JMIR Publications

ABSTRACT

Background:

Systemic factors have led to the overrepresentation of Black, Latinx, and Indigenous youth in the child welfare system. Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide in this population, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, educational, substance use and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions.

Objective:

To address this gap in access to services, we adapted an in-person empirically supported family-based affect management intervention utilizing a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system. We describe the intervention adaptation process and an open trial to evaluate the intervention’s feasibility and acceptability.

Methods:

Adaptations to the in-person family-based affect management intervention were conducted iteratively in collaboration with youth, caregivers, and systems partners. Through focus groups and collaborative meetings with system partners, a caregiver only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility, and to inform further refinements prior to a larger scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys pre-, post- and 3-months post-treatment. Qualitative exit interviews were also conducted with a subset of participants (67%) to further understand their experiences with the intervention.

Results:

Session attendance was high and both caregivers and teens reported high acceptability of clinicians and sessions according to feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated families utilized effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have had their teen also participate in the intervention. All interview participants reported they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication.

Conclusions:

An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems impacted families. Clinical Trial: Clinicaltrials.gov NCT04488523