Related Publications
Intervening in Children's Lives: An Ecological, Family-Centered Approach to Mental Health Care
by Thomas J. Dishion and Elizabeth A. Stormshak
Intervening in Adolescent Problem Behavior: A Family-Centered Approach
by Thomas J. Dishion and Kate Kavanagh
EcoFIT programs:
Adolescent Transitions Program (ATP)
EcoFIT
CFC is unique in the format and kind of mental health services it provides to children and families. EcoFIT, developed by CFC researchers, is an ecological approach to family intervention and treatment that acknowledges the influences of a child’s immediate environment: peers, siblings, caregivers, teachers, neighborhood. EcoFIT is a fluid principle and not a single theoretical perspective; it defines and guides our efforts to improve our intervention services.
EcoFIT has six unique features:
The intervention services are based on research into
child and adolescent mental health problems and early drug use.
- They examine what causes these problems.
- They determine which interventions work to reduce or treat these problems.
The intervention services are family centered.
- They address and support parents of children and adolescents in the change process.
- They focus on supporting parents’ leadership role in their children’s lives.
The intervention services are assessment driven.
- Decisions about how to tailor interventions to individual and family needs are based on careful assessments of the child and family at home.
- Decisions are also based on the child in the context of school.
The intervention services target the social interactions of children with their caregivers, teachers, and peers to work toward long-lasting change.
- Social interaction patterns with families or peers are automatic.
- Social interaction patterns with families or peers are also powerful for maintaining problem behavior and emotional distress.
- The patterns can be changed with support from our intervention services.
Strengthening client motivation to change is a core component.
- We help families overcome discouragement that can arise during the change process.
- Discouragement about change can interfere with the process of improving family dynamics or children’s behavior and adjustment.
The intervention services are based on a health maintenance model.
- A health maintenance model acknowledges individual vulnerabilities and builds on existing strengths.
- Periodic intervention services support children and families through multiple developmental transitions.
What other features are unique to an ecological approach to intervention?
- An ecological approach is a work in progress, not a final solution.
- EcoFIT provides a set of tools for the systematic design and execution of mental health services for children and families.
- EcoFIT provides a road map for innovation of future interventions that are even more effective and efficient.
- The emphasis on model building is the key to progress in applying science to improve child and adolescent mental health.
- Clinicians, families, basic scientists, intervention scientists, and policymakers are partners in setting the research agenda and targeting areas for future study that will increase intervention effectiveness.
- EcoFIT is not a school of therapy, but a systematic approach to innovation and change.
The Family Check-Up is the cornerstone of EcoFIT
The Family Check-Up enables us to adapt and tailor family-centered interventions to the needs of children and adolescents. Figure 2 (above) shows the overall strategy of EcoFIT and the Family Check-Up. Each check-up includes:
Initial interview. This 60-minute “get to know you interview”
- gives the parent consultant (the school–home liaison) an opportunity to meet with parents and children or adolescents to better understand their current mental health needs and concerns
- involves the completion of a brief questionnaire
- includes a discussion about family needs
- acknowledges that each family is a unique set of individuals
- helps clarify how we can best serve the family
Ecological assessment. Long experience has taught us how important it is to carefully assess each family’s experience before making decisions about intervention options.
- We typically visit the family’s home to videotape family members interacting and to ask them to complete questionnaires.
- We assess each child’s adjustment to school, even if it is an area of strength; a strengths-based approach allows us to look at positive adjustment in addition to behavior that needs attention.
- This information helps us formulate a tentative plan to discuss with each family.
Feedback session. In this review of the findings from the assessments,
- the parent consultant considers the caregiver’s input and motivation for taking action
- current family practices and behaviors that are areas of strength are carefully identified
- feedback is given about family practices and behaviors that may need attention or that may benefit from our services
- feedback is based on many years of working with children and families and on assessments used with numerous and diverse families
- the caregiver and the parent consultant then collaborate to participate in one or more of the available intervention options in the service menu
Service menu
All the interventions that follow the Family Check-Up have been shown in previous studies to help children and adolescents improve their social behavior and their emotional adjustment. The current intervention options are:
Brief family-centered interventions
- These one, two, or three face-to-face meetings with caregivers help us tailor an intervention strategy that best meets the needs of the family.
- We focus on family management practices and positive behavior support.
Parent groups
- Some parents benefit from periodic meetings with other parents to review research-based strategies for improving caregiving and parenting practices.
- Current parenting strengths are emphasized.
- The curriculum that guides the parent group meetings has been tested in several research projects and has been found to be effective.
Family therapy
- Once or twice a week families and the parent consultant meet to identify and support caregivers’ efforts to change family interaction patterns.
- The emphasis is on motivation and collaboration.
- Family therapy can last from one month to one year or longer.
Child interventions
- When we work directly with children and adolescents, the primary focus is to support development of positive skills such as self-control and interaction skills with family and peers.
- Because our approach is family centered, these interventions typically occur at the same time as sessions with a child's caregivers; we rarely work only with children.
- Our usual focus is to improve child and adolescent self-regulation, and it often involves cognitive behavioral strategies.
School-based interventions
- Because our intervention is ecological, we assess all children’s adjustment at school.
- Some children do well in school and require only a brief consultation visit.
- When the majority of behavioral and emotional issues occurs in the school context, we collaborate with key school personnel and develop a positive behavior support plan that bridges home and school.
- Family resource centers in the school provide resources about various parenting topics. The goal, through collaboration with school staff, is to
· engage parents
· establish norms for parenting practices
· disseminate information about risks for problem behavior and substance use
· help parents learn how to identify observable risk factors and how to use effective family management skills, including positive reinforcement, monitoring, limit setting, and relationship skills
The FRC in participating schools also provides
· Home visits to increase participation in family-centered interventions, which increase parental engagement
· Videotape examples of effective family management skills, and a simple rating form to help parents identify observable risk factors in the context of parent–child interaction
· A six-week health curriculum promoting school success, reduced substance use, and reduced conflict
· Direct professional support to parents, including a brief family intervention, school monitoring system, parent groups, behavioral family therapy, and case management services
Ecological management and advocacy
- When child and family clients are involved in other services in the community, we can coordinate our intervention with those services.
- Families may be benefiting from related service providers or periodic service coordination. For example, if medication is required for one or more family members, we work collaboratively with psychiatric services to ensure that medications are helpful and periodic reviews occur.
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Teen Check-Up
The Teen Check-Up (TCU) is a complement to the Family Check-Up for youth between age 13 and 18. It is designed to provide an accurate appraisal and motivation to change for youth in the areas of healthy choices, academics, support systems, and self-strengths.
Assessment
- Teens answer questions related to family, school, peers, and positive and risky behaviors, including drug use.
- Contextual variables such as discrimination, poverty, and cultural identity are assessed.
- The teens participate in a videotaped discussion with their parents that provides information about their communication and problem-solving skills.
Engagement
- Teens are invited to receive information about their strengths for achieving their goals and handling problems.
- Before feedback is given, a family consultant explains the process and helps the teen identify goals and concerns.
Feedback
Motivational interviewing principles underlie the feedback that identifies strengths in the areas of healthy choices, academics, support systems (family and peers), and self-strengths. Feedback can be delivered in one of two ways:
- A written linear profile, with each area delineated and presented on a continuum and color coded from green to yellow to red to indicate strength, improvement, or challenge
- A tactile representation of the teen’s profile accompanies the written profile. It includes a “profile map” and blocks for each of the feedback variables that are color coded as strength, needs improvement, or challenge. This approach works well for younger or less verbally oriented youth.
Follow-up Menu
Based on our family-centered approach, menu options are
- skill building: tip sheets on improving skills are derived from our work with families and also previous teen curricula (Teen Focus, Shape)
- brief family-centered interventions: typically two to three sessions that focus on working with the teen and parents to improve skills or family processes
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Adolescent Transitions Program (ATP)
EcoFIT and the Family Check-Up originated in the Adolescent Transitions Program (ATP), a multilevel family-centered intervention developed in the earlier work of CFC researchers. The ATP was tested across a number of randomized trials at the middle school level and found long-term outcomes associated with reductions in substance use, arrest rate, school failure, and truancy. The intervention was also found to directly affect parental monitoring and family relationships, which mediate later changes in rates of problem behavior.
The Adolescent Transitions Program has been rated as
- “Best Practice” by the Center for Substance Abuse Prevention
- “Exemplary” by Strengthening America’s Families
- “Proven to be Effective” by the National Institute on Drug Abuse
- “Exemplary” by the Office of Juvenile Justice and Delinquency Prevention
ATP is described in the National Institute on Drug Abuse Red Book: Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders (2nd ed.)
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Intervening in Children’s Lives: An Ecological, Family-Centered Approach to Mental Health Care, by Thomas J. Dishion and Elizabeth A. Stormshak (APA Books, 2007)
This book, authored by the CFC codirectors, discusses the dynamics of children’s lives and puts the understanding of effective intervention services, and how to implement them, into readers’ hands. It describes an approach to child and family intervention services that targets individual children, families, and multiple systems affecting children; that is, the child’s environment. This ecological approach, called EcoFIT, is an empirically based, assessment-driven, family-centered intervention. It uses a motivation to change strategy that gives clients feedback in a supportive, nonconfrontational way and works in a health maintenance framework by acknowledging variation in vulnerability to environmental stress and the need for periodic check-ups and intervention services.
The book’s four sections provide a look at
- developmental factors that underlie child and adolescent problem behavior and emotional adjustment and the design and implementation of interventions
- the Family Check-Up, a family-centered intervention that involves initial contact, assessment, and feedback and which is offered at the CFC outpatient clinical services
- the intervention strategies that follow the Family Check-Up, such as a combination of family management therapy and interventions aimed at adolescent self-regulation
- the context within which the clinician works and the importance of maintaining high levels of service quality that requires team support, accountability, feedback, and training, as well as guiding principles for ethical decision making
To view Table of Contents/purchase this book
What they are saying about this book
nePsy.com
“How refreshing to encounter a book that unapologetically encourages psychotherapists to work with children and families over a span of years, in contrast to the current ethos in which brief therapies are expected to bring lasting change to complex problems in only weeks or months.”
http://www.masspsy.com/book/0710_ne_book_paul_intervention.html
PsycCRITIQUES
”… impressive for its well-documented, yet concise, presentation of a rationale for helping children in a manner that considers the real world in which the child lives and recognizes that it is essential to involve the child’s family in the interventions. This book is superior for providing the student or practitioner with ideas for staying abreast with research and is a source for gleaning ways to formulate and implement interventions.” http://www.apa.org/books/4317115c.pdf
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Intervening in Adolescent Problem Behavior, by Thomas J. Dishion and Kate Kavanagh (Guilford Press, 2003)
This book presents a multilevel intervention and prevention program for at-risk adolescents and their families. Grounded in over 15 years of important clinical and developmental research, the Adolescent Transitions Program (ATP) has been nationally recognized as a best practice for strengthening families and reducing adolescent substance use and antisocial behavior. The major focus is to support parents' skills and motivation to reduce adolescent problem behavior and promote success.
To view Table of Contents/purchase this book
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