Utilizing Family Strengths and Resilience: Integrative Family and Systems Treatment (I-FAST) with Children and Adolescents with Severe Emotional and Behavioral Problems

Background and Purpose: Community mental health agencies are consistently challenged to provide realistic and effective home-based treatment that meets local needs and can realistically fit within available budget and resource capabilities. Agencies are required to use evidenced-based approaches for working with these families although most approaches (e.g., MST, FFT, MDFT, BSFT) were developed outside community mental health agencies and required considerable investment of time and resources, ongoing consultation, and reorganization of service delivery at the agency level. Integrated Family and Systems Treatment (I-FAST) is developed within the local mental health system and is based on existing evidence-based approaches and a strengths perspective for working with at-risk children and their families. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol that builds on and is integrated with mental health agencies existing expertise in home-based treatment.

Methods. This is an intervention development study that used a one-group pre- and post-test design with a six-month follow-up to examine the feasibility of I-FAST for treating families with children at-risk of out-of-home placement. The study included 77 families who completed I-FAST program and provided data at pre-treatment and termination. Among the 77 children, 64.9% were males and 35.1% females and their ages ranged from 4 to 17 (mean: 11.8, S.D. 3.3). All children had DSM -IV diagnoses with 48.4% having a diagnosis of Hyperactive Attention Deficit Disorder. Outcome variables of the study included children's out-of-home placement status, children's behavioral outcomes (The Ohio Scales, Olges Lambert, & Masters, 1996), family functioning (FACEII, Olson, Portner, & Bell, 1982), family participation in treatment (Family Participation Scale, Friesen, 2001), and parental competence (Parental Competence Scale, Campis, Lyman, & Prentice-Dunn, 1986). The study used repeated measures analysis of variance to assess the within-subjects changes from pre-treatment, termination, to 6-month follow-up. In addition, Wilcoxon signed-rank tests were used to assess the within-subject changes for categorical variables. The study used I-FAST Checklist for fidelity analyses. Findings of intra-class correlation showed a satisfactory level of inter-rater reliability. The ICC for therapeutic alliance was .84, for second-order change was .86, and for system collaboration was .88.

Results. Findings of the outcome study provide initial empirical evidence that I-FAST is effective in improving children's behavioral problems, reducing out-of-home placement, improving family functioning, enhancing parental competence in addressing problems in children, and facilitating family participation in treatment. There were significant improvements in all evaluated dimensions from pre-treatment to termination or 6-month follow-up, and the children or families were able to maintain their positive changes at 6-month follow-up.

Significance: I-FAST can provide a feasible alternative home-based treatment model that is developed within the local mental health system, addresses challenges of cost containment, facilitates the continuation of expertise in home-based treatment at the agency level, and meets the realities of practice demands to serve families with children at risk of out-of-home placement. A more rigorous research design with random assignment, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.