Research projects

Deakin Family Options: Engaging youth with high prevalence mental health problems using family based interventions (DFO 3)

Principal researchers

Associate Professor Andrew Lewis1
Professor John Toumbourou1
Professor Daniel Lubman2,3
Dr Tess Knight1

Institution/ARC funding partners

1 Deakin University
2 Monash University, Eastern Health
Australian Drug Foundation
3 Drummond Street Services Inc,
Turning Point Alcohol and Drug Centre

Funding

$40,000 (Plus in-kind contribution $27,462)

Co-funded with

ARC Linkage Grant (Total funding $242,394)

Award type

ARC Linkage Grant

Project completion year

2013

Project brief

Youth depression, anxiety and substance abuse are prevalent, distressing and costly problems impacting one in five young Australians. This collaborative project – called ‘Deakin Family Options’ – will evaluate a family-based intervention in order to broaden the therapeutic approaches used for young people and their families.

80 per cent of youth with mental health problems do not seek assistance from services. A consortium of national bodies, clinical services and Deakin University will conduct a multi-centre evaluation of a family-based intervention for families who have youth with identified mental health problems but refuse services. We propose that this intervention – refined and developed over more than a decade – will be more effective in engaging youth in services and improving all family members’ mental health as compared to current standard practice. The project will enhance the capacity of current service delivery, influence policy development via key national bodies and deliver improved family mental health to address the national crisis in youth mental health.

Background

This project seeks to complete a comprehensive evaluation to establish a novel mental health intervention for adolescents as an evidence-based intervention. It will provide an evaluation of a family-based interventions capacity to reduce the mental health symptoms of both young people (12-25 yrs) and the members of their families, and engage young people reluctant to use mental health services individually by working therapeutically with the whole family unit.

The intervention to be evaluated is known as the Behaviour Exchange Systems Training (BEST) program and has been developed over three distinct stages. The BEST intervention was originally developed by Toumbourou and Bamberg as a professionally led, multifamily group education program for parents, with content focussed on Alcohol and Drug (AOD) use by adolescents. This version of the intervention was shown to reduce parental mental health symptoms and family stresses.

To increase efficacy for the youth themselves, the second stage of development (BEST-Plus) included siblings who join their parents in the group for the final four weeks of the eight-week program. Evaluations showed additional positive changes in the family system were produced in mental health and stress symptoms, family cohesion and increases in action by young people to address their substance use. In the third stage of the development, which we refer to as BEST-YMH, three of the Chief Investigators (Lewis, Toumbourou and Knight) – in collaboration with clinical staff of our industry partner Drummond Street Services – have drawn on funding from beyondblue to further develop and evaluate BEST as a broader intervention suitable for youth who present with depression and anxiety  as well as AOD abuse. Together with BEST-YMH, this suite of interventions is known as Deakin Family Options.

Current treatment evidence for youth mental health

The evidence for treatments of YMH is less well established than for adult populations. A number of comprehensive reviews and meta-analyses show that there is not a large amount of evidence available. The evidence which is available is not convincing as to the efficacy for either pharmacological or current psychological therapies for youth depression, anxiety and co-morbid AOD abuse.

The family as target for intervention

Family-based interventions have increasing support as a treatment for YMH. Family-based interventions can be effective by:

  • enhancing youth engagement
  • targeting interactions between members and resolving conflict
  • increasing support, family cohesion and maintaining adolescents within protective family environments for a longer period.

There is evidence to suggest that depressed youth who have conflicting relationships with their parents are not responsive to individual treatments. There is also substantive evidence from cohort studies that risk for depressive and anxious symptoms and substance abuse are predicted by poor parent-child relationships, high family conflict, poor family attachments, and detachment from family activities.

Given the evidence for family influences, researchers have repeatedly called for the development and evaluation of prevention and early intervention programs that target family factors.

Project aims

This project aims to:

  • conduct a high quality evaluation of the efficacy of the BEST: YMH as a youth mental health treatment
  • build capacity and increase service integration across several service delivery sectors by providing an evidence-based intervention programs for youth and their families and influence national and state government policy on family-based approaches to YMH
  • make use of the current partnerships for national promotion and dissemination of family-based treatment models for YMH.

The present study of a full-scale trial of BEST YMH will allow the researchers to test its effectiveness as a treatment and a youth engagement tool. In addition, they will continue to develop and disseminate a parenting seminar that has been designed and trialled. The one-off, 1.5 hour seminars have proved popular and been used to engage concerned parents in discussion and provide resources related to youth mental health and substance use, as well as to assist us to identify families where BEST YMH would be a viable treatment option. The research team have also developed and validated a formal assessment protocol for families. A comprehensive 60–90 minute family assessment interview has been designed, trialled and proved feasible, for participants entering the beyondblue pilot study.

Study design

A multicentre randomised controlled trial with two arms of intervention: (active treatment) a parent and family program (BEST YMH) versus a (control treatment) supportive counselling condition designed to mirror treatment as usual for families (TAU).

Two primary outcomes are predicted: in comparison to the control treatment, BEST-YMH will produce a greater improvement in parental and youth mental health, and a larger number of youth engaging in individual treatments through the course of the family-based interventions. The study will collect data at three points: entry to the study (T1), completion of treatments (T2), and at six month follow-up (T3).

References

Publications

Yap, M., Allen. N.B., O’Shea, M., Di Parsia, P., Simmons, J.G., Sheeber, L. (2011). Early adolescents’ temperament, emotion regulation during mother child interactions, and depressive symptoms. Development and Psychopathology, 23, 267-282.

Cheetham, A., Allen, N.B., Yücel, M., & Lubman, D.I. (2010). The role of affective dysregulation in drug addiction. Clinical Psychology Review. 30: 621-634.

Whittle, S., Yap, M.B.H., Sheeber, L., Dudgeon, P., Yücel, M., Pantelis, C., Simmons, J.G., & Allen, N.B. (2011). Hippocampal volume and sensitivity to maternal aggressive behavior: A prospective study of adolescent depressive symptoms. Development and Psychopathology, 23, 115-129.

Zipursky A, Whittle S, Yücel M, Lorensetti, V., Wood, S., Lubman, D., Simmons, J., & Allen, N.B. (2011) Pituitary volume prospectively predicts internalizing symptoms in adolescence. Journal of Child Psychology and Psychiatry, 52, 315-323.

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