Treatment Adherence and Longitudinal Clinical Outcomes in an Effectiveness Evaluation of Community-Based Multi-Family Psychoeducational Psychotherapy for Childhood Mood Disorders
Year: 2015
Type: article
Abstract: Despite the existence of several psychosocial Evidence-Based Treatments (EBTs) for childhood mood disorders, limited research has examined the effectiveness of these interventions in practice settings.When EBTs are implemented in the community, they often demonstrate reduced effects compared with efficacy trials.This study examined effectiveness of community-based Multi-Family Psychoeducational Psychotherapy (MF-PEP), an eight-session, adjunctive group treatment for children with mood disorders.Forty-one children ages 7 to 12 with a depressive or bipolar spectrum disorder and their parents participated in six MF-PEP groups at three agencies over two years.Fourteen community therapists were trained in and facilitated MF-PEP.Adherence checklists were developed and sessions were audio-recorded and coded by undergraduate raters to evaluate inter-rater reliability and therapist adherence.Clinical outcomes measured via semi-structured assessment and parent/child questionnaires were collected at pretreatment, post-treatment, 6-month follow-up, and 12-month follow-up, and analyzed via hierarchical linear modeling.Numerous analyses were conducted to examine patterns of findings among adherence and clinical outcomes.Adherence checklists generally demonstrated adequate inter-rater reliability for items (overall kappa = .76)and scores (overall intraclass correlations for single/average measures = .89/.94), and therapists displayed satisfactory adherence (overall adherence percentages = 66.7% to 78.7%, iii Median = 71.1%).However, complicated therapeutic components and parent sessions evidenced lower reliability and adherence.Children experienced significant improvement in depressive and manic symptoms, and parents reported a significant increase in knowledge of mood disorders.MF-PEP was most impactful for children with bipolar spectrum disorders, who initially presented with more severe mood symptoms and demonstrated a significantly faster rate of improvement in symptoms and positive treatment beliefs than depressed youth.Parents of children with limited treatment history started MF-PEP with minimal understanding of mood disorder symptoms and treatment, but reported the largest improvement in knowledge.Attendance was generally not a predictor of outcome; however, children in more adherent groups started treatment with more severe mood symptoms, and children in groups that were more adherent to Review/Summary components demonstrated faster improvement in depressive symptoms.Overall effect sizes (Cohen's d) using means and standard deviations ranged from small to large for mood outcomes (d = 0.34 to 1.18), knowledge (d = 1.02), and treatment beliefs (d = 0.04 to 0.41).Preliminary results suggest MF-PEP may be effective in practice settings, particularly for children with bipolar spectrum disorders and parents of youth with limited treatment history.Adherence checklists demonstrated satisfactory reliability, suggesting usefulness as a quality assurance or supervision tool.Also, adequate therapist adherence suggests MF-PEP can be successfully implemented in community agencies, though additional training may be required for complex components and parent sessions.Finally, children who present with more severe mood symptoms may influence therapists to be more adherent to manualized EBTs, and iv Review/Summary components may be particularly important for ameliorating youths' depressive symptoms.Results should be interpreted within the context of study limitations, particularly the small sample, open design, missing data, and dichotomous adherence measurement.Nevertheless, findings are promising and indicate that MF-PEP may be an effective EBT for children with mood disorders and their parents in practice settings.v Dedication Dedicated to Ed and my family for their love and support.vi Acknowledgments First, I would like to thank my mentor, Dr. Mary A. Fristad.She has been a tremendous source of support and encouragement throughout this project and my graduate career.I have grown both professionally and personally thanks to her guidance.I could not have asked for a more wonderful advisor, and for that I am eternally
Author: Heather A. MacPherson
Institution: The Ohio State University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2524060039