Pilot Effectiveness and Transportability Trial of Multi-Family Psychoeducational Psychotherapy (MF-PEP) for Childhood Mood Disorders in a Community Behavioral Health Setting

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Limited research has examined the effectiveness, transportability, and dissemination of Evidence-Based Treatments [EBTs], especially for children and adolescents (APA Task Force on EBP for Children and Adolescents, 2008; Barlow, Levitt, & Bufka, 1999; Higa & Chorpita, 2008; Kendall & Beidas, 2007). Even when EBTs are implemented in the real-world, psychotherapy has stronger effects in university-based research studies than in community settings (Weersing & Weisz, 2002). Multi-Family Psychoeducational Psychotherapy (MF-PEP) is an adjunctive, manual-driven, group-based EBT for children with mood disorders and their parents which has shown positive results in two randomized controlled efficacy trials (Fristad, Goldberg-Arnold, & Gavazzi, 2002, 2003; Fristad, Verducci, Walters, & Young, 2009; Goldberg-Arnold, Fristad, & Gavazzi, 1999; Mendenhall, Fristad, & Early 2009). The current study examined a pilot implementation of MF-PEP at two community behavioral health centers. Fifteen community therapists were trained in MF-PEP and completed questionnaires after sessions. Twenty community therapists self-selected to refer families and completed questionnaires following MF-PEP. Forty children aged 8 to 12 years (M = 10.15, SD = 1.23) with mood disorders and their parents were referred to MF-PEP and completed questionnaires pre- and post-treatment. Treatment effectiveness and response, consumer and provider satisfaction, and financial feasibility were examined. Paired pre-post data were available for 22 parents and 20 children (9 children for depressive symptom report). Data were analyzed via two-tailed, dependent-measures t-tests. Upon completion of therapy, parents showed significant increases in knowledge of mood disorders, t (21) = -3.36, p = .003, d = .60. Though all measures showed shifts in the hypothesized directions, significant differences were not found for: parental treatment beliefs, t (21) = -1.55, p = .14, d = .23; children’s treatment beliefs,t (19) = -0.84, p = .41, d = .22; children’s depressive symptoms, t (8) = 0.03, p = .98, d = .01; or children’s manic symptoms, t (21) = 0.36, p = .73, d = .08. Post-treatment satisfaction ratings were available for 26 parents and 24 children on a measure with a potential score range of 1 to 5 (5 indicated highest satisfaction). Parents (M = 4.43, SD = 0.52) and children (M = 4.04, SD = 0.68) reported high satisfaction with MF-PEP. Mean satisfaction scores were significantly larger than the neutral score of 3 for: parents, t (25) = 13.99, p < .001, d = 2.75; and children, t (23) = 7.55, p < .001, d = 1.54. Qualitative feedback from community therapists indicated high satisfaction with MF-PEP training and facilitation and as an adjunctive treatment. The agency did not break-even financially; however, MF-PEP is financially feasible given adequate number of therapists and families. The small sample size, sub-optimal data collection, and different follow-up assessment times between efficacy and effectiveness investigations hindered the power to detect statistically or clinically significant results. Preliminary results support the transportability and acceptability of the intervention. Future effectiveness trials using larger samples, a control comparison, and follow-up data are needed. Limitations of the current study and implications for effectiveness, transportability, and dissemination of MF-PEP are discussed.

Health & Well-Being
18 May