Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
JMIR Form Res. 2024 Oct 15;8:e57939. doi: 10.2196/57939.
Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions.
To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact.
Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention.
Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication.
An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families.
ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523.
尽管创伤暴露、物质滥用、心理健康问题和自杀的发生率很高，但受系统影响的青少年及其照顾者获得循证行为健康服务的机会有限。基于家庭的干预措施最有利于改善心理健康、教育、物质使用和犯罪结果，但在儿童福利介入期间发生的家庭和安置中断可能会干扰基于家庭的干预措施的实施。
为了解决服务获取方面的这一差距，我们采用了一种基于创伤知情视角的面对面、循证、基于家庭的情感管理干预措施，并通过远程医疗向受儿童福利系统影响的家庭提供（家庭远程医疗项目）。我们描述了干预措施的改编过程和一项开放性试验，以评估其可行性、可接受性和影响。
通过青少年、照顾者和系统合作伙伴的投入，对基于家庭的情感管理干预措施进行了迭代改编。通过焦点小组和与系统合作伙伴的合作会议，还开发了一种仅针对照顾者的干预措施。对干预措施进行了开放性试验，以评估家庭对其可接受性和可行性的看法，并在进行更大规模评估之前提供进一步的改进。参与者包括过去 12 个月内参与儿童福利系统的英语家庭，以及年龄在 12-18 岁之间的青少年。照顾者有资格单独参加（亲生照顾者、亲属照顾者或寄养父母；n=7）或与他们的青少年一起参加（仅亲生照顾者；n=6 对）。参与者在治疗前、治疗后和 3 个月后治疗时间点完成了会议反馈表和调查。对一组参与者（12/19，63%）进行了定性退出访谈，以进一步了解他们对干预措施的体验。
会议出席率很高，照顾者和青少年在反馈表上都报告了对治疗师和会议的高度可接受性。家庭对视频技术感到满意，只有极少数（<5%）会议报告了技术问题。对退出访谈记录的主题分析表明，家庭使用了干预过程中教授的有效沟通和情绪管理技能。关于挑战和障碍，一些仅照顾者的参与者表示希望他们的青少年也能参加干预措施。所有接受采访的参与者都表示愿意向他人推荐该干预措施，并且对该干预措施的看法非常积极。定量调查显示，在情绪管理和沟通方面，对干预措施的反应存在差异。
受儿童福利系统影响的家庭的基于技能的远程医疗干预措施——家庭远程医疗项目的开放性试验表明，该干预措施具有很高的可行性和可接受性。参与者指出，在经常受到创伤和家庭分离影响的领域取得了进展：沟通和情绪管理。青少年和照顾者对整体干预措施的看法都非常积极。家庭远程医疗项目在解决受系统影响的家庭在获得行为健康服务方面的差距方面显示出了希望。
ClinicalTrials.gov NCT04488523；https://clinicaltrials.gov/study/NCT04488523。
