Efficacy of Integrative Family and Systems Treatment: A Moderated Common Factor Approach for Treating at-Risk Children and Adolescents

Background and Purpose

Implementing and sustaining evidence-based family treatments for at-risk children and adolescents faces multiple challenges such as cost, potential model incompatibility with the agency’s culture and climate, as well as feasibility in terms of EBP that usually address specific client populations while community mental health agencies are required to provide services to families in need regardless of their presenting problems and diagnoses. Organized around common factors and meta-level treatment protocols, Integrative Family and Systems Treatment (I-FAST) provides a coherent and evidence-informed practice framework at the meta-level that allows flexibility for professionals in developing effective treatments in which they can integrate their existing skills and expertise in their unique setting with a wide variety of client populations and problems. This study examines the treatment outcomes of I-FAST as compared to treatment-as-usual (TAU) on child and family level outcomes. This study hypothesized that effective I-FAST treatment would lead to improved functioning, reduced problem severity in the child and improved family functioning in terms of family cohesion, adaptability, communication and satisfaction.

Method

This quasi-experimental study examined treatment efficacy of I-FAST as compared to treatment-as-usual (TAU) on child-and family-level outcomes. Participants included 80 families who have received I-FAST treatment and 27 families who have received TAU. All child clients have DSM diagnoses. The study assessed child level and family level outcomes at pre-treatment, six-weeks into treatment and at termination using The Ohio Scales and FACES IV. This study used repeated measures analysis of variance to assess within-subjects changes for both groups, and linear mixed model analyses for between-group comparisons.

Results

There were no significant differences between I-FAST group and TAU on baseline characteristics. Based on reports from parents and youth age 12 or above, findings indicated significant changes in I-FAST group and non-significant changes in TAU on child level outcomes of problem severity and functioning, family level outcomes of family cohesion and family satisfaction from pre-treatment to termination. Findings of between-group comparisons indicated significant treatment effects from pre-treatment to termination for child-level outcomes but not family-level outcomes between I-FAST and TAU. I-FAST group has significantly reduced problem severity than TAU based on parents’ report (B = -13.61, p < 0.05, [-21.71, -5.50]) and significantly improved functioning based on both parents and youth reports (parents B = 13.55, p < 0.05, [5.86, 21.23]; youths B = 14.27, p = 0.050, [-0.03, 28.57]).

Conclusion and Implications: By utilizing and building upon client, therapist and agency strengths and uniqueness, I-FAST could potentially provide a coherent yet flexible strength-based empowerment model for treating families with children who have received DSM diagnoses. Training professionals to develop skills in these common factors rather than the numerous different specific treatment models may be more realistic and relevant to the reality of daily practice at community mental health agencies. However, future research using a randomized controlled trial with representative samples is needed to develop more definitive evidence of the effectiveness of I-FAST as a moderated common factors approach as well as to refine the mechanisms of change related to it.