Multi-family Therapy for Eating Disorders Across the Lifespan.

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.

Examining clinicians' perceptions and experiences working with diverse families in family-based treatment: Common adaptations and considerations for treatment engagement.

OBJECTIVE: Family-Based Treatment (FBT) is the leading manualized treatment for adolescent eating disorders; however, there is limited research on the adaptation of FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices). The purpose of this qualitative study was to address: (1) adaptations made to the FBT model (if any) by clinicians working with diverse youth and families; (2) the barriers/facilitators of maintaining adherence (fidelity) to the model for these families; and, (3) the barriers/facilitators to access and engagement in FBT for diverse families. METHOD: Forty-one FBT clinicians were recruited globally using purposive and snowball sampling, and listservs from eating disorder networks. Clinicians participated in individual interviews or focus groups, discussing their experiences delivering and adapting FBT for diverse families. Qualitative data was transcribed verbatim and analyzed using directed content analysis. RESULTS: Some participants reported making adaptations to every phase of the FBT model, while others did not, when working with diverse families. In Phase 1, participants cited adapting the family meal, length/number of sessions provided, and addressed systemic barriers. In Phase 2, participants adapted the length of the phase and rate/level of independence given back to the adolescent. In Phase 3, participants increased or decreased the number of sessions, or eliminated this phase to address barriers to engagement in FBT. DISCUSSION: This is the first study to qualitatively examine clinicians' experiences of implementing FBT with diverse families. Results may inform future FBT planning, clinician training, clinical decision-making tools, and opportunities for modifications to the foundational model. PUBLIC SIGNIFICANCE: This qualitative study examined clinicians' perceptions and experiences implementing FBT with diverse families, specifically what adaptations (if any) were made to the foundational model, and the barriers and facilitators to adhering to and engaging in the model. Results show that some participants reported making adaptations to every phase of FBT, while others did not, with diverse families. Findings may inform future treatment planning, clinician training, clinical decision-making tools, and potential modifications to FBT.

Feasibility and acceptability of a pilot studying investigating multi-family parent-only guided self-help family-based treatment for adolescent anorexia nervosa.

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.

'Before, we ended up in conflicts, now we can provide support'-Experiences of Community Reinforcement and Family Training (CRAFT) for parents of young adults with hazardous substance use.

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.

Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review.

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.

The processes and outcomes related to 'family-centred care' in neuromotor and functional rehabilitation contexts for children with cerebral palsy: A scoping review.

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.

Inclusion and anti-racism work as performance or deep work? It literally is either-or: A qualitative study in the CFT field.

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.

Culturally adapting relational savoring: A therapeutic approach to improve relationship quality.

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.

Therapeutic Alliance in Family-Based Treatment of Anorexia Nervosa: In-Person Versus Telehealth.

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.

Family Therapy for Kosovar Mothers Who Experienced Conflict-Related Sexual Violence and Their Children in Postwar Times: A Pilot Randomised Waitlist-Controlled Trial.

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.

Comparing in Person to Telehealth Delivery of a Family Violence Intervention.

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.

Families tackling adolescent anorexia nervosa: family wellbeing in family-based treatment or other interventions. A scoping review.

PURPOSE: Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. METHOD: Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. RESULTS: The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. CONCLUSION: The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Updates in the treatment of eating disorders in 2023: a year in review in eating disorders: the Journal of treatment & Prevention.

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 & Prevention 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.

Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa.

This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12-18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.

Sensitivity to change of the Systemic Therapy Inventory of Change (STIC) intersession scales.

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.

Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study.

OBJECTIVE: For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family-based treatment (FBT), the gold-standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration. METHODS: This proof-of-concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first-time hospitalization for medical stabilization of AN or atypical AN. Parents completed a battery of measures and a semistructured interview assessing the acceptability and feasibility of OSOG. RESULTS: Parents described the tool as credible and acceptable. Qualitative feedback highlighted common themes of caregiver burden, nutrition education, and acceptability of the tool. DISCUSSION: Results point to the need for more work in supporting parents in Phase I of FBT. PUBLIC SIGNIFICANCE: Families are instrumental in supporting youth to recover from anorexia nervosa. During treatment, parents are charged with selecting and serving their adolescent's meals, often requiring them to change grocery shopping and food preparation habits to meet their child's high caloric needs. Parents reported feeling overwhelmed by this task and noted struggling with learning different approaches to nourish their adolescent during an already stressful time. Collaboratively with parents, we modified a tool to support parents in shifting thier shopping habits, which they reported as being a helpful springboard in the early phase of treatment.

Extending single-session interventions to target parents as agents of change in adolescent eating disorders.

Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single-session intervention (SSI) models to the eating disorders (EDs) intervention spectrum. In this commentary, we propose extending the potential of SSIs to target parents as agents of change for youth with restrictive EDs, particularly anorexia nervosa (AN). Directing SSIs to parents of children with AN can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to protect a child and advance their capacity to thrive. Key design components of effective SSIs map well onto the core principles of family-based treatment (FBT), which can be distilled to inform the development of SSIs for parents of youth at risk or exhibiting emerging or diagnostic AN. The participatory action research framework highlighted by Schleider et al. (2023) speaks to the importance of developing SSIs using co-design methodologies with parents. Doing so reflects the FBT principle of parent empowerment, acknowledges the research on parental self-efficacy as a mediator of FBT, and recognizes parents as both key stakeholders in the prevention and treatment of child and adolescent EDs, and as the intended recipients of the SSIs created for this population. PUBLIC SIGNIFICANCE: Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single-session intervention (SSI) models to eating disorders (EDs). In this commentary, we extend the potential of SSIs to target parents as agents of change for youth with restrictive EDs. Parent-focused SSIs can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to advance their child's capacity to thrive.

Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings.

OBJECTIVE: The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. METHOD: The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. RESULTS: Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach's α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. CONCLUSIONS: Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.

Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial.

Importance: Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective: To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants: This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions: Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures: The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results: Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance: Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration: ClinicalTrials.gov Identifier: NCT02873715.

Researching what we practice-The paradigm of systemic family research: Part 1.

This is part 1 of two articles that focus on the ideological and philosophical preference regarding how to relate to and conduct research in the field of systemic couple and family therapy. Thus, this article outlines the theoretical groundwork for part 2 of "Researching what we practice" in the same journal. Research in certain areas of systemic couple and family therapy (CFT), such as that influenced by social constructionism and postmodernism, has a different epistemological tradition than in the natural sciences. Thus, only research from a narrow, selected spectrum of epistemologies has been incorporated as a key source in the knowledge base of systemic CFT. The consequence is that the field of postmodern systemic CFT risks promoting only a limited range of research designs and knowledge while excluding other designs and knowledge types, reasoning that these are less useful in clinical practice. The rationale behind this perspective is derived from ideology and philosophy rather than scientific criteria. Accordingly, in our field of study, different epistemological perspectives are easily viewed as dichotomous, thus causing professional gaps in our field. This tendency constrains the mutual exchange and development that are needed. We present a possible way out of this dichotomized deadlock, first and foremost by acknowledging - and encouraging the use of - the great variety and breadth of existing research and knowledge. Referring to the guiding principles of evidence-based practice, we argue that this would endow the systemic CFT therapist and researcher with a greater knowledge base and range of research methodologies. This could help improve the quality of treatment provided to our clients and enhance the legitimacy of postmodern systemic CFT as a branch of psychotherapy.