Depressive symptoms and self-harm among youngsters referred to Child Welfare: The role of trust in caregiver support and communication

Depressive symptoms and self-harm, i.e. non-suicidal self-injury and suicidal behaviors, are highly prevalent in youngsters involved in Child Welfare System (CWS) services. Little research investigates, however, why these CWS youngsters are at risk. We explored whether trust in caregiver support and communication about experiences with primary caregivers, are associated with CWS youngsters’ depressive symptoms and/or self-harm. An anonymous online survey of 271 CWS youngsters (10-21 years of age, 57.2% female) was used to assess trust and communication, and depressive symptoms/self-harm. Results showed significant negative associations between self-reported trust in maternal and paternal support, and depressive symptoms/self-harm. Communication about experiences with one’s biological mother mediated the relationship between trust in maternal support and depressive symptoms/self-harm. Furthermore, the presence of an additional trustworthy caregiver buffered the impact of low trust in maternal or paternal support on depressive symptoms/self-harm. Implications for interventions targeting CWS youngsters’ depressive symptoms and self-harm are discussed.status: publishe

Attachment-Based Family Therapy between Magritte and Poirot: Dissemination dreams, challenges and solutions in Belgium

Attachment-Based Family Therapy (ABFT) was introduced into Belgium in 2009. Since then, three home-based services (Child Welfare System) and one inpatient young adult psychiatric unit (Mental Health care System) implemented ABFT as a treatment model. Although financial and organizational barriers exist, preliminary data suggest that ABFT can be successfully implemented in Belgium, and yields promising results. ABFT appeals to counselors and therapists who receive training. Future dissemination will be facilitated by the establishment of a new ABFT training center in Flanders.status: publishe

Werken met gehechtheid in behandeling van kinderen en adolescenten

status: publishe

Middle childhood support-seeking behavior during stress: links with self-reported attachment and future depressive symptoms

This study tested whether children's more anxious and avoidant attachment is linked to decreased support-seeking behavior toward their mother during stress in middle childhood, and whether children's decreased support-seeking behavior enhances the impact of experiencing life events on the increase of depressive symptoms 18 months later. Ninety-eight 8- to 12-year-old children filled out questionnaires assessing their level of anxious and avoidant attachment and depressive symptoms. Children's support-seeking behavior was observed through measuring the time children waited before calling for their mother's help while carrying out a stressful task. Results supported the hypothesis that more anxiously or avoidantly attached children waited longer before seeking maternal support. Moreover, waiting longer was related to increased depressive symptoms at follow-up in children who reported more experienced life events.status: publishe

Attachment-Based Family Therapy for Adolescents and Young Adults With Suicide Ideation and Depression An Open Trial

Background: Suicide ideation among adolescents is difficult to treat. Attachment-based family therapy (ABFT) is a promising evidence-based family intervention developed to decrease depressive symptoms and suicide ideation among adolescents. Aims: This open trial assessed the feasibility of ABFT for adolescents (12-23 years) with suicide ideation and depression in an outpatient community mental health center in the Netherlands, by monitoring treatment compliance and satisfaction, treatment dose, and symptom reduction. Methods: Eligible patients were referred by the multidisciplinary treatment team at the facility. Treatment dose was monitored by the therapist. Depression (CDI-2), family functioning (SRFF), and strengths and difficulties (SDQ) were assessed online before the intervention and at 3, 6, and 9 months after baseline. Suicide ideation (SIQ-JR) was assessed at each therapy session, and a satisfaction questionnaire was administered postintervention. A total of 25 families signed informed consent, received ABFT treatment, and were included in the analyses. The therapists were at beginners' level of ABFT, working under supervision during the trial. Results: The treatment dose was acceptable, though impacted by COVID-related lockdowns, and treatment compliance was 89%. Patients received on average 22 ABFT sessions, and about half of the patients received additional psychotherapy. On average, patients were satisfied with ABFT. There was a significant decrease in suicide ideation postintervention (d = 0.69) and significant effects on the CDI-2, SRFF, and SDQ at follow-up with medium-to-large effect sizes (d = 0.53-0.94). Limitations: These results should be interpreted with considerable caution, as there was no control group to establish the effectiveness of ABFT, and the sample was small. Conclusion: ABFT appears to be a feasible therapy for youth with depression and suicide ideation in an outpatient community mental health setting.</p

Exploring Acceptability and Feasibility of Evidence-Based Practice in Child Welfare Settings: A Pilot study with Attachment-Based Family Therapy

The Flemish Child Welfare System (CWS) is in great need of a shared empirically informed clinical strategy for working with depressed adolescents and their families. Many evidence-based practices (EBP) exist, but little is known as to whether they can be successfully imported in the CWS. Therefore, the current study explores implementation of one EBP, Attachment-Based Family Therapy (ABFT), in home-based services of the Flemish CWS in Belgium. Specifically, the study focused on (1) the acceptability of ABFT by counselors and whether negative attitudes about EBP can be changed (n = 73 counselors), and (2) the feasibility of implementing ABFT (n = 43 adolescents, 11 – 17 years old, 72% female) by exploring initial effectiveness. The results suggested that (1) initial negative attitudes of counselors towards ABFT were significantly more positive after attending training and discussions about ABFT, and that (2) ABFT could be used by counselors to successfully reduce adolescent depressive symptoms. Future research should include a control group to draw stronger causal conclusions. Strengths and limitations of the study’s design and their implication for further dissemination are discussed.status: publishe

Exploring acceptability and feasibility of evidence-based practice in child welfare settings : a pilot Study with attachment-based family therapy

The Flemish Child Welfare System (CWS) is in great need of a shared empirically informed clinical strategy for working with depressed adolescents and their families. Many evidence-based practices (EBP) exist, but little is known as to whether they can be successfully imported in the CWS. Therefore, the current study explores the implementation of a particular EBP, Attachment-Based Family Therapy (ABFT), in home-based services of the Flemish CWS in Belgium. Specifically, the study focused on (1) the acceptability of ABFT by counselors and whether negative attitudes about EBP can be changed ('n' = 73 counselors), and (2) the feasibility of implementing ABFT ('n' = 43 adolescents, 11–17 years old, 72% female) by exploring initial effectiveness. The results suggest that (1) initial negative attitudes of counselors towards ABFT were significantly more positive after attending training and discussions about ABFT, and that (2) ABFT could be used by counselors to successfully reduce adolescent depressive symptoms. Future research should include a control group to draw stronger causal conclusions. Strengths and limitations of the study’s design and implications for further dissemination are discussed

Children’s attentional breadth around mother: Comparing stimulus-driven versus cognitively controlled processes

Attentional processes in children are tuned towards their mother. It is unclear whether this is a cognitively controlled or more automatic, stimulus-driven process. Therefore, 172 children (age 9-13) were assigned to either a cognitively controlled or a stimulus-driven task measuring the breadth of their attentional field around mother. Results demonstrated a narrower field around mother in the more stimulus-driven measure. Moreover, only for the latter task, this effect was linked with the interaction between children’s age and self-reported trust in maternal support. More trust was linked with a narrower attentional field around mother in younger children, but with a less narrow field in older children. This resembles the expected age-related shift towards increased autonomy and points at stimulus-driven attentional processes.status: publishe