Evaluating the Effectiveness of a Dialectical Behaviour

Therapy-Based Skills Training Group for Family Members

of Youth with Concurrent Disorders

Tali Boritz, Ryan Barnhart, Joanna Henderson and Shelley

McMain
ISSPD
Montreal, Quebec
October 16, 2015

Mental Health Problems in Youth

Mental health disorders begin in childhood

and adolescence

Median age of onset: 11 years

Amongst 4-16 year olds in Ontario, 1 out

of 5 suffer a psychiatric disorder

Suicide risk is the 2nd leading cause of

death among youth ages 15-19
(Patel et al., 2007; Smetanin et al., 2011; Statistics
Canada, 2009)

Introduction

Caregivers of youth with comorbid mental illness and addiction

problems typically experience considerable emotional, financial
and social burdens, including:
Stress managing their childs needs
Difficulties accessing services,
Stigma and social isolation from family, friends, and their
community

Family involvement and support in youth mental health

treatment has been shown to enhance quality of life of family
members and treatment of the youth struggling with
concurrent disorders

Despite these findings, families are often neglected in formal

mental health and addiction systems
(Gyamfi et al. 2010; Mueser et al., 1998, 2002; Pringle et al.,

Introduction

The Family Connections group is based on the strategies and skills of

Dialectical Behaviour Therapy (DBT)

The Family Connections group provides information about emotion

dysregulation and training in coping skills, in a supportive and
validating environment

Family Connections is a 12-week manualized course, usually taught

by peer facilitators

Research studies have demonstrated significant pre- to post-therapy

reductions in grief and burden and a significant increase in mastery,
with changes that were maintained at six months post-baseline

No studies have examined whether DBT skills training is effective for

family members of youth with concurrent disorders

(Linehan, 1993; Hoffman et al., 2005)

Aim and Hypotheses

To determine the feasibility and effectiveness of

implementing an adapted version of the Family
Connections group for family members of youth
with concurrent disorders

Participants will show reduced caregiver burden

and parenting stress from pre to post treatment

Study Design

Design: Pre-post

Sample:
N = 100

Toronto (n = 40)

Ottawa (n = 35)

Thunder Bay (n=25) * Data analysis in progress, not included in results

Family members of an adolescent with significant substance abuse or mental health problems

18 years of age or older

Treatment:

DBT skills training group for families based on the Family Connections model, adapted for family
members of youth with concurrent disorders

12-week skills training group led by therapists and/or peer facilitators

Assessments:
Baseline, Mid-Treatment (6 weeks), Post-Treatment (12 weeks), Follow-up (24 weeks)

Outcome Measures

Primary Outcomes:

Caregiver Burden - Burden Assessment Scale

(BAS: Reinhard & Horwitz,

1995)

Caregiver Stress - Stress Index for Parents of Adolescents

(SIPA:

Sheras et al., 1998)

Secondary outcomes:

Caregiver Report of Childs Behaviour - Child Behaviour Checklist

(CBCL: Achenbach & Rescorla, 2001)

Affect - Family Experience Interview Schedule

(FEIS: Tessler & Gamache ,

1995)

Mastery - Mastery Scale (MS: Pearlin & Schooler, 1978)

Coping - DBT-Ways of Coping Checklist (DBT-WCCL: Neacsiu et al., 2010)
Grief - The Grief Scale (GS: Struening et al., 1995)

Statistical Analysis

Toronto and Ottawa sites pooled; Thunder Bay

site analysis in progress
Multilevel Linear Growth Models (MLM) were
used to estimate change over time

Wald tests of the slope parameter

MLM Effect Sizes were calculated for change from
baseline at follow-up using the pooled level 1
residuals in order to estimate Cohens d

Small Effect ~ 0.3

Medium Effect ~ 0.5
Large Effect ~ 0.8

Results: Primary Outcomes

Caregiver Burden

Effect size=.96

Caregiver Stress

Effect size=1.09

Results: Secondary Outcomes

Child Behaviour Checklist:
Total Problems Subscale
Effect size=1.09

Results: Secondary Outcomes

Caregiver Affect
Effect sizes=.94 and . 98
Worry
Displeasure

Grief
Effect size=4.6

Results: Secondary Outcomes

Coping

Mastery

ffect sizes=.72 and .99

Skill Use

Dysfunctional
Coping

Effect size=.59

Results: Secondary Outcomes

Child Behaviour Checklist:
Total Problems Subscale
Effect size=1.10

Results: Secondary Outcomes

Caregiver Affect
Worry

Displeasure

Grief

Results: Secondary Outcomes

Coping
Skill Use

Mastery
Dysfunctional
Coping

Limitations/Future Directions

No control group

Preliminary analyses suggest Thunder Bay site

may operate differently than other two sites

Future research will need to target

mechanisms of change to determine how the
treatment is effective

Discussion

Family members experienced decreases in

their levels of burden and stress, worry over
the duration of the FC group and 3-month
follow-up

The FC group for family members of youth

with concurrent disorders is an attractive
treatment option that may be inexpensive to
deliver and feasible to disseminate