A Review of the Evidence

Evidence‐based Synthesis Pro

(ESP)

Family Involved Psychosocial Treatments 

Mental Health Conditions Conditions

A Review of the Evidence

Laura A. Meis, PhD

Core Investigator

Center for Chronic Disease Outcomes Rese

Minneapolis Minneapolis VA Healthcare Healthcare System

June 18, 2012
Evidence‐based Synthesis Pro

(ESP)

Ak l c now edgements

Co-Authors Expert Panel/Revi

o Joan M Griffin PhD Joan M. Griffin, PhD o Sonja Batten PhD Sonja Batten, PhD o Nancy Greer, PhD o Lisa Brenner, PhD 

o Agnes C. Jensen, BS o Lisa Dixon, MD, MP

o R do erick M acDonald, MS o J ho n Fai b PhD rbank, PhDo Maureen Carlyle, MPH o Shirley Glynn, PhD 

o Indulis Rutks, BS o Susan McCutcheon

o Timothy J. Wilt, MD, MPH o Josef Ruzek, PhD 

o Steven Sayers, PhD 
Evidence‐based Synthesis Pro

(ESP)

Disclosure

This report is based on research research conducted conducted by the Evidence Evidence‐based 

Program (ESP) Center located at the Minneapolis VA Healthcare Sys

Minneapolis, Minnesota, funded by the Department of Veterans Af

Health Administration Administration, Office of Research Research and Development Development, Qualit

Qualit

Enhancement Research Initiative. The findings and conclusions in t

are those of the author(s) who are responsible for its contents; the 

conclusions conclusions do not necessarily necessarily represent represent the views of the Departm

Departm

Affairs or the United States government. Therefore, no statement 

should be construed as an official position of the Department of Ve

No investigators estigators have any affiliations affiliations or financial financial involvement (e.g., 

consultancies, honoraria, stock ownership or options, expert testimpatents received or pending, or royalties) that conflict with materia

the report.
a e as o o o e e ea a d ea 

Evidence-based Synthesis Progra

(ESP) 

VA Evidence-based Synthesis (

Program Overview Program Overview 

• Sponsored by VA Office of Research & Development, Q

Enhancement Research Initiative (Q ) UERI

).

• Established to provide timely and accurate syntheses/

healthcare topics identified by VA clinicians, managers m

a

k

e

rs, ey as they w

ork t

o im

p 

r

o

v

e th

e health 

a

n

d health

Veterans. 

• Builds on staff and expertise already in place at the Ev

based Practice Centers (EPC) designated by AHRQ. based Practice Centers (EPC) designated by AHRQ. Fo

Fo

EPCs are also ESP Centers: 

o Durham VA Medical Center; VA Greater Los Angeles Healt

System; Portland VA Medical Center; and Minneapolis VA System; Portland VA Medical Center; and Minneapolis VA 

Center. 
Evidence‐based Synthesis Pro

(ESP)

• Provides evidence syntheses on important clinical practice to

to Veterans, and these reports help:

o develop cli i l n ca poli i c es i f n ormed by evidence,o the implementation of effective services to improve 

outcomes and to support VA clinical practice guidelin

performance measures, and

o guide the direction for future research to address gap

knowledge.

• Broad topic nomination process – e.g. VACO, VISNs, field – fa

ESP Coordinating Center (Portland) through online process:

http://www.hsrd.research.va.gov/publications/esp/TopicNomin
;

Evidence‐based Synthesis Pro

(ESP)

• Steering Committee representing research and operations (PC

and VISN) provides oversight and guides program direction.

• Technical Advisory Panel (TAP)

o Recruited for each topic to provide content expertise

o Guides topic development; refines the key questions

o Reviews data/draft report.

• External Peer Reviewers & Policy Partners

o Reviews Reviews and comments comments on draft report

• Final reports posted on VA HSR&D website and disseminated 

through the VA.

http://www.hsrd.research.va.gov/publications/esp/reports
Evidence‐based Synthesis Pro

(ESP)

Current Report

Family Involved Psychosocial Treatments Fo

M t en al H lth ea C diti on ons

A Review of the Evidence Evidence

June, 2012

F ll u ‐length report available on ESP web it s e:

http://www.hsrd.research.va.gov/publications/esp/reports
Family Involved Psychosocial Treatments

Overview 

1. Need for Review Need for Review 2. Key Questions 3. Search Strategy 4. Analyses and Approach 5. Results 

• Describe RCTs Broadly Describe RCTs Broadly • Address Key Question 1 by Condition • Address Key Question 2 by Condition 

6. Summarize 

7. Limitations 

8. Future Research Future Research 
Poll Question Question #1

What is your primary roll in the VA?1. Student, trainee, or fellow 2. Clinician 3. Researcher 4. Manager or other policy maker Manager or other policy maker 5. Other 
Family Involved Involved Psychosocial Psychosocial Treatme

Treatme

Rationale

•Shifts in VA Care 

o Greater emphasis on including families o Expanding VA authority to provide family services Expanding VA authority to provide family services 

•Need to Identify 

o Efficacious and promising family interventions o Which family interventions are superior to alternative 

(individually-oriented or family -oriented)

o Physical and Mental Health 
Poll Question Question #2

My k l f b d f 

nowledge of evid ence based fam

treatments for mental health condi

• This is my first exposure • Novice • Moderately familiar • I have training in family mental health treatment(s

• I deliver or research family mental health treatmen
Present Study

Key Questions

Key Question 1: Eff icacy • Wh i h ffi f f il i l d i 

What is the efficacy of family involved interv

in improving outcomes for adult patients wit

health conditions health conditions 

o compared to no psychosocial treatment: (a) wait

compared to no psychosocial treatment: (a) wait

treatment or (b) medication management only 
Present Study

Key Questions

Key Question 2: Specificity • Wh i h ff i What is the effectiveness of f il i l d family involved 

interventions compared to alternative interv

in improving outcomes for adult patients win improving outcomes for adult patients w

health conditions 

o compared to any (a) individually-oriented or (b) 

family-oriented py s chosocial intervention 
t 

Analytic Analytic Framework Framework with Patie

Patie

Caregiver) Focused Outcom

Population 

Intermediate 

Intervention: Outcomes

p Family involved 

Adults with a 

mental 

health 

condition 

and their 

1. Treatment attendance/ 

adherence 

2. Social support for 

Family involved 

care 

and their 

family 

members 

pp 

patients 

3. Patient satisfaction 

Comparators: KQ1. No psychotherapy KQ 2. Alternativetreatment (individual or family) 

Adverse 

Effects 

Patie1. S

ii

2. Q3. UFam1. F

2. R 

R

f

Post

term 

follo
Search Strategy

• Literature Search:

– MEDLINE and PsycINFO– Search terms i ld nc u ed:

• family, couples, home nursing, legal guardians, gran

OR

• couple therapy, family therapy, and marital therapy

• Inclusion Criteria • Exclusion C

o 1996 to Nov 2011 o Age < 18 o English o Non-US stuo RCT/RCT review o No outcomo Family-involved psychosocial interest 

t trea ment o N t o a cond

interest o Mental health condition 
Analyses

For all interventions, we rated their efficacy, strengt

evidence, and quality of each RCT

Efficacy

• Efficacious and specific: superior in at least 2 RCTs cond

by independent research teams compared to placebo,

nonspecific nonspecific, or an alternative alternative intervention intervention

• Efficacious: superior in at least 2 RCTs conducted by

independent research teams compared no psychosocia

treatment

• Possibly efficacious or possibly efficacious and specific

criteria are met by a 1 study
Analyses

Study Quality (fair, good, poor)• Allocation concealment, blinding, intention‐to‐treat analysis, rep

withdrawals/drop‐outs (Higgins, 2011)

• Treatment integrity: Use of manuals, supervision, fidelity to manStrength of E id v ence (low, moderate, high):• Confidence that the evidence reflects true effect and additional r

unlikely to change estimate of the effect (Owens, 2010)

Pooled analyses• Bh i l e avioral couples therapy for sub ts ance use

• Weighted mean differences and Hedges’ g adjusted for sample si

random‐effects model (.2 small, .5 medium, .8 large effect size)
Literature Literature Search Result

Result

Screening: 2,469 abstracts r(excluded 2 025), ; 444 full text 

reviewed 

Full Text Review: 444 articl(excluded 397); hand search/acorrespondence add ed4 

Included: 51 articles 

39 unique R39 unique R
Overview Overview of RCTs

Unique 

Mental Health Condition Trials 

Substance Use Disorders 22 Bipolar 6 Schizophrenia Spectrum 4 

Posttraumatic Stress Disorder (PTSD) 2 Erectile Dysfunction 2 

Depression 1 Binge Eating Disorder 1 

Nicotine Dependence 1 Total 39 

NR = not reported 
Overview Overview of RCTs

21 different active family treatments Most of fair quality 

o 10 good, 20 fair, 9 poor 

Exclusions 

• Active psychosis, suicidality, intimate partner vi

pregnancy or counter-indicated medical conditi

medication was required (e g psychotic disordmedication was required (e.g., psychotic disord

functioning) 

• Dual substance use disorders 

KQ1 (efficacy): 8 with waitlist or medication only 

KQ2 (specificity): 33 with an alternative intervent

si il m arly, or more intensive)
t t t t

Key Question 1: Efficacy

vs Waitlist or Medication

Mixed evidence with non-significant finding

findings favoringfamil y treatment across 

mental health conditions 

I d d i l dj Improved symptoms and marital adjustment • Depression (1 trial) 

• Brief,disorder specific, co gnitive behavioral couple t

Improved initiation/attendance • 2 trials: PTSD and substance use 2 trials: PTSD and substance use 

• Family involving in aftercare planning while in detox • Coffee and Family Education and Support groups (CA
• 

t t t

t

Key Question 1: Efficacy

vs Waitlist or Medication

No differences in symptoms • Bipolar disorder (2 trials) 

• B t eter global f unctioning and medi cation adh ere

• Distressed families: lower mood episodes 

• Erectil e dysfuncti on (2 t rials)

• Greater satisfaction with treatment 

• PTSD (1 i PTSD (1 trial) 

• Initially better outcomes erode with time

Higher drop out Higher drop out 

• Binge eating disorder (1 trial) 

• Lower binge eating but similar to individually Lower binge eating, but similar to individually -o

o

intervention 
y p g 

Key Question 2: Specificity

Substance Use Disorders

Substance use disorders (21 trials) • BFT or BCT (16 trials) 

• Pooled analyses comparing BCT/BFT to individu

• 9 pooled on substance use outcomes (percent da

abstinent) 

• 10 pooled on relationship adjustment (Dyadic Ad

10 pooled on relationship adjustment (Dyadic Ad

Scale) 

• CRAFT (3 trials) CRAFT (3 trials) • Single trial interventions (2 trials) 
, 

Key Question 2: Specificity

Substance Use Disorders

BCT/BFT versus individual thera

Slower rate of relapse for the BCT/BFT 

• Intervention effects eroded more slowly 

Meta-Analyses 

• BCT/BFT greater days abstinent post treatment, sh

long term follow-up compared to individually-orient

• Post: weighted mean difference (WMD) = 4.43% da

95% CI = 2 16 6 70 2.16, 6.70 

• 6 months: WMD = 11.21% days abstinent, 95% CI • 12 months: WMD = 11.93% days abstinent, 95% C
Key Question 2: Specificity

Substance Use Disorders

Sensitivity Analysis 

Weighted Mean Difference between BCT/BF

Individual Treatment 

Difference in Days Use Post 6m 

Per month (all trials)1 Per month (other labs)2 Per year (all trials)1 y ( Per year (other labs)2 19 trials; 22 trials; 31 trial
Key Question 2: Specificity

Substance Use Disorders

Sensitivity Analysis 

Weighted Mean Difference between BCT/BF

Individual Treatment 

Difference in Days Use Post 6m 

Per month (all trials)1 1.3 3.Per month (other labs)2 3.8 4.Per year (all trials)1 y ( 16.2 40Per year (other labs)2 46.4 4919 trials; 22 trials; 31 trial
Key Question 2: Specificity

Substance Use Disorders

Sensitivity Analysis 

Weighted Mean Difference between BCT/BF

Individual Treatment 

Difference in Days Use Post 6m 

Per month (all trials)1 1.3 3.Per month (other labs)2 3.8 4.Per year (all trials) y ( 1 16.2 40Per year (other labs)2 46.4 4919 trials; 22 trials; 31 trial
Key Question 2: Specificity

Substance Use Disorders

Relationship Adjustment Outcome

• Significant group differences favoring BCT at all time 

Indicator Post 6m 

BCT Average DAS1 I di id l Th A DAS1 Individual Therapy Average DAS1 Effect Size C fid I t l Confidence Interval Note. Below 97.5 used as a screen for relationship distress (scores rangChristenson et al 2004) Christenson et al. 2004). 1Weighted Means Weighted Means. 
Key Question 2: Specificity

Substance Use Disorders

Relationship Adjustment Outcome

• Significant group differences favoring BCT at all time 

Indicator Post 6m 

BCT Average DAS1 112.7 106I di id l Th A DAS1 Individual Therapy Average DAS1 100 5. 93 Effect Size 0.75 0.7C fid I t l Confidence Interval 0 56 . -0 93 . 0 52 . -Note. Below 97.5 used as a screen for relationship distress (scores rangChristenson et al 2004) Christenson et al. 2004). 1Weighted Means Weighted Means. 
Key Question 2: Specificity

Substance Use Disorders

Relationship Adjustment Outcome

• Significant group differences favoring BCT at all time 

Indicator Post 6m 

BCT Average DAS1 112.7 106I di id l Th A DAS1 Individual Therapy Average DAS1 100 5. 93 Effect Size 0.75 0.7C fid I t l Confidence Interval 0 56 . -0 93 . 0 52 . -Note. Below 97.5 used as a screen for relationship distress (scores rangChristenson et al 2004) Christenson et al. 2004). 1Weighted Means Weighted Means. 
Key Question 2: Specificity

Substance Use Disorders

Relationship Adjustment Outcome

• Significant group differences favoring BCT at all time 

Indicator Post 6m 

BCT Average DAS1 112.7 106I di id l Th A DAS1 Individual Therapy Average DAS1 100 5. 93 Effect Size 0.75 0.7C fid I t l Confidence Interval 0 56 . -0 93 . 0 52 . -Note. Below 97.5 used as a screen for relationship distress (scores rangChristenson et al 2004) Christenson et al. 2004). 1Weighted Means Weighted Means. 
Key Question 2: Specificity

Substance Use Disorders

BCT Alterations• BFT vs. individual therapy (2 trials)

– One trial found no differences differences in substanc

substanc

– The other trial favored BFT at 18 months

• differences eroded at 30 months

• BCT vs. brief BCT (2 trials)

– outcomes largely similar
Key Question 2: Specificity

Substance Use Disorders

Some BCT Alterations and Subgroups

BCT vs. BCT + relapse prevention (2 trials)

• One trial found no differences• The other trial, a Veteran Veteran study, BCT + relapse relapse pre

pre

superior on substance use 18 months posttreatme

– Differences eroded at 30 months

– For BCT alone: relationship adjustment improved f

through 12 months

– For BCT + relapse relapse prevention: prevention: relationship relationship adjustm

adjustm

improved from pre through 24 months

– Strongest difference among distressed couples
Key Question 2: Specificity

Substance Use Disorders

CRAFT (3 trials) • Compared to alternative family interventions 

o Improves initiation by 30 to 48% o No significant difference in substance use (2 tro No significant difference in couple/family functi

No significant difference in couple/family functi

trials) 

2 Additional Opioid Interventions 2 Additional Opioid Interventions • Greater heroin use and less partner support a

with dual using, treatment seeking, pregnant with dual using, treatment seeking, pregnant 

• Improved family functioning but not substance 

among opioid users 
= = = = 

Substance Use Disorders

Initially Efficacious and/or Spe

Family Intervention Family Intervention Comparator Comparator Outcome Outcome 

ND = No Differences; ND No Differences; 1 = Efficacious & Specific; 2 = Efficacious; 3 = 1 Efficacious & Specific; 2 Efficacious; 3 Possibly Efficacious & 

Efficacious & 

Possibly Efficacious (1 study); Moderate = moderate confidence evidence reflects true effect

evidence reflects true effect. a7 of 9 trials conducted by a single laborato
Substance Use Disorders:

I i ntia yll Effi cacious and/or

Specific

Famil

y Intervention Com

parator Outcome 

Substance Use 

BCT Individual Behavioral Therapy Relationship Adjustment 

Substance Use Substance Use 

BCT + relapse prevention BCT Relationship Adjustment 

Substance Use 

BFT Individual Behavioral Therapy 

Family Functioning 

ND = No Differences; Differences; 1 = Efficacious & Specific; 2 Efficacious & Specific; 2 = Efficacious; Efficacious; 3 = 

Possibly Efficacious & 

Efficacious & 

Possibly Efficacious (1 study); Moderate = moderate confidence evidence reflects true effect. 

evidence reflects true effect. a7 of 9 trials conducted by a single laborato
C te at e a eat e ts

Substance Use Disorders:

I i ntia yll Effi cacious and/or Specific

FamilyIntervention Comp arator Outcome 

Substance Use 

BCT Individual Behavioral Therapy 

Relationship Adjustment 

Substance Use Substance Use 

BCT + relapse prevention BCT Relationship Adjustment 

Substance Use 

BFT Individual Behavioral Therapy Individual Behavioral Therapy 

Family Functioning 

Substance Use 

CRAFT Alternative Family Treatments Family gFunctioning 

Treatment Initiation 

Family aftercare for detox Detox only 

Substance Use 

Treatment Engagement Treatment Engagement 

Couple counseling, contingency 

management, & Naltrexone 

Contingency management & 

naltrexone 

Substance Use 

Family Functioning 

ND = No Differences; 1 = Efficacious & Specific; 2 = Efficacious; 3 = Possibly Efficacious & 

Possibly Efficacious (1 study); Moderate = Moderate confidence evidence reflects true effect. 

evidence reflects true effect. a7 of 9 trials conducted by a single laborato
C te at e a eat e ts

Substance Use Disorders:

I i ntia yll Effi cacious and/or Specific

FamilyIntervention Comp arator Outcome 

Substance Use 

BCT Individual Behavioral Therapy 

Relationship Adjustment 

Substance Use Substance Use 

BCT + relapse prevention BCT Relationship Adjustment 

Substance Use 

BFT Individual Behavioral Therapy Individual Behavioral Therapy 

Family Functioning 

Substance Use 

CRAFT Alternative Family Treatments Family gFunctioning 

Treatment Initiation 

Family aftercare for detox Detox only 

Substance Use 

Treatment Engagement Treatment Engagement 

Couple counseling, contingency 

management, & Naltrexone 

Contingency management & 

naltrexone 

Substance Use 

Family Functioning 

ND = No Differences; 1 = Efficacious & Specific; 2 = Efficacious; 3 = Possibly Efficacious & 

Possibly Efficacious (1 study); Moderate = Moderate confidence evidence reflects true effect. 

evidence reflects true effect. a7 of 9 trials conducted by a single laborato
Key Question 2: Specificity

Bipolar Disorder (5 trials)

Family Focused Treatment (FFT) superior to 

intensive but no different from equally int

i t ti interventions 

FFT or FFT FFT or FFT -Health Promoting Intervention (FFT Health Promoting Intervention (FFT -HP

HP

• Better symptom response than alternative, less inten

interventions (2 trials) 

• Mi d diff ixed differences wi h i ithndivid ual t di herapy (2 i tr als)General Family Therapy vs Disorder Specific Multif

Family Therapy vs. Disorder Specific Multif

Groups: 1 trial 

• No differences in recovery rates 
Bipolar Disorder:

Initially Efficacious and/or Sp

Family Intervention Comparator Outcome Ef

FFT Health Promoting Health Information DVDs Symptoms 

Crisis Management with 

In-Home Family 

Sessions 

Symptoms 

FFT 

Individual 

Psychoeducation Symptoms 

Cognitive Behavioral 

Therapy Symptoms 

Interpersonal and Social 

Rhythm Therapy Symptoms 

Note . ND No Differences; = No Differences; 1 Efficacious & Specific; 2 Efficacious; 3 = Efficacious & Specific; 2 = Efficacious; 3 = Possibly Effi

Effi

study); 4 = Possibly Efficacious (1 study); Moderate = Moderate confidence evidence re

= Low confidence evidence reflects true effect. 
t t t t

Key Question 2: Specificity

Schizophrenia (4 trials)

Long Term Interventions with Complex Pat

Mixed Findings 

Multifamily Psychoeducational Groups vs Individu

Psychoeducational I (1 Intervention (1 trial) 

• Mixed findings 

• One year into treatment One year into treatment: Favored multifamily g

: Favored multifamily g

negative symptoms and 12% lower state hospi

• One year aft er 2 year treatment: N diff oerence

hospitalization or crisis care
Key Question 2: Specificity

Schizophrenia (4 trials)

Intensive vs. Less Intensive Family Interventions •No differences in 

• symptoms (2 trials), rates of hospitalization (2 

family adjustment (1 trial) 

•Significant differences favoring intensive treatments 

• Employment during 2 year treatment not by fin

assessment (1 trial) 

• Rates of family rejection (1 trial)

• Schizophrenia symptoms for dual diagnosis pat

Schizophrenia symptoms for dual diagnosis pat

(schizophrenia and substance use) but not lowsubstance use (1 trial) 
Schizophrenia:

Initially Efficacious and/or Specif

Family Intervention Comparator Outcome E

Symptoms 

Multiple Family Groups Standard individually Standard A H it li ti , individually- oriented care Any Hospitalization State 

Hospitalization 

Applied Family 

Management Family intervention 

Symptoms 

Family Adjustment 

P i R j i Patient Rejection 

Family Intervention for Family Intervention for 

Dual Disorder 

Short term Short term 

psychoeducation 

Schizophrenia 

Symptoms Substance Use 

Note. ND = No Differences; 1 = Efficacious & Specific; 2 = Efficacious; 3 = Possibly Effi

study); 4 = Possibly Efficacious (1 study); Moderate = Moderate confidence evidence re

= Low confidence evidence reflects true effect. 
Key Question 2: Specificity

Additional Single Trial Conditions (2 tri

PTSD • No significant differences in PTSD symptoms betw

exposure therapy with or without family therapy foVeterans 

• Higher rates of drop out Higher rates of drop out Binge EatingDisorde r • No differences between CBT for binge eating with 

spouse involvement (partner-assisted) 

Smoking among Pregnant Women • No differences between individually oriented or par

No differences between individually oriented or par

assisted treatment
Conclusions

Since 1995, literature largely underdeveloped o

substance use 

Outside of BCT and CRAFT, many trials did not compa

conditions on 

• Family/couple functioning 

• Treatment adherence

• Satisfaction with care Satisfaction with care 

Many studies evinced mixed findings either fav

family treatment of demonstrating non-signi

differences 
t 

Conclusions

Two Exceptions: Few negative effects • PTSD: E h di Exposure therapy + disord ifi er specific f amil y 

led to greater treatment drop out 

• Heroin use: Family intervention for male opioid us

pregnant opioid dependent treatment-seeking pat

greater heroin use and poorer support greater heroin use and poorer support 
Conclusions

Efficacious and Specific Interventions for Substa

BCT or BFT (16 trials) • Improves substance use and relationship adju

more than individual therapy more than individual therapy 

• Many trials in the same research group • Most trials excluded participants where family 

substance use disorder substance use disorder 
Conclusions

Efficacious and Specific Interventions for Substa

CRAFT (3 trials) • Improves treatment initiation (intermediate 

outcome) 

• Differences in substance and family functio

non-significant 

• CRAFT is designed in promote initiation 

• Should be paired with an evidence based treat

Should be paired with an evidence based treat

ensure adequate treatment response 
Conclusions:

Bipolar and Schizophrenia

FFT or FFT‐HPI (4 trials)• Better sy p m tom response than alternative, less inte

interventions (2 trials)

• Mixed differences with equally intensive, individual

interventions

• No family outcomes reportedSchizophrenia studies• Efficacy of family treatments established prior to th• Studies reviewed included complex cases (multiple 

problems), but provided little clarity regarding whic

interventions are best
p )

Conclusions

Limitations among Trials Revie

Most trials were 

• Fair to poor quality • Mostly white, male samples, under 40 years old • Excluded participants with co-occurring substance 

crisis, history of family/partner violence 

• Did not target or exclude participants with other co

problems or disorders (2 RCTs for schizophrenia recomplex cases for inclusion) 

• Did not report on Veteran status (3 exceptions) 

Applicability to Veterans and complicated patien

unknown 
Limitations

Studies published since 1996 • Few studies addressing KQ1 (efficacy) Studies conducted in the US • Additional work exists outside the US, but applicab

these trials to US Veterans unknown these trials to US Veterans unknown 

Only RCTs • Numerous family interventions in various stages of Numerous family interventions in various stages of

development and evaluation

Only patient outcomes of interest Only patient outcomes of interest • Caregiver interventions and family perspectives are 

important for further review 
Future Research

• RCTs with Veterans and understudied conditions• Family interventions interventions may be more effective effective with dist

dist

• RCTs addressing multiple problems/conditions with n

female, and older populations

• Preferences for individual versus family‐oriented trea

• Methods of motivating family and veterans for family 

• Alternative Alternative family and couple constellations constellations
Evidence‐based Synthesis Pro

(ESP)

Questions?

If you have further questions,

feel free to contact:

Laura Meis, PhD

612‐467‐4516

Laura.meis@va.gov

The full report and cyberseminar presentation is available on the E

http://www.hsrd.research.va.gov/publications/esp/