Using the CBPR to Develop and Test a Sustainable Model of Family Therapy for Community Mental Health

Background and significance: The low income families seen in community mental health settings rarely present with a single symptomatic individual. Although most have multiple psychological and family problems, there are few clinicians with family therapy skills prepared to meet their needs, especially in rural areas. Our previous work has documented high levels of unmet mental health need among mothers who seek behavioral health treatment for their children, suggesting that family therapy could be an effective and efficient way to address maternal and child problems simultaneously. Additionally, the agency was actively seeking to expand its ability to offer family therapy, making the development and testing of a family therapy model an appropriate target for the collaboration. This paper describes shared work to adapt a model of Structural Family Therapy for community mental health settings. Structural Family Therapy was developed as one of the first family models of intervention, and its basic principles and strategies have been integrated into many different approaches to family therapy under different names. With this work we also aimed to jointly develop sustainable techniques for providing training, and for rigorously testing, the resulting treatment model. Method. A university researcher and an agency director, both expert in Structural Family Therapy, summarized the core elements of the model, and developed a preliminary manual and training plan. Participants in the training group included five agency clinicians who volunteered to contribute to finalizing the model, modifying the training, and delivering the treatment. This group met twice monthly for six months. At each meeting core elements of the treatment were presented, and discussion focused on the applicability of both the treatment and training models to community mental health. A second training with similar elements has been undertaken with the Director of the Marriage and Family Treatment Program from Seton Hill University as part of their course work and practicum, allowing the proposed treatment and testing models to be further refined. Results: These experiences have resulted in a standardized training program that introduces the core elements of Structural Family Therapy, including principles of assessment, treatment planning, and intervention. Didactic lectures have been minimized in favor of using videotapes and role plays to teach the identification of dysfunctional patterns and sequences of family interaction, boundaries and hierarchies, enacting and reframing skills, and joining/engaging processes. Based on the immediate needs of clinicians in the field, we reversed the traditional order of training, by first presenting hands-on skills, and then later adding discussion of relevant theory. The work has also allowed us to begin to develop approaches to measuring treatment fidelity and comparison groups that will be appropriate for testing of the model in the community setting. Conclusions and implications. This paper illustrates a number of principles important to the collaboration. Sharing all phases of the work sets the stage for bridging the rigor/relevance gap by creating treatments that can be trained and delivered in community mental health settings, and for which appropriate effectiveness tests can be designed.