A Prospective Observational Study of Family-based Interventions for Children With Neuropsychiatric and/or Psychiatric Disorders
Condition: ADHD; Asperger Syndrome; Child Behavior Disorders
MeSH terms: Mental Disorders; Problem Behavior; Asperger Syndrome; Child Behavior Disorders
Study type: Observational

Summary: 
      The purpose of this study is to examine the feasibility and the effects of family-based
      interventions for children (aged 5-12) with neuropsychiatric and psychiatric disorders in
      Finnish health care settings.
    

Detailed description: 
      1. Introduction

           The role of the Social Insurance Institution of Finland (Kela) is to complement publicly
           funded Finnish health care delivery system. In 2003, the Finnish Ministry of Social
           Affairs and Health further defined that Kela fund mental health services for children
           under 16 years old should incorporate family oriented psychological counselling and
           multicomponent rehabilitation. The purpose of the present prospective observational
           study is to examine the feasibility and tentative effectiveness of a multi-systemic and
           multicomponent family interventions for 5-12 year-old children with neuropsychiatric
           symptoms. The present study design is defined by the following key characteristics: (a)
           it comprises the comparison of three clinically relevant interventions based on family
           therapeutic activities; (b) it involves a diverse population of participants from
           heterogeneous practice settings; and (c) intervention outcomes are defined relatively
           broadly. All study participants will be recruited in Finland. The research is also
           conducted in Finland by the Finnish research consortium. The research project is funded
           by the Health department of the Social Insurance Institution of Finland.

        2. Effectiveness of family-systemic interventions for children with mental health problems

           Empirical evidence supports the effectiveness of family-systemic and family-based
           interventions for children who may suffer from, for example, socio-emotional and
           developmental problems that relate to neuropsychiatric disorders such as ADHD and Autism
           Spectrum Disorder. Family-systemic interventions may, firstly, refer to a more
           traditional and distinct method of psychotherapy (i.e. family therapy) provided by a
           licensed therapist. Secondly, the family systemic and therapeutic approach has further
           influenced the development and implementation of specific licensed family-focused and
           empirically supported treatment program protocols (e.g. MST and MDFT). Thirdly, there
           are also specific behavioral and cognitive-behavioral parent training protocols
           available (e.g. PMTO and Triple P), which are considered a form of family-based
           approach. However, the rationale in parent training protocols stems more solely from
           social learning theory and interventions are typically delivered in a parent group
           format. It could be further argued that family-focused treatment protocols and parent
           training programs reflect the emergence of a so-called third-generation family
           therapeutic perspective by enhancing the need to establish evidence-based interventions
           through randomized controlled clinical trials. In addition to discussions above, family
           therapy is the most popular therapy approach among licensed psychotherapists working in
           the health care system in Finland. However, there is very little research on the effects
           of family-systemic interventions on the well-being of children with mental health
           problems and their families in Finnish health care settings.

        3. Description of the interventions

           The multi-systemic and multicomponent family intervention for 5-12 year-old children
           with neuropsychiatric symptoms is based on the intervention program developed by the
           Health department of the Social Insurance Institution of Finland. In order to
           incorporate the best current practices and delivery formats, an independent expert panel
           of child psychiatry specialists from the Finnish University Hospitals was recruited in
           intervention development. Intervention feasibility and acceptability were further
           assessed by piloting work. At the present project, time-limited services (12 to 24
           months) are provided in two different arms (i.e. separate intervention programs)
           referred to as LAKU and Etä-LAKU family intervention programs. Aims of the family
           intervention are to help children to strengthen their socio-emotional skills at home and
           in everyday life settings, help children and families to cope with their experiences,
           and strengthen interpersonal interaction among family members to overcome possibly
           difficult life situations, thoughts and emotions.

           The family therapeutic approach is the key intervention component. Family sessions are
           provided by a licensed family therapist and a co-worker who is also an experienced
           mental health care professional. Multi-systemic approach addresses the importance of
           individualized needs of children and families. This includes the work with other
           important social systems (e.g. child daycare and school). The multi-systemic approach
           also includes both visiting and monitoring the child in his/hers social environment as
           well as collaborative meetings together with the family and the child's significant
           others from daycare and school. The collaborative stance further requires that family
           workers attach assigned family consultants from the health care delivery system as part
           of the therapeutic system too. The multicomponent approach, for its part, is designed to
           provide different delivery formats for the families involved such as group meetings for
           parents. Other important delivery formats include one-to-one sessions with the child.
           The families are also given an opportunity to attend family weekends where they can meet
           other families who share similar life situations.

           LAKU and Etä-LAKU family intervention programs have some pertinent differences. The
           prior intervention program is provided in an 'urban' context and therapeutic sessions
           may take place flexibly both at a clinic and in the family's home. Etä-LAKU, however, is
           strictly an ecosystem-based family intervention program. It is tailored for families who
           live in rural parts of Finland with very limited health services available. The Etä-LAKU
           family intervention program does not include the delivery of parent group sessions
           either. The LAKU family program involves service providers and child mental health
           clinics in the Finnish towns of Helsinki, Kotka, Tampere and Oulu as well as their
           environs. The Etä-LAKU intervention program is provided in Lapland and Kainuu/Ylä-Savo
           environs.

        4. Prospective observational clinical study

      The centerpiece of the project will be a prospective observational study of 5-12 year-old
      children and their parents who attend family-systemic interventions in different practical
      settings. The observational study is further based on multisource (i.e. child, parent and
      teacher report) assessment design. The study has been approved by the Research Ethics
      Committee of the Hospital District of Southwest Finland and the Research Ethics Committee of
      the Kela research department. Study approval from the Hospital District of Southwest Finland
      is in process.

      The control group consists of children and families attending family therapy. Time-limited
      family therapy (12 to 24 months) is provided via the Hospital District of Southwest
      Finland/Turku University Hospital's Child Psychiatry clinic (TYKS) and takes place in the
      town of Turku environs. All data will be collected in Finland and stored at the Research
      department of the Social Insurance Institution of Finland, located in Helsinki. Study
      measures will be administered in Finnish only.

      The study design does not include randomization. However, it provides an opportunity to
      compare possible changes in child and parent well-being within and between three different
      and clinically relevant family intervention programs. Beyond this, key outcome variables are
      determined by giving the possibility to scrutinize intervention effectiveness more closely.
      The study design enables comparing the results from primary and secondary outcomes to those
      from nationally representative school- and population-based surveys conducted in Finland.
    

Intervention name(s): LAKU family program; Etä-LAKU family program; Family therapy
Intervention type(s): Other; Other; Other
Intervention description(s): Multi-systemic and multicomponent family-based intervention program; Ecosystem-based intervention for families living in rural parts of Finland; Treatment as usual (TAU)
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The LAKU family program service is provided in Helsinki, Kotka, Tampere and Oulu environs.
        The Etä-LAKU intervention program is provided in Lapland and Kainuu/Ylä-Savo environs.
        Families are admitted to the programs by the child mental health clinics in the respective
        localities. The control group (treatment as usual) consists of children and families
        attending the family therapy fund by the Hospital District of Southwest Finland/Turku
        University Hospital's Child Psychiatry clinic (TYKS) and takes place in the Hospital
        District of Southwest Finland environs. Potential participants (i.e. the families admitted
        to the family-based intervention) will receive both oral and written information about the
        study and an invitation to volunteer. Both parents (when applicable) and child are advised
        to participate independently. Power analysis is utilized to ensure minimum necessary number
        of study participants. Anticipated sample sizes are: n=125 (LAKU), n=72 (Etä-LAKU), and
        n=33 (TAU group).
      
Keywords: Child Mental Health; Parenting; Family Issues