Effectiveness of an Empirically Supported Family Intervention: Mental Health Outcomes, Mechanisms of Effect, and Organizational Factors

项目总结/摘要 支持家庭沟通和改善青少年心理健康的具有成本效益的简短方案是一种 迫切的需求;但很少有基于证据的方案存在。我们的团队开发并严格测试了 * 以得到医疗支助的家庭系统方法改善家庭中的沟通和冲突， 改善青年人的心理健康。对青年心理健康和其他适应指数的有益影响 与幸福家庭课程相关的一些有效性试验得到了支持， 各种风险背景。然而，功效研究的价值是有限的，除非随后在 在有效性试验的背景下。考虑到广泛实施《快乐宣言》的潜在大规模效益， 家庭课程，一个关键的需要存在的有效性试验，以评估该计划时， 在社区环境中实施，由促进者在“真实的世界”环境中提供该方案。我们 本提案的目的是在不同的风险背景下，测试大样本的有效性 (i.e. 4节）心理教育和沟通培训方法用于我们的疗效试验，并 检查与作为计划结果而发生的变化过程相关的机制，包括 情绪安全作为节目效果的中介和与参与者的情绪相关的效果的调节者。 社会经济和背景风险以及可能影响计划有效性的组织因素。 我们的中心假设是，参与该计划将改善沟通和冲突的模式 在家庭中，从而改善青年的心理健康。这一假设得到了广泛的功效研究的支持 及根据最近进行的“幸福家庭课程”可行性研究所得出的结论， 建议进行有效性试验。我们的理论基础是，提供一个家庭系统的方法来改善家庭， 环境将随着时间的推移支持青年的心理健康。具体目标是：（1）评价方案 有效地改善沟通，减少家庭中的破坏性冲突， 青年健康，（2）测试过程模型，由情绪安全理论（EST;戴维斯& Cummings，1994），以解释如何，为什么，为谁和何时，变化发生的结果，程序，和（3） 评估与计划有效性相关的组织因素，包括组织的影响 结构和主持人类型，以及组织对计划的主观评价。这种方法 创新，因为它利用RCT设计来测试经过验证的家庭系统方法的有效性， 代表了一种简短、廉价和易于扩展的方法，以促进家庭沟通的变化。 模式和改善心理健康。该计划是基于一个完善的理论模型， “效果机制”，并得到计划有效性证据的支持。这项研究意义重大，因为它 将导致一个廉价的模式计划，家庭系统一级的干预，是可持续的， 它在组织中进行测试，并随时适应其他环境。

Project Summary/Abstract Cost-effective, brief programs to support family communication and improve mental health in youth are a pressing need; yet few evidence-based programs exist. Our group has developed and rigorously tested an empirically-supported family-systems approach to improving communication and conflict in families, thereby improving mental health in youth. Beneficial effects for youth mental health and other indices of adjustment associated with the Happy Families Curriculum have been supported in several efficacy trials with families from a variety risk contexts. However, the value of efficacy research is limited unless it is subsequently tested in the context of an effectiveness trial. Given the potential large-scale benefits of broad implementation of the Happy Families Curriculum, a critical need exists for an effectiveness trial to evaluate the program when it is implemented in community settings by facilitators who would provide the program in “real world” settings. Our objective in this proposal is to test the effectiveness for a large sample, in different contexts of risk, of the brief (i.e. 4 session) psycho-educational and communication training approach used in our efficacy trials, and to examine the mechanisms associated with change processes that occur as a result of the program, including emotional security as a mediator of program effects and moderators of effects associated with participants’ socioeconomic and contextual risks as well as organizational factors that may impact program effectiveness. Our central hypothesis is that participation in the program will improve patterns of communication and conflict in families, thereby improving youth mental health. This hypothesis is supported by extensive efficacy research on the Happy Families Curriculum and conclusions based on a recently conducted feasibility study of the proposed effectiveness trial. Our rationale is that providing a family-systems approach to improving the family environment will support youth mental health over time. The specific aims are: (1) evaluating program effectiveness for improving communication, reducing destructive conflict in families and enhancing mental health in youth, (2) testing process models, guided by the Emotional Security Theory (EST; Davies & Cummings, 1994), to explain how, why, for whom and when, changes occur as a result of the program, and (3) evaluating organizational factors associated with program effectiveness, including the impact of organization structure and facilitator type, and organizations’ subjective evaluation of the program. This approach is innovative because it utilizes an RCT design to test the effectiveness of a proven family-systems approach that represents a brief, inexpensive and readily scalable approach to foster change in families’ communication patterns and improve mental health. The program is based on a well-established theoretical model for “mechanisms of effect” and backed by evidence for program efficacy. This research is significant because it will result in an inexpensive model program for family-system-level interventions that is sustainable in the organizations it is tested in, and readily adjusted to other contexts.