Systemic Therapies for Parents of Youth with Chronic Medical Conditions

Note: Systemic Therapies include Behavioral Family Systems Therapy, Family Therapy, and Multisystemic Therapy

Editors: Emily F. Law, Ph.D.; Emma Fisher, Ph.D.

Date: July, 2019

Empirical review statusInsufficient Evidence: Existing meta-analyses are not of sufficient quality.

Summary of sample characteristics across studies:

Variable

Example

Child Age

Across trials, there was variability in the age range of children:

1.      Preschool to Adolescence (4-14 years) (Lask et al., 1979)

2.      Elementary to Adolescence (8-18 years) (Celano et al., 2012; Ellis et al., 2005; Ellis et al., 2012; Laffel et al., 2003)

3.      Adolescence (11-18 years) (Wysocki et al., 1999; Wysocki et al., 2006)

Child Sex

All trials enrolled both male and female children

Parent Sex

The majority of studies enrolled >90% mothers (e.g., Celano et al., 2012; Ellis et al., 2004).

Family Ethnicity/Race

The majority of trials enrolled primarily Black and/or Hispanic families (Celano et al., 2012; Ellis et al., 2004; Ellis et al., 2005; Ellis et al., 2012).

Therapist type

In the majority of trials, treatment was delivered by master’s level therapists, Ph.D. doctoral students, or Ph.D. level psychologists. In one trial, treatment was delivered by research assistants (Laffel et al., 2003).

Presenting problem

1.      Asthma: Celano et al., 2012; Lask et al., 1979

2.      Diabetes (Ellis et al., 2004; Ellis et al., 2005; Ellis et al., 2012; Laffel et al., 2003; Murphy et al., 2012; Wysocki et al, 1999; Wysocki et al., 2006).

Socioeconomic status

In all trials, families were from predominantly lower socioeconomic backgrounds.

Language

In all trials, the intervention was delivered in English.

 

Brief summary of treatment:

  • Basic premise: Systemic therapies for parents and families of youth with chronic medical conditions include behavioral family systems therapy, family therapy, and multisystemic therapy. These treatments emphasize the influence of the family and broader social context on an individual’s adjustment and emotional functioning in the context of a chronic childhood disease. 
  • Essence of therapy: Systemic therapies alter patterns of interactions between family members and broader community systems (school, work, medical team) to support adjustment to and management of the child’s medical condition. 
  • Length: Treatment duration for children: 4 hours-48 hours. Treatment duration for parents: 4 hours-48 hours. 

 

Treatment resources:

Treatment Manual Available For Purchase
Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach (Robin & Foster, 1989)

Self-Help Books
The Ten Keys to Helping Your Child Grow Up with Diabetes, 2nd Edition (Wysocki, 2003)

Training Resources
Surviving Cancer Competently Intervention Program Training Workshop. Sponsored by the Center for Pediatric Traumatic Stress at the Children’s Hospital of Philadelphia and Nemours A.I. DuPont Hospital for Children. 

 

Clinical Trials, Systematic Reviews, and Meta-Analyses:

Clinical Trials:

  1. Celano, M. P., Holsey, C. N., & Kobrynski, L. J. (2012). Home-based family intervention for low-income children with asthma: a randomized controlled pilot study. J Fam Psychol, 26(2), 171-178. doi: 10.1037/a00272182012-04370-001 [pii]
  2. Ellis, D. A., Naar-King, S., Chen, X., Moltz, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine, 44, 207-215.
  3. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Cunningham, P. B., & Cakan, N. (2005a). The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findings from a randomized, controlled trial. Pediatrics, 116, e826-e832. doi: 10.1542/peds.2005-0638.
  4. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Cunningham, P. B., & Cakan, N. (2005b). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control. Diabetes Care, 28, 1604-1610.
  5. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M., & Greger, N. (2004). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in poor metabolic control: A pilot investigation. Journal of Clinical Psychology in Medical Settings, 11(4), 315-324.
  6. Ellis, D. A., Naar-King, S., Templin, T., Frey, M. A., & Cunningham, P. B. (2007a). Improving health outcomes among youth with poorly controlled type 1 diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy. Journal of Family Therapy, 21, 363-371.
  7. Ellis, D. A., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B., Podolski, C., . . . Cakan, N. (2007b). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174.
  8. Ellis, D. A., Yopp, J., Templin, T., Naar-King, S., Frey, M. A., Cunningham, P. B., . . . Niec, L. N. (2007c). Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial. Journal of Pediatric Psychology, 32, 194-205. doi:10.1093/jpepsy/jsj116.
  9. Grey, M., Whittemore, R., Jaser, S., Ambrosino, J. Lindemann, E., Liberti, L., . . . Dziura, J. (2009). Effects of coping skills training in school-age children with type 1 diabetes. Research in Nursing & Health, 32, 405-418.
  10. Laffel, L. M., Vangsness, L., Connell, A., Goebel-Fabbri, A., Butler, D., & Anderson, B. J. (2003). Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr, 142(4), 409-416. doi: S0022-3476(03)00039-8 [pii]10.1067/mpd.2003.138
  11. Lask, B., & Matthew, D. (1979). Childhood asthma. A controlled trial of family psychotherapy. Archives of disease in childhood, 54, 116-119.
  12. Murphy, H. R., Wadham, C., Hassler-Hurst, J., Rayman, G., & Skinner, T. C. (2012). Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes. Diabet Med, 29(8), e249-254. doi: 10.1111/j.1464-5491.2012.03683.x
  13. Wysocki, T., Greco, P., Harris, M. A., Bubb, J., & White, N. H. (2001). Behavior therapy for families of adolescents with diabetes: Maintenance of treatment effects. Diabetes Care, 24, 441-446.
  14. Wysocki, T., Harris, M. A., Greco, P., Bubb, J., Danda, C. E., Harvey, L. M., . . . White, N. H. (2000). Randomized, controlled trial of behavior therapy for families of adolescents with insulin-dependent diabetes mellitus. Journal of Pediatric Psychology, 25, 23-33.
  15. Wysocki, T., Miller, K. M., Greco, P., Harris, M. A., Harvey, L. M., Taylor, A., . . . White, N. H. (1999). Behavior therapy for families of adolescents with diabetes: Effects on directly observed family interactions. Behavior Therapy, 30, 507-525.
  16. Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Mauras, N., & White, N. H. (2007). Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents. Diabetes Care, 30(3), 555-560.
  17. Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., . . . White, N. H. (2008). Randomized, controlled trial of behavioral family systems therapy for diabetes: Maintenance and generalization of effects on parent-adolescent conflict. Behavior Therapy, 39, 33-46.
  18. Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., . . . White, N. H. (2006). Effects of behavioral family systems therapy for diabetes on adolescents’ family relationships, treatment adherence, and metabolic control. Journal of Pediatric Psychology, 31, 928-938. doi:10.1093/jpepsy/jsj098

Systematic Reviews and Meta-Analyses:

  1. Eccleston, C., Fisher, E., Law, E. F., Bartlett, J., & Palermo, T. M. (2015). Psychological therapies for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews 2015, Issue 4.
  2. Eccleston, C., Palermo, T.M., Fisher, E., & Law, E. F. (2012). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews. Issue 8.
  3. Law, E.F., Fisher, E., Fales, J., Noel, M., & Eccleston, C. (2014). Systematic review and meta-analysis of parent and family-based interventions for children and adolescents with chronic medical conditions. Journal of Pediatric Psychology 39(8), 866-886.

Related Resources

Progress Notes