Family Based Mental Health Services (FBMHS) with an embedded clinical model, Ecosystemic Structural Family Therapy, is an intervention designed for youth with a serious emotional disturbance (SED) who are at risk of out-of-home placement. The current evaluation examines the association between receipt of FBMHS and rates of out-of-home and community-based care during and after an episode of FBMHS. We identified 25,016 Medicaid-enrolled youth ages 3 to 17 years with receipt of a new FBMHS episode from 1/1/2015 to 6/30/2021. 14

The main aim of this study was to evaluate the effectiveness of Pennsylvania’s state-wide intensive in-home treatment for youth with serious emotional disturbance (SED), EcoSystemic Structural Family Therapy-Family Based Mental Health Services (ESFT-FBMHS). Despite its long history of implementation, the program remains empirically under-evaluated. In this archival study, out-of-home placement and youth functioning outcomes were compared across four tiers of length of stay. Given the high-risk population treated in ESFT-FBMHS, it was hypothesized that the families and youth who completed the full duration of treatment (169–224 days) would have better outcomes than those who stopped treatment after 168 days or less. We utilized an ex post facto quantitative research design analyzing archived medical claims data of 2251 youth treated between 2018 and 2022 to assess out-of-home placement rates and analyzed archived data from six domains of the Child and Adolescent Needs and Strengths (CANS; Problem Presentation, Risk Behaviors, Functioning, Child Safety, Caregiver Needs, and Child Strengths) to assess changes in youth functioning post-discharge (90 and 180 days). An analysis using generalized estimating equations (GEE), controlling for potential confounding variables such as demographics and clinical features, suggest that length of stay in ESFT-FBMHS was significantly associated with out-of-home placement and youth improvement on the CANS at both 90- and 180-days post-discharge. As a group, youth with SED who did not complete the full duration of the program had 2–3 times the odds of out-of-home placement at 90 days post-discharge and 1–3 times the odds at 180 days post-discharge as compared to program completers. CANS scores showed improvement in 40.1

Adverse childhood experiences, especially with primary caregivers, impacts the mental, physical, and relational health of individuals (Felitti et al. in Am J Prev Med, 14(4):245-258. https://doi.org/10.1016/s0749-3797(98)00017-8 , 1998). Therefore, caregiver adversity is important to consider when delivering therapeutic interventions to children (Gardner et al. in Clin Soc Work J 42(1):81-89. https://doi.org/10.1007/s10615-012-0428-8 , 2014; Eslinger et al. in J Child Fam Stud 24(9):2757. https://doi.org/10.1007/s10826-014-0079-1 , 2015; Hagan et al. in J Trauma Stress 30(6):690-697, 2017). This study analyzed archival data to understand the role of caregiver adversity in Eco-Systemic Structural Family Therapy (ESFT) outcomes, within Family Based Mental Health Services. Results indicate caregiver lifetime adversity score did not predict treatment outcome. However, caregiver current adversity and family length of stay were negatively correlated as were length of stay and client discharge level of care. These findings suggest that ESFT benefits families regardless of caregiver childhood adversity level and that clinician attention to caregiver current adversity is important to ensure families receive the full benefits of ESFT. Implications for optimizing ESFT and future directions for ESFT clinical research are discussed.

The 2020 COVID-19 pandemic and resulting stay at home orders halted face-to-face in-home therapy for youth at risk of out-of-home placement in Pennsylvania and Delaware. Three family therapy training centers collaborated with state officials managed care organizations, and supervisors to create a two-step process for orchestrating an abrupt, unwanted shift to technology-assisted intensive in-home family therapy. The first step encouraged supervisors to set the stage for this change through an ethics-based lens. The central tenet was to tenaciously advance the wellbeing of the child and their family. The second step encouraged supervisors to remain grounded in the basic principles of treatment and supervision that they followed before telehealth, but with a few adaptations. Three principles are emphasized. Principle one focused on securing clinician commitment to a adapting a family therapy model to a telehealth format. Principle two focused on an unremitting adherence to a preferred family therapy model by using a checklist adapted for technology-based challenges. Finally, principle three focused on fostering professional competence through attending to case conceptualization, supervision-based practice, person-of-the-self challenges, and family-clinician-supervisor isomorphic patterns. Two case examples illustrate the beginning and ending phases of technology-assisted intensive in-home family therapy. Based on feedback from in-home agencies, implementation of these two-steps helped supervisors effectively lead pandemic-induced, practice-based change to a telehealth format with intentionality, conviction, and self-efficacy.

Abstract An aspect of reframing interventions that is crucial in facilitating family members' acceptance of new frames, but which is often neglected in clinical case reports, is frame cultivation. This paper describes frame cultivation as a focused interactional process during which therapists systematically punctuate data that is consistent with a new frame of meaning before explicitly labeling it with the family. Focused questions, metaphors, and behavioral enactments are described as useful tactics in cultivating these new frames. The emphasis on frame cultivation is based on notions borrowed from both cognitive and interactional literatures regarding the organization of meaning and how social information is processed.

It is the thesis of this paper that there are some problem contexts in which the risk for either no‐response or negative effects of therapy are considerably greater than the probability of positive outcomes, despite the competence level of the therapist or special characteristics of the client system. It is these contexts that warrant the inclusion of a no‐treatment option among therapists' current range of treatment choices. Rather than turning client systems away in an absolute sense, however, no‐treatment is presented as a frame in which therapists are not obligated to help change a problem but may continue to have some form of contact with the client‐system. Four no‐treatment prescriptions are presented that can be employed strategically either (a) to increase available opportunities for therapist leverage within a problem context, or (b) to amplify competence in pivotal family members when the problem context demands immediate competent responses. Case studies are presented to highlight the contextual information used in making no‐treatment decisions.

Juvenile and Family Court JournalVolume 36, Issue 1 p. 37-45 Problem Formulation in Juvenile Court Interventions With Unruly Children and Their Families C. Wayne Jones M.A., Corresponding Author C. Wayne Jones M.A. Doctoral candidate in clinical child and family psychology at Georgia State University in Atlanta323 S. 46th St. Philadelphia, PA 19143Search for more papers by this author C. Wayne Jones M.A., Corresponding Author C. Wayne Jones M.A. Doctoral candidate in clinical child and family psychology at Georgia State University in Atlanta323 S. 46th St. Philadelphia, PA 19143Search for more papers by this author First published: February 1985 https://doi.org/10.1111/j.1755-6988.1985.tb01797.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume36, Issue1February 1985Pages 37-45 RelatedInformation