Categories associated with best practice:
Determinants of Health: Personal health practices and coping skills, Social relationships (including those that respect diversity), Social support networks, Healthy child development
The Family Talk preventive intervention is a strength-based, family-focused program targeting families in which one or both parents have depression. Children of parents with mood disorders are two to four times more likely to develop mood disorders themselves, relative to children in families with no parental illness. Numerous studies also report increased rates of other psychiatric disorders in these children at risk. However, despite the associated risks, many children of depressed parents are resilient. One of the primary goals of the Family Talk prevention program is to improve family relationships, functioning and communication. These goals are important because adverse family environments (i.e., poor communication, parent withdrawal and irritability) are key risk factors for the development of childhood depression and other related problems.
Family Talk involves a series of meetings in which parents learn about depression, discuss their experiences with parental depression and how it has affected the family, and build coping skills. There is also a child session and a Family Meeting. These discussions help to build a family narrative regarding depression and help to break the silence about the illness and its effects. Another key goal of the intervention is to assist parents in recognizing and building on strengths in the family in order to enhance resilience in themselves and their children. There are 7 core modules in the intervention, including a follow-up meeting typically scheduled six months after the end of the intervention. The sessions typically take place weekly and more than one session is sometimes required to complete a module. The program is delivered by trained psychologists, social workers, and nurses.
The impacts of two formats of the preventive intervention, lecture based and clinician facilitated, were compared in a large-scale trial involving 105 families who were followed over four and half years after study enrollment. Analyses indicated that both groups made positive changes in the areas of decreased marital discord, improved family communication and problem-solving, increased focus on children, and improved understanding. Additionally, improvement in family problem-solving, communication, and understanding, remained robust several years after the initial intervention. Parents in the clinician-facilitated group reported greater changes than did parents in the lecture group. Additionally, children in the clinician-facilitated group reported greater understanding of parental depression than those in the lecture-only group.
The increased benefit of the clinician-facilitated version has led to a greater emphasis on this format.
Primary Source Document
W Beardslee, J Martin and T Gladstone, Family Talk Preventive Intervention manual. FAMpod (Families Preventing & Overcoming Depression)
Contact information of developer(s) and/or implementer(s)
The intervention was developed by Dr. William R. Beardslee and collaborators at the Judge Baker Children's Center, an affiliate of the Harvard Medical School in Boston, Massachusetts.
|Intervention Goal / Objective||Level(s) Targeted||Equity Focus|
|Help families plan for the future and prevent the onset of difficulties in the children.||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
|Address any existing child problems.||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
|Strengthen coping skills such as communication and problem-solving.||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
|Maximize current family assets and build resiliency.|
|Help family members talk about depression and create a shared family depression narrative.|
|Instill hope in families struggling with depression.|
|Educate parents and children about depression and resiliency.|
Health Issue(s) that is/are addressed by the Intervention
- Mental Health
Specific Activities of the Intervention
- Counselling sessions to those who are at high risk for a chronic disease
- Information sessions offered about a risk factor or condition
- Group process/program
Priority/Target Population for Intervention Delivery
- Children (age 6-12 years)
- Youth (age 13-18 years)
- Young adult (age 19-24 years)
- Adults (age 25-64 years)
- Health care setting
|Outcomes and Impact Chart|
|Level of Impact||Description of Outcome||Equity Focus|
|Individual Level||Recognition of depression in children was much higher at post-intervention assessments than at baseline: 12 of 17 (71%) versus 2 of 16 (13%), respectively; x² (1) = 11.4, p < .001.||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Individual Level||Parents in the clinician group averaged more child-related behavior and attitude changes than lecture parents did: (effect size= 0.84; x² (1) = 52.8, p <.0001. The number of reported changes increased across the four follow-up assessments, x² (3) = 88.6, p = .0001. Neither gender nor the couple’s worst functioning predicted the parents’ response to intervention in this domain. The average number of changes made did not vary by completion status.||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Individual Level||Internalizing t scores decreased from baseline levels, x² (1) = 9.0, p < .001; effect size = 0.32. Baseline levels significantly predicted later internalizing scores, x² (1) = 28.2, p < .0001. With baseline scores in the model, there was no main effect for intervention group, but there was a main effect for gender, with girls scoring higher, on average, than boys did, x² (1) = 8.3, p <.01; effect size = 0.37. In addition, completers scored lower, on average, than partial completers did, x² (1)= 4.1, p < .05.||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Individual Level||Children in the clinician group scored higher, on average, on improved understanding of parental mood disorder than those in the lecture group did across the four follow-up assessments: clinician and lecture (effect size = 0.33; x² (1) = 5.0, p < .05. Scores increased significantly over time, x² (3) = 9.0, p < .05, but, with developmental stage in the model, this increase was not significant. Completion status was a significant covariate, with completers scoring higher, on average, than partial completers did, x² (1) = 5.3, p < .05.|
Parent family functioning scores increased, on average, from baseline, x² (1) = 11.2, p < .001; effect size = 0.20. Controlling for baseline family functioning scores, the intervention groups did not differ in post-intervention scores, x² (1) = 0.3, p < .1.
Child family functioning scores increased from baseline, x² (1) = 19.3, p < .0001; effect size = 0.50. Adjusting for baseline family functioning scores, the groups did not differ in post-intervention scores, x² (1) = 1.8, p > .1; nor did scores vary by completeness status, x² (1) = 0.74, p >.1. Neither gender nor developmental stage predicted levels of family functioning (ps > .1).
- Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.
Expertise Required for Implementation within the Context of the Intervention
- Requires specialized skills that are easily available within the context - The intervention requires the participation of personnel with advanced skills (e.g. medical doctors, epidemiologists, social workers) but that are easily available within the intervention context.
Are there supports available for implementation
Yes. Free online training; consultation
Are there resources and/or products associated with the interventions
Yes. Program manual