MFG is a 16-week service delivery model that was guided by a manualized protocol. Each group met weekly for approximately a 90- to 120-min/session and included six to eight families, composed of identified youth, their adult caregiver(s), and sibling(s) between the ages of 6 and 18. As a foundation, MFG takes a common elements approach by identifying essential components from the empirical literature from BPT methods (e.g., Chorpita & Daleiden, 2009 (
link); Garland et al., 2008 (
link)) and family therapy (e.g., Alexander, Pugh, Parsons, & Sexton, 2000 ; Keiley, 2002 (
link)) regarding core effective practices for treating DBDs, represented as the “4Rs” (i.e., Rules, Responsibility, Relationships, Respectful Communication) and factors related to family engagement in mental health services, represented as “2Ss” (Stress and Social Support). Core components of BPT included in MFG were positive reinforcement (i.e., labeled praise, positive attending, tangible reinforcement/ rewards), which was incorporated into sessions focused on “relationships”; limit setting (i.e., monitoring, effective commands, response-cost; behavioral contracting/goal setting), which was mainly incorporated into sessions focused on “rules” and “responsibility”; psychoeducation and affect education (i.e., learning about, identifying, and labeling stress-related emotions and behavior; developing methods to address common triggers for stress), which was incorporated into sessions focused on “stress.”
Core components of family therapy included in MFG were role identification (i.e., understanding the unique and integrated role each member plays in a family and supporting how family members can support each other in achieving desired family outcomes), which was incorporated into sessions focused on “relationships”; reframing (i.e., developing new strategies to regulate emotions and interactions between family members), which was incorporated into sessions focused on “relationships” and “respectful communication”; communication training (i.e., identifying behaviors [e.g., eye contact] that demonstrate engaging in a conversation, using “I” statements to express needs/wants, utilizing congruent affect and speech when communicating, etc.), which was incorporated into sessions focused on “relationships” and “respectful communication.” Methods to improve within-family and external sources of emotional, tangible, informational, and companionship social supports (e.g., Chacko et al., 2009 (
link)) were incorporated into the session focused on “social support.” Lastly, given the high-risk nature of the population for poor engagement to treatment, core aspects of evidence-based engagement practices (e.g., aligning expectations for treatment with anticipated treatment benefits, reducing stigma related to receipt of mental health services, etc.; McKay & Bannon, 2004 (
link)) were also integrated into the MFG program.
Core MFG sessions focused on one of the 4Rs and 2Ss and proceeded with the following processes: (a) creating social networks, (b) information exchange/homework review, (c) group discussion regarding the skill, (d) individual family practice, and (e) homework assignment. MFG content areas (4Rs and 2Ss) were integrated into the program during the first (Sessions 1–8) and the second (Sessions 9–16) halves of MFG to provide opportunities for repeated exposure and practice with content.
Participants in the MFG condition were not prohibited from utilizing any additional services available to them through the outpatient mental health clinic where they were receiving MFG. In this sample, 53% of the participants in the MFG condition did not receive additional interventions. Those 47% of youth who did receive additional services also received outpatient individual services (49%), outpatient medication management (34%), school-based mental health (9%), case management (<1%), and crisis management services (<1%) during the course of the 4-month MFG group. Moreover, for those youth who received additional services beyond receipt of MFG, the majority of youth received one (53%), two (40%), or three (7%) additional services. No youth received more than three additional mental health services.
Chacko A., Gopalan G., Franco L., Dean-Assael K., Jackson J., Marcus S., Hoagwood K, & McKay M. (2014). Multiple Family Group Service Model for Children With Disruptive Behavior Disorders: Child Outcomes at Post-Treatment. Journal of emotional and behavioral disorders, 23(2), 67-77.