van Cappellen S Marjolein, Creemers Hanneke E, Hoogsteder Larissa, Asscher Jessica J
Department of Clinical Child & Family Studies, Utrecht University, P.O. Box 80140, Utrecht, 3584 CS, the Netherlands.
Faculty of Social and Behavioral Sciences, University of Amsterdam, P.O. Box 15776, Amsterdam, 1011 NG, the Netherlands.
Child Adolesc Psychiatry Ment Health. 2025 Jul 3;19(1):71. doi: 10.1186/s13034-025-00935-z.
Interventions aimed at juveniles exhibiting challenging antisocial behavior often face motivation issues, high drop-out rates, and difficulties in achieving substantial and long-lasting effects. Gaining insight into how families experience these interventions may be a crucial step in obtaining more understanding of what does and does not work for clients in forensic youth care. The current study investigated the experiences of juveniles and caregivers with Forensic Outpatient Systemic Therapy (FAST), an intensive intervention aiming to reduce juvenile antisocial behavior. The study examined how juveniles and caregivers evaluated FAST in terms of the process of setting treatment goals, helpful components, points of improvement, their therapist, and a blended version of FAST (FASTb) that is partially offered online.
Semi-structured interviews were conducted after treatment termination with 24 participants from 16 families (9 juveniles, 15 caregivers) who participated in a randomized controlled trial or quasi-experimental study on the effectiveness of FAST. A purposive sampling method was used to yield a diverse sample and varied experiences. Thematic analysis was performed in three phases.
Treatment goals were generally set collaboratively and agreement was often achieved, but juveniles were not always involved in setting the treatment goals or in treatment in general. Evaluations of FAST's success were varied but generally positive. Most helpful treatment components were conversations with the therapist and, to caregivers, program specific components. Although most participants evaluated their therapist positively, some reported the need for more responsivity. FASTb increased treatment accessibility for some caregivers, but most participants preferred face-to-face appointments.
This study provides insight into how FAST is perceived and factors influencing engagement, yielding several clinical implications for systemic treatment in forensic youth care. First, building a strong therapeutic alliance is important. Juveniles benefit from a kind, activity-based approach, whereas caregivers value therapist empathy. Given the severity of antisocial behavior in FAST's target group, initial safety interventions may be necessary before being able to invest in the therapeutic alliance. Second, therapists should persist in engaging juveniles, for instance, by incorporating (physical) activities. Third, blended care may improve accessibility. Therefore, it is important to discuss its potential with families throughout treatment.
针对表现出具有挑战性的反社会行为的青少年的干预措施，常常面临动机问题、高辍学率以及难以取得显著且持久效果的困境。深入了解家庭如何体验这些干预措施，可能是更深入理解在青少年司法照护中哪些对服务对象有效、哪些无效的关键一步。本研究调查了青少年和照料者对法医门诊系统疗法（FAST）的体验，这是一种旨在减少青少年反社会行为的强化干预措施。该研究考察了青少年和照料者如何从设定治疗目标的过程、有益的组成部分、改进要点、他们的治疗师以及部分在线提供的FAST混合版本（FASTb）等方面对FAST进行评估。
在治疗结束后，对来自16个家庭的24名参与者（9名青少年，15名照料者）进行了半结构化访谈，这些参与者参加了一项关于FAST有效性的随机对照试验或准实验研究。采用目的抽样方法以获得多样化的样本和不同的体验。主题分析分三个阶段进行。
治疗目标通常是共同设定的，并且常常达成共识，但青少年并不总是参与设定治疗目标或总体治疗过程。对FAST成功与否的评价各不相同，但总体上是积极的。最有帮助的治疗组成部分是与治疗师的交谈，而对照料者来说，是特定于项目的组成部分。尽管大多数参与者对他们的治疗师评价积极，但一些人报告需要更多的响应性。FASTb提高了一些照料者获得治疗的便利性，但大多数参与者更喜欢面对面预约。
本研究深入了解了FAST的认知情况以及影响参与度的因素，为青少年司法照护中的系统治疗带来了一些临床启示。首先，建立强大的治疗联盟很重要。青少年受益于友善的、基于活动的方法，而照料者看重治疗师的同理心。鉴于FAST目标群体中反社会行为的严重性，在能够投入建立治疗联盟之前，可能需要进行初步的安全干预。其次，治疗师应坚持让青少年参与，例如，通过纳入（身体）活动。第三，混合照护可能会提高可及性。因此，在整个治疗过程中与家庭讨论其潜力很重要。
Zotero 插件