Development and Testing of FAME: Advancing Care for Families and Their Teens with Mental Disorders

Background: Family members of Adolescents with mental disorders, particularly Disruptive Behavior Disorders (DBDs) face unique challenges [1, 3]. DBDs include Oppositional Defiant Disorders and Conduct Disorders which are characterized by overt aggressive, defiant, and antisocial behaviors. In the United States of American, racial minority groups such as African Americans (AA) adolescents with DBDs and their family members are especially vulnerable to poor outcomes because of socioeconomic disadvantage [3]. They experience poor quality mental health services and often drop out of care resulting in significant mental health disparities. AA family members also report low efficacy in managing interactions not only within the family, but with child service system professionals (i.e., mental health, schools, juvenile justice, or child welfare). These interactions lead to a series of problems: High stress, poor quality of life, and poor family functioning. When it comes to these problems, there are still no published interventions (Author). 

Purpose: The purpose of this 2-phase is to (1) develop and (2) evaluate the feasibility, acceptability, and preliminary outcomes of the FAmily Management Efficacy (FAME) Intervention.

Methods: This 2-phase study was guided by a community advisory board of families of teens with DBDs and the professionals who work with them. In phase 1, we partnered with 6-member family and 5-member professional advisory board to iteratively develop the FAME intervention. The theoretical framework for FAME intervention is based on pilot study, the literature and the Network Episode Model published in their seminal work related to mental health of children and families. Core components of the FAME intervention focuses on practicing communication/problem solving skills within a social network context where participants learn from and support one another. Repeated practice increases family members’ confidence or self-efficacy in communication/problem solving skills that they can apply to other stressful family and/or child service system interactions [2]. FAME intervention is designed to improve family and child service system interactions. We propose that improvements will lessen family member stress, improve their quality of life and family functioning. In phase 2, we used a 2-group randomized control study design to test feasibility, acceptability, and preliminary outcomes of the FAME intervention. Subjects were recruited from a large publicly-funded community mental health center in Mid-western part of the United States of America. Sample included 24 primary caregivers (biologically or non-biologically related) of an AA adolescent aged 13-18 years diagnosed with DBDs by a mental health provider and 24 individuals identified as kin or fictive kin by the caregiver. The sample of 24 families (24 primary caregivers and 24 kin or fictive kin) were randomized to intervention (n = 12) or usual care (n = 12). For each cohort, assessment were done at baseline, within one week post-intervention, and two months later. Assessment were completed with standardized measures and semi-structured interviews. Qualitative data are been analyzed using appropriate descriptive, univariate, and multi-level mixed-effects models. Qualitative data were audio recorded and transcribed and been translated with standard content analytic procedures.

Results: Phase 1. The FAME intervention protocol is fully manualized complete with facilitator guide and family workbook. The FAME intervention is delivered in a multi-family group format to facilitate learning and social support and to strengthen social networks among participants. The FAME intervention is delivered as six, 2-hour sessions over six weeks by a trained interventionist. Each session focuses on a specific topic and include information sharing, participatory or experiential learning, and role playing to enhance skills building. Phase 2. 24 families (24 primary caregivers and 24 kin or fictive kin) were randomized to intervention (n = 12) or usual care (n = 12). Usual careconsist of standard outpatient mental health care including individual treatment for the adolescent (therapy, case management, and/or medication) with some family involvement. No multiple family groups are offered. Data were collected and are currently been analyzed. Preliminary data analysis show that it is feasible to conduct FAME in a group format: Once engaged, participants attended at least 5 of the 6 workshop sessions. Narrative comments from qualitative interview from participants indicate that they find FAME intervention acceptable and useful to them in managing the stress of interacting with multiple child service providers because of their teens’ DBDs. Final data analysis are in progress and will be complete for presentation at the congress.

Conclusion: Findings provide nurses with practical suggestions about how to collaborate or partner with families to promote mental health of all family members in order to enhance their capacity to care for teens with DBDs. Practical suggestions include enhancing family member’s self-efficacy in effective use of communication and problem solving skills in their interactions within the family and child service providers to lessen stress, improve family functioning and quality of life.