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

项目总结/文摘

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.