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Abstract
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The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.
VioLit summary:
OBJECTIVE:
This study by Gutstein et al. provided information about the clinical effectiveness, safety, and economic viability of the Systemic Crisis Intervention Program (SCIP). SCIP was designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system.
METHODOLOGY:
This study employed a quasi-experimental design. The goal of SCIP was to aid families in learning about their inherent crisis-intervening potential by taking advantage of the crisis precipitated by the adolescent's life-threatening behavior (e.g., attempted suicide, running away, and drug use). The selection criteria for SCIP included: 1) recommendation for psychiatric hospitalization from a medical/mental health professional; 2) clear, crisis-precipitating behavior; and 3) family members who were so highly disturbed that they felt they could not continue with the present situation. On average, treatment consisted of one three-hour evaluation session, six to ten one-hour preparation sessions with individual family members, and two four-hour extended family gatherings during the crisis period. In most of the cases, some from of post-treatment was recommended, which often involved a combination of family and group therapy.
Thirty-four male and 41 female patients were treated by SCIP at the Houston Child Guidance Center. They ranged in age from 7 to 19 years, with a mean age of 14.3. Thirteen were African-American, 14 were Hispanic, 47 were White, and 1 was Asian American. The cases included for study were the first 90 patients seen by SCIP between January 1, 1984 and April 30, 1985. During this time, 142 families were seen for evaluation. 83.3% of the cases were followed.
Included among the measures used to assess the clinical effectiveness of SCIP were three subjective parent ratings and two objective measures of patient behavior. Parents rated the severity of the child's problem, in addition to family and marital functioning on Likert-type scales. The number of problem episodes youth experienced was monitored sing an extensive, 46-item problem checklist. Adaptive behavior was measured by means of a 23-item adaptive behavior scale that addressed issues of school, family, social, and interpersonal functioning on the part of the patient. Measures were taken at the initial evaluation, and follow-up interviews were taken at 3, 6, 12, and 18 months. A subsample of patients (n=10) were randomly selected and followed for 24 months to assess treatment stability. During the follow-up interview, parents rated the severity of the problem that precipitated treatment, the marital and family functioning, and adaptive behavior of their children.
FINDINGS/DISCUSSION:
Of the 75 adolescents involved in the study, two made minor suicide attempts during the follow-up period. In both cases the attempts were mad within six months of treatment and neither proved fatal. There were no suicide attempts during treatment. In addition, there were no reports of injury to either that patient or family members during the treatment phase or follow-up period. Over 85% or pre-treatment problem-severity ratings were in the "severe" to "catastrophic" range. Ratings improved markedly three months following treatment with only 21% indicating that the crisis had, for the most part, not been resolved. Only 16% of parents indicated that the problem remained severe over 12 months after treatment and only 10% at 24 months. In addition, the number of problem episodes did not increase following treatment. There was a significant decrease over the next two-year period (p<.001). Five out of the 75 adolescents wee hospitalized or placed in a residential treatment facility during the follow-up period. Lastly, the mean cost of SCIP was $3200. This compared favorably with the average cost of over $40,000 in the authors' area for a single adolescent hospitalization.
Successful cases were judged based on five criteria: 1) no occurrence of suicidal behavior or actions that would endanger other during follow-up; 2) a clear decrease of behavior severity according to parents' ratings; 3) no occurrence of new crisis behavior; 4) no time spent in an institutional setting; and 4) regular attendance in school or work. Only cases that had at least 12 months of follow-up data were considered for this analysis. Of the 68 cases analyzed in this manner, 50 (74%) clearly met the criteria for success. Fourteen cases (21%) failed to meet one of the five criteria.
In sum, as evidenced by ratings for problem behavior severity, adaptive behavior, and family/marital functioning, SCIP was judged to be effective in resolving the crisis situation that precipitated treatment and in yielding stable change. In addition to providing a safe and effective treatment environment, SCIP also sought to prevent or eliminate institutional dependency among families in the program and operated within structured and competitive economic guidelines.
AUTHORS' RECOMMENDATIONS:
The author suggested further investigation into the determination of factors that would best predict for whom SCIP will be successful. Also, the authors believed that a crucial issue in validating the SCIP model was situated in determining whether the beneficial effects of SCIP were due to improved kinship system functioning, as they hypothesized them to be.
(CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - 1980s
KW - Texas
KW - Treatment Program
KW - Treatment Effectiveness Evaluation
KW - Intervention Program
KW - Program Effectiveness
KW - Program Evaluation
KW - Parent Involvement
KW - Family Based
KW - Family Treatment
KW - Family Functioning
KW - Family Relations
KW - Parent Child Relations
KW - Child Behavior
KW - Child Problem Behavior
KW - Child Runaway
KW - Child Substance Use
KW - Child Suicide
KW - Suicidal Behavior
KW - Suicide Attempted
KW - Suicide Intervention
KW - Behavior Intervention
KW - Behavior Treatment
KW - Drug Use Intervention
KW - Drug Use Treatment
KW - Substance Use Intervention
KW - Substance Use Treatment
KW - Child Treatment
KW - Juvenile Treatment
KW - Juvenile Behavior
KW - Juvenile Problem Behavior
KW - Juvenile Suicide
KW - Juvenile Substance Use
KW - Juvenile Runaway
KW - Middle Childhood
KW - Late Childhood
KW - Late Adolescence
KW - Early Adolescence
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