To describe providers&amp... more To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns.
OBJECTIVES: The goals were to develop and to validate the Internet-based, Behavioral Health Scree... more OBJECTIVES: The goals were to develop and to validate the Internet-based, Behavioral Health Screen (BHS) for adolescents and young adults in primary care. METHODS: Items assessing risk behaviors and psychiatric symptoms were built into a Internet-based platform with broad functionality. Practicality and acceptability were examined with 24 patients. For psychometric validation, 415 adolescents completed the BHS and well-established rating scales. Participants recruited from primary care waiting rooms were 12 to 21 years of age (mean: 15.8 years); 66.5% were female and 77.5% black. RESULTS: The BHS screens in 13 domains by using 54 required items and 39 follow-up items. The administration time was 8 to 15 minutes (mean: 12.4 minutes). The scales are unidimensional, are internally consistent (Cronbach's α = 0.75–0.87), and discriminate among adolescents with a range of diagnostic syndromes. Sensitivity and specificity were high, with overall accuracy ranging from 78% to 85%. Patien...
Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014) is an empirically supported tre... more Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014) is an empirically supported treatment designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security. This therapy is grounded in attachment and emotional processing theory and provides an interpersonal, process-oriented, trauma-informed approach to treating adolescents struggling with suicide and associated problems such as depression and trauma. ABFT offers a clear structure and road map to help therapists quickly address the attachment ruptures that lie at the core of family conflict, which can fuel adolescent distress. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanisms of change. In this paper, we provide an overview of the theories underlying the model, the clinical strategies that guide the treatment, the outcome research that demonstrates efficacy, and the process research that explores the proposed mechanisms of change.
In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment... more In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed c... more Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers' experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers' belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.
Australian and New Zealand Journal of Family Therapy
The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 2... more The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment-Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence-based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case.
Australian and New Zealand Journal of Family Therapy, 2016
In Australia the movement toward evidence based practice was supported by the first National Ment... more In Australia the movement toward evidence based practice was supported by the first National Mental Health Strategy. For mental health clinicians the shift from evaluating process to outcome measurement also brought greater focus on specific disorders and targeted interventions, raising questions about the efficacy and effectiveness of treatment. The gap between research and practice is well documented, and has engendered much debate particularly in regard to empirically supported treatments (ESTs) and the technologies to widely disseminate practice whilst supporting treatment adherence. In this paper we first, describe the Attachment Based Family Therapy (ABFT) model before giving consideration to the criticisms of ESTs, and reviewing the dissemination of ABFT in Australia, and the perspectives of Australian clinicians in respect to the model and its relevance to their practice. Finally, we turn to the mission of this Special Issue which is to increase the awareness of ABFT primarily amongst practicing clinicians as we introduce the selected papers that demonstrate the application of the model to a variety of clinical presentations, and clinical settings
Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitali... more Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.
Australian and New Zealand Journal of Family Therapy, 2016
Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and we... more Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment-Based Family Therapy (ABFT) with FBT, and argue that ABFT's focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent-child relational ruptures.
To describe providers&amp... more To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns.
OBJECTIVES: The goals were to develop and to validate the Internet-based, Behavioral Health Scree... more OBJECTIVES: The goals were to develop and to validate the Internet-based, Behavioral Health Screen (BHS) for adolescents and young adults in primary care. METHODS: Items assessing risk behaviors and psychiatric symptoms were built into a Internet-based platform with broad functionality. Practicality and acceptability were examined with 24 patients. For psychometric validation, 415 adolescents completed the BHS and well-established rating scales. Participants recruited from primary care waiting rooms were 12 to 21 years of age (mean: 15.8 years); 66.5% were female and 77.5% black. RESULTS: The BHS screens in 13 domains by using 54 required items and 39 follow-up items. The administration time was 8 to 15 minutes (mean: 12.4 minutes). The scales are unidimensional, are internally consistent (Cronbach's α = 0.75–0.87), and discriminate among adolescents with a range of diagnostic syndromes. Sensitivity and specificity were high, with overall accuracy ranging from 78% to 85%. Patien...
Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014) is an empirically supported tre... more Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014) is an empirically supported treatment designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security. This therapy is grounded in attachment and emotional processing theory and provides an interpersonal, process-oriented, trauma-informed approach to treating adolescents struggling with suicide and associated problems such as depression and trauma. ABFT offers a clear structure and road map to help therapists quickly address the attachment ruptures that lie at the core of family conflict, which can fuel adolescent distress. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanisms of change. In this paper, we provide an overview of the theories underlying the model, the clinical strategies that guide the treatment, the outcome research that demonstrates efficacy, and the process research that explores the proposed mechanisms of change.
In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment... more In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed c... more Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers' experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers' belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.
Australian and New Zealand Journal of Family Therapy
The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 2... more The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment-Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence-based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case.
Australian and New Zealand Journal of Family Therapy, 2016
In Australia the movement toward evidence based practice was supported by the first National Ment... more In Australia the movement toward evidence based practice was supported by the first National Mental Health Strategy. For mental health clinicians the shift from evaluating process to outcome measurement also brought greater focus on specific disorders and targeted interventions, raising questions about the efficacy and effectiveness of treatment. The gap between research and practice is well documented, and has engendered much debate particularly in regard to empirically supported treatments (ESTs) and the technologies to widely disseminate practice whilst supporting treatment adherence. In this paper we first, describe the Attachment Based Family Therapy (ABFT) model before giving consideration to the criticisms of ESTs, and reviewing the dissemination of ABFT in Australia, and the perspectives of Australian clinicians in respect to the model and its relevance to their practice. Finally, we turn to the mission of this Special Issue which is to increase the awareness of ABFT primarily amongst practicing clinicians as we introduce the selected papers that demonstrate the application of the model to a variety of clinical presentations, and clinical settings
Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitali... more Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.
Australian and New Zealand Journal of Family Therapy, 2016
Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and we... more Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment-Based Family Therapy (ABFT) with FBT, and argue that ABFT's focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent-child relational ruptures.
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