Discerning How Family Intervention Works, and How to Improve It

Family intervention is central to prevention science. Family interventions are widely implemented to support parent-child relationships, enhance children’s well-being, and reduce their mental health problems. The effects of family interventions, however, tend to be small to medium at best—a figure that has not improved over decades. In this presentation, we explain how discerning the effects of family interventions to establish contributions of discrete and combined components may improve our understanding of how family interventions work. Such an improved understanding of family intervention can guide our efforts to strengthen it.

As of yet, there is little consensus on how the effects of interventions can be disentangled. We present a framework to overcome this status quo. Specifically, we present research strategies that allow prevention researchers to generate hypotheses on components that may drive intervention effects (e.g., identifying components shared by effective therapies, testing associations between intervention components and intervention effects), and research strategies to test these hypotheses (e.g., microtrials, additive and dismantling trials). This two-part approach provides a model for implementing the experimental therapeutic approach recommended by the National Institute of Mental Health (NIMH; U.S. Department of Health and Human Services, 2015). The aim of this approach is to improve our understanding of the factors that change mental health problems, and translate them to intervention components. We provide examples from prevention science to illustrate how each of the research strategies can be used, and the type of research questions it answers, often using secondary analyses of data from decades of rigorous prevention research.

In addition to identifying the effective components of interventions, discerning intervention effects may contribute to answering several other enduring questions about prevention. For example, to what extent do more intensive interventions, or those that offer more components, yield stronger effects? What components benefit some families more than others, and can we identify components that work equally well for most families? Research strategies that help identify the empirical merit of discrete and combined intervention components may be able to shed light on these issues.

In sum, we will present a framework for prevention scientists to put the experimental therapeutic approach recommended by NIMH into practice, by disentangling the effects of family interventions into contributions of discrete and combined components. Such research, we propose, will inform efforts to improve the effectiveness of family interventions.