Jacob D. Christenson

A Summary Report of Cost-Effectiveness: Recognizing the Value of Family Therapy in Health Care

The purpose of this chapter is to provide a summary of cost-effectiveness research on the work of marriage and family therapists in healthcare contexts. Twenty-one studies based on four sources of data were considered: (a) a western United States Health Maintenance Organization covering 180,000 subscribers; (b) the Kansas State Medicaid system with over 300,000 beneficiaries; (c) Cigna, a large United States health insurance benefits management company which provided data regarding more than six million claims for 500,000 unique persons across 6 years; and (d) a family therapy training clinic in the western United States serving approximately 700 individuals and families annually. All DSM diagnostic groups are available for analysis. Studies regarding schizophrenia, depression, sexual disorders, somatoform disorder, substance abuse, and relational diagnosis have been published and others are underway. Results support the potential for a medical offset effect after family therapy, with the largest reduction occurring for high utilizers of health care. The studies also show that family therapy as a treatment modality is a cost-effective form of treatment and trained family therapists are cost-effective providers. These outcomes are particularly important for medical family therapists (MedFT) who need to understand how medical offset, healthcare utilization, and cost-effective treatments are relevant to their work.

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost-effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost-effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.

Integrating flow theory and the serious leisure perspective into mental health counseling

This article explores how flow theory and the serious leisure perspective (SLP) can be integrated into mental health counseling. Although different counseling models have acknowledged the role of leisure in the counseling process, leisure is largely an unknown and superficial concept in the mental health counseling literature. Four broad-based pragmatic ideas regarding how flow theory and the SLP can be integrated into the counseling process include mental health counselors (1) understanding the concepts of serious leisure, casual leisure, project-based leisure, flow (enjoyment), and hedonistic pleasure; (2) becoming aware of various assessment instruments that measure flow and serious leisure; (3) using the provision characteristics of entering flow into the counseling process; and (4) empowering clients to becoming community change agents through serious leisure pursuit, resulting in flow experiences.

Family Involvement in the Treatment of Adolescent Substance Abuse

This chapter explores addiction related concepts and the role of the family system in the treatment of adolescent substance abuse. Family therapy is especially important for adolescents and young adults struggling with substance abuse issues due to the influential nature of this system. Involvement of family members in an adolescent’s treatment program has demonstrated the ability to reinforce and extend the benefits of treatment. Regardless of whether the inclusion consists of primary guardians or more of a non-traditional family configuration, adolescents can benefit from the incorporation of loved ones into their treatment process. The first part of this chapter will introduce the reader to some of the key concepts that adolescents and families need to understand about the nature of addiction. The second part of the chapter will outline the following therapeutic approaches for working with adolescents with substance abuse issues: Brief Strategic Family Therapy, Multidimensial Family Therapy, Multisystemic Therapy, andMultiple Family Group Therapy.

Expanding Our Understanding of Family Therapy in Residential Treatment

Residential treatment remains a necessary and effective service for helping adolescents with severe emotional and behavioral issues and for the benefit of their families. One of the major challenges consistently debated in the literature is whether or not youth are able to maintain treatment gains once they return to their home and community environments. Therefore, it makes sense that engaging the family in the adolescent’s treatment and drawing on their strengths and resources is crucial. This book sought to emphasize how family-oriented approaches and techniques can be used to engage adolescents and their families, as well as address many of the inherent challenges associated with treating youth in this setting. This chapter serves as the epilogue to the book and provides an examination of the contents of this book as they relate to the objectives of the authors and highlights the continued need to strengthen the place of family therapy in residential treatment.

Investigating Family Therapy with Qualitative, Quantitative, and Mixed Methods in Adolescent Residential Treatment Programs

Research concerning outcomes for adolescents in residential setting has consistently shown that family involvement is an important part of effective treatment. Nevertheless, most of the research that has been done on this topic is focused on outcomes and does not sufficiently focus on the process of family therapy in these settings, nor does the available research consider the cost of the treatment. The lack of cost-effectiveness research in this area of study leaves the field open to criticism that the outcomes do not justify the costs. In order to strengthen the role of family therapy in residential settings for adolescents more research is needed to address these gaps. This chapter discusses how qualitative, quantitative, and mixed methods can be used to advance family therapy research in such settings. Furthermore, examples are provided of research questions that could be answered using these methods, as well as examples of different studies that could be conducted to deepen the understanding of the role of family therapy in positive outcomes with this population.

Introduction to Family Therapy with Adolescents in Residential Settings: Intervention and Research

Despite the call for more community-based treatment options, each year a significant number of adolescents find themselves participating in some form of residential treatment. Therapists working with these adolescents need support to ensure they are delivering the best treatment possible and effectively integrating family therapy into the treatment process. Therefore, the purpose of this book is to provide therapists and researchers foundational information that will help increase the use of family therapy in residential work with adolescents. This particular chapter presents background information on residential treatment and the challenges associated with working in these settings, as well as a discussion of the costs of residential treatment and who pays for these services. General definitions and terminology are also presented to help orient the reader. This chapter serves as the introduction to the book and concludes with a rational for the organization of the chapters, as well as components of the chapters that are the same throughout the book.

The Use of Letters to Create Movement in Residential Settings with Adolescents and Their Parents

Adolescents in therapeutic residential treatment can, at times, be a difficult population to treat. This chapter outlines how letters can be effectively used to promote change within the individual and family. The effective use of therapeutic letter writing results in both the adolescent and parent being more open to change and motivates them to work on their part of the system that sustains the problem. Descriptions of types of therapeutic letters are provided, along with a rationale for the use of letter writing as an intervention when working with families within which an adolescent is in residential treatment. Methods are also outlined for holding parents accountable for their behaviors when necessary and helping them to change their approach to working with their child. The goal of this type of letter writing for adolescents and families is to learn and execute effective communication during difficult situations, which should help them to contain negative interactions.

Readiness for Change Within the Family and the Identified Patient

Adolescence is a considerably challenging period of human development and can be viewed as a critical time for individuals to learn to regulate emotions, while also balancing biological and social changes. The family plays a key role in an adolescent’s development and the family’s role in the etiology, course, and outcome of an adolescent’s issues must be taken into account. Thus, it is imperative for families to remain involved when adolescents are in residential treatment. Accordingly, the benefits of, and methods for, increasing the adolescent’s and the family’s readiness for change is explored in this chapter. The process of increasing family engagement in residential treatment is considered through the lens of the Stages of Change model. By using the Stages of Change model, programs can better understand where the adolescent and family are at in their readiness for change and help them find and maintain the motivation to change mutually destructive behavior. The barriers practitioners may face with adolescents and their families in increasing readiness for change are also discussed.