Description and Preliminary Investigation of Family TIES (Training in Essential Skills), a Strategy for Treating Youth Aggression and Related Problems in a Social Services Agency

By Ellenbogen, Stephen; Calame, Robert et al. | International Journal of Child and Adolescent Health, April 1, 2015 | Go to article overview

Description and Preliminary Investigation of Family TIES (Training in Essential Skills), a Strategy for Treating Youth Aggression and Related Problems in a Social Services Agency


Ellenbogen, Stephen, Calame, Robert, Parker, Kim, Finne, Johannes, Trocmé, Nico, International Journal of Child and Adolescent Health


Introduction

A growing body of research demonstrates that cognitive behavioural treatments are effective for treating youth aggression and related problems (1), their efficacy further established in meta-analyses (2, 3). In a review of juvenile justice programs (4), Aggression Replacement Training® (ART®) was determined to be the most cost effective, providing an estimated cost-benefit ratio of between 45:1 and 20:1. However, mixed findings have also been reported (5). Furthermore, Armelius and Andreassen (2) concluded that the capacity of cognitive behavioural treatments to reduce anti-social behaviour was modest, and contributed to a reduction of roughly 10% in past-year recidivism. Given the public costs associated with these problems (6) and the savings expected with helping even a fraction of youth, continued research on promising treatment options is imperative.

One alternative is to adopt a multilevel approach and incorporate prevention activities, youth/parent skills training, family counselling, and school/juvenile justice policy changes. Ecological (7) and transactional (8) models provide useful frameworks for understanding the need for such approaches, positing the root causes of persistently aggressive behaviour to be issues of not only temperament or genetic makeup, but also breakdowns in family, peer, and community relations. Thus, programs for the treatment of youth behaviour problems should involve their social environment (1). The downside of multilevel programs is that they require considerable resources and complicated collaborations between government, police, schools, and social services.

Family-centred programs (9) represent an appealing compromise, as they address issues at three levels (youth, parent, and family), but are more economical and manageable than comprehensive ecological approaches. Results of meta-analyses are encouraging (10, 11). Interventions targeting younger children are preferred because the family is more likely to be intact, and patterns of dysfunction are less likely to be ingrained (12). However, this is not always possible, and a more prudent policy would be to intervene whenever the family is ready to accept help. Moreover, treatment of families with adolescent children was found to be effective (9, 10, 13).

In this paper, we describe Family TIES, a unique program that combines family skills training, ART®, and the principles of family therapy, and report the findings of an internal investigation. Family TIES is a voluntary program delivered within a comprehensive social service agency to families struggling with youth anger and aggression problems. An objective of the investigation was to examine whether participants experienced significant changes in emotion, behaviour, and family functioning, from the beginning of the program to 5-7 weeks after the last session. Because there is no comparison group, this study cannot serve as an assessment of treatment effects. However, the design does allow an estimation of the magnitude of change in families and whether a more sophisticated evaluation is merited.

A major benefit of this research is that Family TIES is an agency program. Thus, other child protective and youth offender service networks could reasonably expect to be able to successfully implement such a program. This issue of external validity is particularly relevant. Youth aggression treatment evaluations are often conducted on demonstration projects, which tend to generate larger effect sizes than institution-based evaluations (3). This is not surprising, as university-based projects tend to unfold in enviable conditions, e.g., supervision by leading experts and suitable funding.

The relatively low-cost (approximately $24,000 USD) project described here is part of a growing trend toward university-public sector research collaboration. In response to a request from the host organization to evaluate their program, university-based researchers led the study, with practitioners and managers offering data gathering and other assistance. …

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