parental education/guidance component and the amount of intervention carried out by parents. It is possible that the elements chosen by the therapist in a FCFTI depend on characteristics of the child and caregivers., (© 2024 John Wiley & Sons Ltd.)

Objective: The therapeutic alliance is broadly linked with positive outcomes. However, nearly all research in this area involves in-person therapy, whereas teletherapy has grown increasing common since the COVID-19 pandemic. There is now a pressing need to establish whether the nature and importance of the therapeutic alliance is impacted by teletherapy. This study examined therapeutic alliance in families of youth with anorexia nervosa who were participating in a randomized controlled trial that transitioned from in-person to telehealth visits during the COVID-19 pandemic., Method: We analysed data from 53 adolescents and their parents (20 began in-person, 33 began with telehealth). Both parents, youth and therapist completed the Working Alliance Inventory-Short Revised after 4 weeks of treatment., Results: We found no significant differences across telehealth and in-person treatment for paternal or therapist reported data. However, both adolescents and mothers reported higher bond and goal-related alliance for in-person sessions compared to telehealth., Conclusions: Findings regarding alliance across telehealth and in-person sessions were mixed, with some preference among mothers and youth for in-person treatment. Future studies should determine whether possible adaptations can improve working alliance during family-based treatment for anorexia nervosa via telehealth., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Background: Residential treatment is among the most intensive and expensive settings for children with behavioral health challenges; yet, the extent to which evidence-based practices are used in these settings is unknown., Aim: The purpose of this study was to describe the extent which family therapy, case management, telehealth, peer support, and family psychoeducation are provided in residential treatment using data from the National Mental Health Services Survey (N-MHSS). Organizational factors-region, ownership, payment, licensing/accreditation, and facility size-were examined in relation to evidence-based practices to understand disparities in care., Methods: This was a secondary analysis of publicly available data from the 2018 N-MHSS. A subpopulation was created consisting of residential facilities that served children ( N = 576). Descriptive statistics were used to describe the sample, and Cohen's h was calculated to determine patterns of evidence-based practice utilization., Results: Evidence-based practices from most to least prevalent were family therapy (76%), family psychoeducation (74%), case management (71.1%), telehealth (17.2%), and peer support (8.7%). The provision of evidence-based practices was not evenly distributed. There were primarily small to moderate differences by organizational factors, including region (i.e., Northeast, Midwest), ownership status (i.e., for-profit), payment type (i.e., self-pay, private insurance), licensing/accreditation (Department of Family and Children Services), and facility capacity (>251 clients served per year)., Conclusion: Findings demonstrate a need for research-practice partnerships to determine the barriers that prevent effective evidence-based practices from being implemented in the residential treatment setting., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Adopted children are often at a risk of experiencing several neurobiological and psychosocial difficulties. Adoptive parents must support these difficulties whilst managing their own idiosyncratic challenges. Family-based psychotherapeutic interventions which promote adoptive family functioning, environments and relationships can mediate these difficulties for adopted families. This review synthesises evidence exploring family-based psychological interventions for adoptive families, appraises the literature's strengths and weaknesses, and reports characteristics of promising interventions. Included studies recruited domestically adoptive families receiving psychotherapeutic interventions delivered to at least one adoptive parent and child. The authors searched seven electronic information databases, four grey literature databases, two journals and five relevant websites up to 12.12.2022. The quantitative Risk of Bias in Non-Randomised Studies of Interventions tool and the qualitative Critical Skills Appraisal Programme checklist assessed risk of bias. The narrative synthesis presents 20 papers detailing 18 studies involving at least 729 adopted children and 829 adoptive parents. Findings provide preliminary support for integrative interventions which include aspects of sensory activities, attachment-based play, Dyadic Developmental Psychotherapy and Eye Movement Desensitisation and Reprocessing with Therapeutic Input provided to adopted children and adoptive parents separately, alongside the adoptive family. However, risk of bias was high, limiting the conclusions. Future research should examine the feasibility, acceptability and efficacy of integrative therapeutic approaches for adoptive families to further direct clinical practice., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Children with mental illness commonly live with caregivers who suffer from mental illness. Integrated mental-health-treatment approaches can provide more convenient and comprehensive care for families. This case report describes family-based treatment (FBT) for one parent/child dyad. The parent was a 37-year-old female with a history of anxiety and major depressive disorder and concern for symptoms of attention-deficit/hyperactivity disorder (ADHD). The child was an 8-year-old female with generalized anxiety disorder and concern for ADHD and behavioral problems. The parent received individual cognitive behavioral therapy (CBT) and parent management training. The child received CBT. Both also received medication management. The FBT team met regularly for coordinated treatment planning. Self-reported assessments via the Child Behavior Checklist showed meaningful improvement; anxiety decreased to nonclinical range week 12 and depression decreased to nonclinical range week 8. Clinician assessments showed improvement for both patients. Though more time intensive, FBT can yield significant improvement, particularly for children. Pragmatic approaches to treatment planning are important to minimize barriers to FBT.

Background and Aims: Internet addiction (IA) has been identified as a major public health problem that is more prominent in adolescents and young adults. Some researchers have indicated certain advantages of family-based therapy over other treatments in participants with IA, but no conclusive evaluation has been reported. The present meta-analysis aims to review the efficacy of family-based therapy on Internet addiction in adolescents and young adults., Methods: Relevant articles published from 1996 to February 15th, 2024, were searched from 14 databases, including three Chinese databases. A total of 19,590 articles were identified using a combination of three sets of search terms (Internet addiction, family therapy, and adolescents). Only RCTs and nonrandomized controlled trials were included., Results: 18 studies, most of which were conducted in Asian countries, were included in the final data analysis. The overall severity of Internet addiction in the family-based therapy group was significantly lower than that in the control group. However, significant heterogeneity was detected. Subgroup analysis showed a beneficial effect of family-based therapy when compared with non-intervention and when added to another psychological or behavioural therapy in psychiatric patients with co-medication. Few studies have examined secondary outcomes or follow-up effects., Discussion and Conclusions: Family-based therapy is most effective in reducing the severity of Internet addiction when combined with other therapies, especially medication treatments in psychiatric patients. It might also be helpful to relieve depression and enhance family functions, which needs further evidence. More studies following up on the post-intervention effects are recommended in the future.

Objective : The Systemic Therapy Inventory of Change (STIC) is a systemic measurement feedback system that provides therapists with feedback regarding the multidimensional clinical change in individual, couple, and family therapy. The STIC Intersession scales include Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). They are administered to clients before each therapy session. The purpose of the current study is to investigate the STIC Intersession scales' sensitivity to change, the ability to detect reliable and valid changes that occur after an intervention. Method : Participants ( N  = 583) who voluntarily received individual, couple, or family therapy services in a randomized clinical trial attended the study. Results: By comparing the changes in pre-therapy and post-therapy scores of the STIC Intersession scales with those of the corresponding reference measures, the external sensitivity to change of the STIC Intersession scales was supported. The IPS Intersession scale showed greater change than the Beck Anxiety Inventory. However, no evidence supported the discriminant validity of CPS's change scores. Conclusion: Thus, the STIC Intersession IPS, RWP, and FH can be validly used to assess multi-systemic changes in both research and clinical work.