Cost-effective, brief programs to support family communication and improve mental health in youth are a pressing need; yet few evidence-based programs exist. Our group has developed and rigorously tested an empirically-supported family-systems approach to improving communication and conflict in families, thereby improving mental health in youth. Beneficial effects for youth mental health and other indices of adjustment associated with the Happy Families Curriculum have been supported in several efficacy trials with families from a variety risk contexts. However, the value of efficacy research is limited unless it is subsequently tested in the context of an effectiveness trial. Given the potential large-scale benefits of broad implementation of the Happy Families Curriculum, a critical need exists for an effectiveness trial to evaluate the program when it is implemented in community settings by facilitators who would provide the program in ?real world? settings. Our objective in this proposal is to test the effectiveness for a large sample, in different contexts of risk, of the brief (i.e. 4 session) psycho-educational and communication training approach used in our efficacy trials, and to examine the mechanisms associated with change processes that occur as a result of the program, including emotional security as a mediator of program effects and moderators of effects associated with participants? socioeconomic and contextual risks as well as organizational factors that may impact program effectiveness. Our central hypothesis is that participation in the program will improve patterns of communication and conflict in families, thereby improving youth mental health. This hypothesis is supported by extensive efficacy research on the Happy Families Curriculum and conclusions based on a recently conducted feasibility study of the proposed effectiveness trial. Our rationale is that providing a family-systems approach to improving the family environment will support youth mental health over time.
The specific aims are: (1) evaluating program effectiveness for improving communication, reducing destructive conflict in families and enhancing mental health in youth, (2) testing process models, guided by the Emotional Security Theory (EST; Davies & Cummings, 1994), to explain how, why, for whom and when, changes occur as a result of the program, and (3) evaluating organizational factors associated with program effectiveness, including the impact of organization structure and facilitator type, and organizations? subjective evaluation of the program. This approach is innovative because it utilizes an RCT design to test the effectiveness of a proven family-systems approach that represents a brief, inexpensive and readily scalable approach to foster change in families? communication patterns and improve mental health. The program is based on a well-established theoretical model for ?mechanisms of effect? and backed by evidence for program efficacy. This research is significant because it will result in an inexpensive model program for family-system-level interventions that is sustainable in the organizations it is tested in, and readily adjusted to other contexts.

Public Health Relevance

The proposed research is relevant to public health because it provides a rigorous test of an in- novative, evidence-based and cost-effective intervention that is readily scalable to support bet- ter family functioning, tests mechanisms of effect for program impact, and evaluates organiza- tional factors contributing to program effects, all in the context of an RCT designed effective- ness trial. This is in response to RFA-MH-18-701, and is specifically relevant to NIMH?s mission because it contributes to the understanding of mental health problems in youth and contributes to prevention and intervention by utilizing a family-systems approach to improving the family en- vironment, which is a crucial developmental context with implications for mental health and ad- justment throughout the lifespan.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1)
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Reider, Eve
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University of Notre Dame
Schools of Arts and Sciences
Notre Dame
United States
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