Examining State Licensing Requirements for Select Master's-Level Behavioral Health Providers for Children.

OBJECTIVE: The authors examined licensing requirements for select children's behavioral health care providers. METHODS: Statutes and regulations as of October 2021 were reviewed for licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists for all 50 U.S. states and the District of Columbia. RESULTS: All jurisdictions had laws regarding postgraduate training and license portability. No jurisdiction included language about specialized postgraduate training related to serving children and families or cultural competence. Other policies that related to the structure, composition, and authority of licensing boards varied across states and licensure types. CONCLUSIONS: In their efforts to address barriers to licensure, expand the workforce, and ensure that children have access to high-quality and culturally responsive care, states could consider their statutes and regulations.

Validation of the intersession alliance measure: Individual, couple, and family versions.

Monitoring the therapeutic alliance throughout treatment can improve client outcomes and lead to improved care. The individual, couple, and family versions of the intersession alliance measure (IAM) were developed to facilitate routine monitoring of the expanded therapeutic alliance. Psychometric properties of the three versions of the IAM were examined using a clinical sample. Participants were drawn from clinics in the United States participating in the Marriage and Family Therapy Practice Research Network. Using this sample, results indicate that items on each version of the IAM load on one factor, are invariant across sex, and that each version has good internal consistency, test-retest reliability, and concurrent validity. The IAM-C and IAM-F also have good predictive validity, while the IAM-I has more limited evidence for its predictive validity. These results suggest that the IAMs are valid and reliable measures that can facilitate the routine monitoring of the expanded therapeutic alliance in psychotherapy.

Crisis Intervention Psychotherapy in the Age of COVID-19.

Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.

An equivalence analysis of provider education in youth mental health care.

OBJECTIVE: To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment. DATA SOURCE: Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States. STUDY DESIGN: We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes. DATA COLLECTION: Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months. PRINCIPAL FINDINGS: Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Δ = 2), total training hours (B = -4.57; CI = -10.52-1.37; Δ = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive. CONCLUSIONS: Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments.

"What Next?": Toward telebehavioral health sustainability in couple and family therapy.

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.

Valoración de resultados en el grupo multifamiliar a través del score-15: un estudio piloto / Valoration of the results in the multifamily group via score- 15: a pilot study

Se describe el grupo multifamiliar que está en marcha desde Septiembre de 2012 en L'Hospitalet de Llobregat. Un grupo que atiende a personas diagnosticadas de trastorno mental severo y sus familiares, con el objetivo general de mejorar su salud y calidad de vida. Se trata de facilitar la comunicación para trabajar aspectos relacionales y vinculares. Se pretende ofrecer un espacio donde poder pensar conjuntamente las experiencias vividas en la propia familia. El SCORE-15 es un cuestionario que se ha demostrado útil para analizar los cambios en terapia de familia. Estudiamos su aplicabilidad en el contexto de terapia de grupo multifamiliar. Se investiga si los asistentes y los terapeutas observan cambios en el funcionamiento de la familia a lo largo de varias sesiones del grupo multifamiliar. Es un estudio observacional en un contexto asistencial público. Se invita a participar en el estudio a los nuevos participantes del grupo multifamiliar entre Enero y Julio de 2017, se les aplica el cuestionario SCORE en 3 ocasiones: antes de comenzar su vinculación al grupo, al cabo de 3 sesiones y en la última sesión. En base a los resultados obtenidos, valoramos el SCORE-15 como una herramienta útil a incluir en el proceso terapéutico de las personas que participan en el grupo multifamiliar que nos permite disponer de un registro de los cambios que se producen a nivel de funcionamiento familiar

It is described a multifamily group that has been ongoing in L'Hospitalet Llobregat since 2012. A group that handles both persons diagnosed with severe mental disorders and their families, with a general goal to improve their health and quality of their lives. It is about facilitating the communication in order to work on the rational and bonding aspects. It is intended to offer a space where it is possible to reflect together the experiences lived within their own family. SCORE is a tool which turned out to be useful for analysis of the changes in family therapy. We are studying its applicability in the context of multifamily group therapy. It is being researched if the assistants and therapists observe the changes in the family function over the series of sessions in the multifamily group. It is an observational study in the context of public assistance. New participants of a multifamily group are invited to participate between January and July 2017. SCORE is applied on 3 occasions: before starting their introduction to the group, after 3 sessions and in the last session. Based on the obtained results, we evaluate SCORE- 15 as a useful tool to include persons who participate a multifamily group in a therapeutic process which further permits us have at our disposal a register of the produced changes at the level of family function

Inviting Autonomy Back to the Table: The Importance of Autonomy for Healthy Relationship Functioning.

Autonomy, or self-determination, is a key ingredient in promoting relationship flourishing. Although autonomy has long been an important concept in the family therapy field (labeled differentiation; Family therapy in clinical practice, 1978), definitional confusions and the ascendency of attachment theory and attachment-based clinical approaches to treating couples have relegated autonomy to a minor role at best and a caricature of rugged individualism and antirelational separateness at worst. Given recent research showing the importance of autonomy for the development of secure attachment in children and the key role autonomy plays in healthy intimate partner functioning, the concept of autonomy needs to take a more central role in our research and clinical practice with couples.

Evaluation of a new model for assessment and treatment of uncomplicated ADHD - effect, patient satisfaction and costs.

Aim: Attention-deficit/hyperactivity disorder (ADHD) is the most common diagnosis within child- and adolescent psychiatry. Waiting lists and delayed care are major issues. The aim was to evaluate if standardized care (SC) for assessment and treatment of uncomplicated ADHD would reduce resource utilization and increase satisfaction with preserved improvement within the first year of treatment.Method: Patients 6-12 years with positive screen for uncomplicated ADHD at the brief child and family phone interview (BCFPI), a routine clinical procedure, were triaged to SC. The control group consisted of patients diagnosed with ADHD in 2014 and treated as usual. BCFPI factors at baseline and follow-up after one year and resource utilization were compared.Results: Patients improved in ADHD symptoms (Cohen's d = 0.78, p < 0.001), child function (Cohen's d = 0.80, p < 0.001) and in family situation (Cohen's d = 0.61, p < 0.001) without group differences. Parents of SC patients participated more often in psychoeducational groups (75.5 vs. 49.5%, p < 0.001). SC had shorter time to ADHD diagnosis (8.4 vs. 15.6 weeks, p = 0.01) and to medication (24.6 vs. 32.1 weeks, p = 0.003). SC families were more satisfied with the waiting time (p = 0.01), otherwise there were no differences in satisfaction between the groups. Families of SC patients had fewer visits (4.7 vs. 10.8, p < 0.001) but used the same number of phone calls (6.3 vs. 6.2, p = 0.71). Costs were 55% lower.Conclusions: A SC for ADHD can markedly reduce costs with preserved quality. As resources are limited, child psychiatry would benefit from standardization.

The Condensed MFT Core Competencies: A Streamlined Approach for Measuring Student and Supervisee Learning Using the MFT Core Competencies.

In this article, the authors present a condensed version of the Marriage and Family Therapy Core Competencies (MFT-CC), collapsing the original 128 MFT-CC to 16 using a qualitative research method. Educators, supervisors, and researchers can more easily and efficiently use the condensed MFT-CC to measure student and supervisee learning for accreditation and training. The 16 Condensed MFT-CC are mapped to the original MFT-CC, COAMFTE's Version 12 Foundational Curriculum Areas and the Association for Marital and Family Therapy Regulatory Boards 6 domains upon which the national exam is predicated.

Conversation Analysis and Family Therapy: A Critical Review of Methodology.

This article critiques the use of conversation analysis (CA) as applied to the study of family therapy. Searches of relevant databases and journals as well as citation searches were conducted in April 2018 for relevant articles. Inclusion criteria included the explicit use of CA either solely or in combination with discourse analysis and discursive psychology. This resulted in the inclusion of 25 articles that were reviewed against a guideline for the evaluation of qualitative research to which five items specific to CA were added to ensure a specific and balanced evaluation of the studies. Articles generally had a good application of quality criteria although there was a variation in detail of transcription, application of sequence analysis, and a limited use of validity testing. CA has the potential to complement existing research on family therapy but requires a rigorous application of process and quality criteria. The article provides recommendations for future CA research into family therapy.

Este artículo analiza el uso del análisis de la conversación (CA) según se aplica al estudio de la terapia familiar. En abril de 2018 se realizaron búsquedas en bases de datos y revistas relevantes así como búsquedas de citas para artículos relevantes. Los criterios de inclusión incluyeron el uso explícito del análisis de la conversación, ya sea exclusivamente o combinado con el análisis del discurso y la psicología discursiva. Esto resultó en la inclusión de 25 artículos que se revisaron según una guía para la evaluación de la investigación cualitativa a la cual se agregaron cinco puntos específicos del análisis de la conversación para garantizar una evaluación específica y equilibrada de los estudios. Los artículos generalmente tuvieron una buena aplicación de los criterios de calidad, aunque hubo una variación en el detalle de la transcripción, la aplicación del análisis de secuencias y un uso limitado de la evaluación de la validez. El análisis de la conversación tiene el potencial de complementar las investigaciones existentes sobre terapia familiar, pero exige una aplicación rigurosa de los criterios de procesamiento y calidad. El artículo ofrece recomendaciones para futuras investigaciones sobre el análisis de la conversación en la terapia familiar.

Treatment of Chinese adolescents with anorexia nervosa in Hong Kong: The gap between treatment expectations and outcomes.

BACKGROUND AND OBJECTIVE: Anorexia nervosa (AN) is one of the most difficult-to-treat psychiatric disorders. AN is associated with individual vulnerability, societal and family factors. There has been limited research in Asia regarding the patients or their families' perceptions on its treatment. This study explored the perceived treatment outcomes among Chinese families having adolescents with AN. METHODS: Qualitative interviews were conducted on parents of adolescents with AN recruited through an eating disorder association in Hong Kong to understand their views and experiences regarding the help-seeking and treatment process. RESULTS: The parents expressed dissatisfaction towards help-seeking and treatment outcomes, including relationships with health professionals, hospitalization, health professionals' knowledge of AN, understanding of the treatment model and parents' role, amount of psychological support, and coordination among health professionals. The parents were unclear about the treatment plan as they received little explanation from the health professionals. The parents perceived that the AN treatment only focused on weight restoration with limited psychological support. Home diet monitoring was seen as a harsh task which worsened the relationship with their children. The parents often needed to take up the coordinator role and search around for different health professionals and integrate their advices by themselves. CONCLUSIONS: The study shows that limited psychoeducation, communication and coordination in the treatment for AN are major problems in a Chinese context. Open communication between the health professionals and the parents about the expected treatment outcomes and limitations is needed to enhance their mutual trust. Besides, treatment should emphasize not only family involvement but also empower them to fight against AN.

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.

A medida que los tratamientos familiares factuales para el consumo de sustancias y los problemas de conducta en los adolescentes ganan terreno, la investigación de vanguardia trasciende los ensayos aleatorizados de eficacia teórica para abordar preguntas, por ejemplo, cómo funcionan estos tratamientos y cómo difundirlos mejor en entornos comunitarios. Un factor clave para la difusión eficaz es la fidelidad al tratamiento, que se refiere a implementar una intervención de una manera consecuente con un manual establecido. Si bien la mayor parte de la investigación de fidelidad es cuantitativa, el presente estudio ofrece un análisis clínico cualitativo de fallas de la fidelidad en un ensayo grande multicéntrico de eficacia real de Terapia Familiar Breve y Estratégica (BSFT) para el abuso de drogas en los adolescentes, donde los desarrolladores de la BSFT capacitaron a terapeutas de la comunidad para que apliquen esta intervención en sus propias agencias. Utilizando informes de casos y grabaciones de vídeo de sesiones de terapia, un panel independiente de expertos evaluó primero 103 casos con escalas de fidelidad cuantitativa basadas en el manual de BSFT y el marco estratégico estructural más amplio que respalda la intervención de la BSFT. Como la fidelidad fue generalmente baja, el panel revisó todos los casos cualitativamente para reconocer tipos o categorías emergentes de fallas de la fidelidad. Surgieron diez categorías de fallas caracterizadas por omisiones del terapeuta (p. ej.: el terapeuta no hizo participar a familiares clave, no pensó en grupos de tres) y licencias (p. ej.: desvío del modelo, formulaciones/intervenciones no sistémicas). De estas opciones, la falla en "no pensar en grupos de tres" pareció básica y particularmente problemática, lo cual refleja el lugar fundamental de esta idea en la teoría y la terapia estructural. Aunque nuestras observaciones estén sujetas a un posible sesgo, estas ponen de manifiesto posibles obstáculos a la hora de exportar un tratamiento familiar complejo como la BSFT a entornos comunitarios. Estos resultados también subrayan la importancia de la fidelidad al tratamiento en la investigación sobre terapia familiar.

"Thank You for Including Us!" - Introducing a Community-Based Collaborative Approach to Translating Clinic Materials.

When working with clients in another language, having culturally relevant and properly translated clinic materials is vital to effective clinical practice. Not having them presents a barrier for bilingual therapists and their clients. This paper reviews common translation methods and introduces a multi-level, community-based approach for translating clinic materials for non-English speaking clients. Informed by decolonizing practices, this five-tier method includes members from the target community as cultural brokers to verify the accuracy and nuances of language for their cultural group, as well as a constant comparative method to ensure methodological rigor in the process of inclusion. We present community member's feedback and recommendations, as well as discuss advantages and challenges of using this collaborative culturally responsive translation method.

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients.

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self-disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.

The Profession of Couple, Marital, and Family Therapy (CMFT): Defining Ourselves and Moving Forward.

The field of Couple, Marital, and Family Therapy (CMFT) has evolved and strengthened, but we still have work to do when it comes to identity, comprehensive scholarly resources, empirical support, and name brand recognition. We explore the reasons for these challenges and propose ways to address them: embracing the interdisciplinary nature of the field, consistently organizing treatment effectiveness by problem rather than by intervention model, continuing innovation in theory development, and utilizing more diverse and meaningful research methods. This approach provides a more accurate representation of the scope of practice of CMFTs, the range of mental and physical health problems we address, and the depth and extent of the existing research on the effectiveness of relational therapies.

From Knowing to Doing: Guidelines for Socioculturally Attuned Family Therapy.

Family therapists know that clinical concerns are not separate from larger sociopolitical contexts. Attunement to clients' sociocultural experience is foundational to good practice, yet few guidelines integrate attention to the larger societal processes or address social equity. The purpose of this article is to help therapists move from knowing about sociocontextual issues to doing socioculturally attuned practice. We offer an overarching framework that returns to Bateson and the roots of family therapy through a call for third order transformation. The approach is responsive to societal context and an analysis of power while working through enduring concepts of major family therapy models. Transtheoretical guidelines that can be integrated across practice models to promote third order change are illustrated with case examples.

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions.

There is a critical need for high-quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention-level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice.

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS' origins in everyday clinical practice. The authors contend that PCOMS represents "both/and," providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time-honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.