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Intervention Summary

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Clinician-Based Cognitive Psychoeducational Intervention for Families (Family Talk)

The Clinician-Based Cognitive Psychoeducational Intervention for Families (Family Talk) is intended for families with parents with significant mood disorder. Based on public health models, the intervention is designed to provide information about mood disorders to parents, equip parents with skills they need to communicate this information to their children, and open dialogue in families about the effects of parental depression. The intervention consists of 6-11 modules that include separate meetings with parents and children, family meetings, and telephone contacts or refresher meetings at 6- to 9-month intervals. Sessions are conducted by trained psychologists, social workers, and nurses. The core elements of the intervention are (1) an assessment of all family members, (2) teaching information about affective disorders and risks and resilience in children, (3) linking information to the family's life experience, (4) decreasing feelings of guilt and blame in children, and (5) helping children to develop relationships within and outside the family to facilitate their independent functioning in school and in activities outside the home. In family meetings, parents talk about their own sessions, their treatment, and how they are working to build resilience and protect their children.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: October 2006
1: Child-related behaviors and attitudes toward parental illness as reported by parents
2: Children's understanding of parental illness
3: Internalizing symptomatology
4: Family functioning
Outcome Categories Family/relationships
Mental health
Ages 6-12 (Childhood)
13-17 (Adolescent)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities White
Race/ethnicity unspecified
Settings Outpatient
Home
Other community settings
Geographic Locations Urban
Implementation History The intervention was first implemented in 1991. It has been used in the United States in Greater Boston, Massachusetts, and Chicago, Illinois, as well as in Australia (Family Focus), Colombia, Costa Rica, Finland, Iceland, the Netherlands, Norway, Rwanda, and Sweden (Beardslees Familjeintervention). Principles of the intervention have been used in a number of other programs and interventions, including Family Connections (a Head Start and Early Head Start teacher training for supporting families facing adversities), FOCUS (a resiliency program for military families), and an intervention for adolescents with inflammatory bowel disease.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations In the United States, the intervention has been adapted for single-parent families of color, single-parent Latino families, and African American families (with an adapted manual). Other adaptations have been developed for families in Australia, Costa Rica, Finland, Iceland, the Netherlands, Norway, Rwanda, and Sweden. Manuals are available in English, Dutch, Finnish, German, and Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective
Indicated

Quality of Research
Review Date: October 2006

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Beardslee, W. R., Gladstone, T. R., Wright, J., & Cooper, A. B. (2003). A family-based approach to the prevention of depressive symptoms in children at risk: Evidence of parental and child change. Pediatrics, 11(2), e119-e131.  Pub Med icon

Beardslee, W. R., Hoke, L., Wheelock, I., Rothberg, P. C., Van De Velde, P., & Swatling, S. (1992). Initial findings on preventive intervention for families with parental affective disorders. American Journal of Psychiatry, 149, 1335-1340.  Pub Med icon

Beardslee, W. R., Versage, E. M., Salt, P., & Wright, E. (1999). The development and evaluation of two preventive intervention strategies for children of depressed parents. In D. Cicchetti & S. L. Toth (Eds.), Rochester Symposium on Developmental Psychopathology, Volume IX, Developmental Approaches to Prevention and Intervention. Rochester, NY: University of Rochester Press.

Beardslee, W. R., Wright, E. J., Gladstone, T. R., & Forbes, P. (2007). Long-term effects from randomized trial of two public health preventive interventions for parental depression. Journal of Family Psychology, 21, 703-713. (NOTE: At the time of the NREPP review, the manuscript of this article had been submitted for publication but not yet accepted.)

Supplementary Materials

Beardslee, W. R. (n.d.). Detailed presentation of data analyses for adaptation. Unpublished manuscript.

Chronology of work from 1979 to present

Podorefsky, D. L., McDonald-Dowdell, M., & Beardslee, W. (2001). Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 879-886.  Pub Med icon

Solantaus, T., Toikka, S., Alasuutari, M., Aronen, P., & Beardslee, W. R. (n.d.). The Effective Family Program: Adaptation of a preventive intervention for families facing mood disorders in Finland. Manuscript submitted for publication.

Outcomes

Outcome 1: Child-related behaviors and attitudes toward parental illness as reported by parents
Description of Measures Parent-reported changes in child-related behaviors and attitudes toward parental illness were measured by the Semistructured Interview About the Intervention (SII). The instrument was administered to each parent before and after the intervention. The SII contains a series of open-ended questions and rating scales that can be coded into changes in child-related behaviors and attitudes of parental illness. Interviewers used information from SII to identify specific changes in categories that most frequently reflect child-related behavior and attitude changes related to parental illness (i.e., increased talking with child about depression, increased understanding of risk and resiliency in children). All scoring was done by trained raters, and many ratings were reviewed by a master rater.
Key Findings Parents receiving the intervention averaged higher scores in their reports of child-related behavior and attitude changes toward parental illness than parents receiving a group-format presentation (p < .0001). The number of reported changes increased across four follow-up assessments up to 4.5 years after the intervention (p < .0001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 2: Children's understanding of parental illness
Description of Measures Children's understanding of parental illness was measured using the Semistructured Child Interview (SCI). Similar to the adult SII, this instrument combines qualitative questions with Likert-type rating scales. Questions elicit information about the children's current functioning, their knowledge, feelings, and experience of their parent's mood disorder, their coping style, and their perceptions of any changes that might have taken place as a result of the intervention. From the data about child's perceptions of differences in the family occurring as a result of being in the project, raters assessed increased understanding of parental illness. Improved understanding was rated on a 5-point scale ranging from no awareness of illness (rating of "0") to 2 or more specific changes (rating of "4"). A score was generated for each child consisting of the mean of the child's rating of understanding and the rater score of improved understanding.
Key Findings Children in families receiving the intervention improved slightly on measures of understanding of parental mood disorder compared with children in families receiving a group-format presentation (p < .05). Further improvement over time appeared to be affected more by developmental stage of the children than by variation in treatment.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 3: Internalizing symptomatology
Description of Measures Children rated their own adaptive and maladaptive behaviors and psychopathology on the Youth Self-Report (YSR). Developed for children 11 to 18 years old, this instrument consists of 112 items and covers various adaptive and maladaptive behaviors and psychopathology during the past 6 months. The YSR includes behavior problems and social competence scales, along with measures of internalizing and externalizing behaviors. Assessors read the measure aloud to those children under the age of 11.
Key Findings Both the intervention and an alternative treatment format decreased scores for internalizing symptoms from baseline. No significant difference between the two treatment formats was found after variation in baseline internalizing symptoms was considered.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)
Outcome 4: Family functioning
Description of Measures Family functioning was assessed using the Family Relationship Inventory (FRI). The FRI is a 27-item instrument with three subscales (Cohesion, Expressiveness, and Conflict) of the relationship dimension of the Family Environmental Scale (FES), a widely used, empirically derived measure of family functioning. The FRI was administered to both parents and children.
Key Findings Child and parent family functioning improved among families receiving the intervention and among families receiving an alternative treatment format. No significant difference between the two treatment formats was found after family variation in baseline functioning was considered.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 6-12 (Childhood)
13-17 (Adolescent)
26-55 (Adult)
57.3% Male
42.7% Female
94% White
6% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Child-related behaviors and attitudes toward parental illness as reported by parents 3.5 2.5 3.5 4.0 3.5 4.0 3.5
2: Children's understanding of parental illness 3.0 2.0 3.5 4.0 3.5 4.0 3.3
3: Internalizing symptomatology 4.0 3.5 3.5 4.0 3.0 4.0 3.7
4: Family functioning 3.5 3.0 3.5 4.0 3.0 4.0 3.5

Study Strengths

The methodology used in the study was impressive, very well thought out, and well described. The methods to ensure fidelity of intervention were outstanding, even across diverse populations and cultures. The developers presented a long-term follow-up study with strong, positive outcomes for the intervention group. Many of the measures are standardized and widely used. The developers' work to adapt the intervention to diverse populations/cultures is very impressive. Participation rates were exceptional, and attrition was very low and analyzed adequately. Authors adequately controlled for confounds. Analyses were well described and appropriately conducted.

Study Weaknesses

Since there was no "no-treatment" group, there was no comparison to the true counterfactual. The study also largely ignored the possibility of genetic/biological factors involved in intrafamily rates of mental illness. Additional information about the development of the Semistructured Child Interview (SCI) would have been helpful in order to better evaluate use of this as an outcome measure. More information about the Family Relationship Inventory (FRI) would have been helpful (i.e., if measures were assessed by independent investigators).

Readiness for Dissemination
Review Date: October 2006

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Adult Post-Intervention Assessment Form (Spanish version)

Avery, M., Ayoub, C., Watts, C., & Beardslee, W. (n.d.). The Family Connections Project: A manual for fostering resilience, increasing positive interactions, and recognizing parental depression in Head Start. Boston: Family Connections Project.

Beardslee, W., & Gladstone, T. (n.d.). Health prevention and promotion. Boston: Children's Hospital Boston.

Beardslee, W. (1998). Prevention and the clinical encounter. American Journal of Orthopsychiatry, 68(4), 521-533.

Beardslee, W. (2003). When a parent is depressed: How to protect your children from the effects of depression in the family. Boston: Little, Brown, and Company.

Beardslee, W., Swatling, S., Hoke, L., Rothberg, P., van de Velde, P., Focht, L., et al. (1998). From cognitive information to shared meaning: Healing principles in prevention intervention. Psychiatry, 61, 112-129.  Pub Med icon

Children's Hospital Boston. (n.d.). Miller Family Teaching Tape [DVD].

Llerena-Quinn, R., Shapiro, R., Bravo, M., Lora, A., D'Angelo, E., & Beardslee, W. (2006). Adapted manual for the Prevention of Depression in Families Program for use with Latino families. Boston: Children's Hospital Boston.

Podorefsky, D., & Beardslee, W. (2006). An overview to the psychoeducational prevention intervention training 25-minute videotape [Handout].

Podorefsky, D., McDonald-Dowdell, M., & Beardslee, W. (2001). Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 879-886.  Pub Med icon

Preventive Intervention Project. (n.d.). Hope, meaning, and continuity: A program for helping families when parents face depression. Boston: Judge Baker Children's Center.

Solantaus, T., & Toikka, S. (2006). The Effective Family Programme: Preventive services for the children of mentally ill parents in Finland. International Journal of Mental Health Promotion, 8(3), 37-43.

Solantaus, T., Toikka, S., Alasuutari, M., Aronen, P., & Beardslee, W. (n.d.). The Effective Family Prevention Program: Adaptation of a preventive intervention for families facing mood disorders. Manuscript submitted for publication.

Toikka, S., & Solantaus, T. (2006). The Effective Family Programme II: Clinicians' experiences of training in promotive and preventative child mental health methods. International Journal of Mental Health Promotion, 8(3), 27-33.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.2 3.3 3.3 3.2

Dissemination Strengths

The implementation manual was strongly grounded in a broad variety of theoretical orientations, particularly a public mental health approach that included practitioners from nursing, social work, psychology, and psychiatry in the design and implementation from the beginning. The manual is available in several different languages. Guidelines and principles are provided to implementers for adapting the intervention from one setting to another while maintaining core principles of the program. Training of master trainers aids in dissemination and creates "early adopters" who lead the local implementation process. The training model includes extensive supervision and support for master trainers in training others. Consultation is offered by program developers. The quality assurance protocol includes adult and child pretest and posttest intervention assessment forms in English and Spanish. Developers also provide specific procedures to follow for adapting this program outside of the university/research setting. The use of the "train the trainer" model also contributes to fidelity on the local level.

Dissemination Weaknesses

The implementation manual could be laid out in a clearer, easier-to-read fashion with better formatting of materials. The manual also does not contain specific, didactic content to be used by implementers, such as specific information on depression. It is unclear how users access training and support. No specific fidelity measure is provided.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation manual Free Yes
Online training Free Yes
Training CD $10 each No
2-day initial training $500 per day Yes
Follow-up training Contact the developer No
Ongoing biweekly supervision and consultation $100 per hour Yes
Quality assurance forms Contact the developer Yes

Additional Information

Delivery of the intervention requires 7-10 hours of clinician time per family, including parent, child, and family sessions.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Beardslee, W. R., Klosinski, L. E., Saltzman, W., Mogil, C., Pangelinan, S., McKnight, C. P., & Lester, P. (2013). Dissemination of family-centered prevention for military and veteran families: Adaptations and adoption within community and military systems of care. Clinical Child and Family Psychology Review, 16(4), 394-409.  Pub Med icon

Beardslee, W. R., Lester, P., Klosinski, L., Saltzman, W., Woodward, K., Nash, W., et al. (2011). Family-centered preventive intervention for military families: Implications for implementation science. Prevention Science, 12(4), 339-348.  Pub Med icon

Beardslee, W. R., Paez, A., Herrera, L. D., Montero, F., Herrera, H. C., Llerena-Quinn, R. I., et al. (2011). Adaptation of a preventive intervention approach to strengthen families facing adversities, especially depression. International Journal of Mental Health Promotion, 13(2), 5-13.

Beardslee, W. R., Solantaus, T. S., Morgan, B. S., Gladstone, T. R., & Kowalenko, N. M. (2012). Preventive interventions for children of parents with depression: International perspectives. MJA Open, 1(Suppl. 1), 23-27.

Betancourt, T. S., Meyers-Ohki, S. E., Stevenson, A., Ingabire, I., Kanyanganzi, F., Munyana, M., et al. (2011). Using mixed-methods research to adapt and evaluate a family strengthening intervention in Rwanda. African Journal of Traumatic Stress, 2(1), 32-45.

D'Angelo, E. J., Llerena-Quinn, R., Shapiro, R., Colon, F., Rodriguez, P., Gallagher, K., et al. (2009). Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families. Family Process, 48(2), 269-291.

Podorefsky, D. L., McDonald-Dowdell, M., & Beardslee, W. R. (2001). Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 879-886.  Pub Med icon

Solantaus, T., Paavonen, E. J., Toikka, S., & Punamäki, R. L. (2010). Preventive interventions in families with parental depression: Children's psychosocial symptoms and prosocial behaviour. European Child and Adolescent Psychiatry, 19(12), 883-892.  Pub Med icon

Solantaus, T., Toikka, S., Alasuutari, M., Beardslee, W. R., & Paavonen, E. J. (2009). Safety, feasibility and family experiences of preventive interventions for children and families with parental depression. International Journal of Mental Health Promotion, 11(4), 15-24.

Contact Information

To learn more about implementation or research, contact:
William R. Beardslee, M.D.
(617) 919-4629
william.beardslee@childrens.harvard.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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