Prospective Pilot Study of the Mastering Each New Direction Psychosocial Family Systems Program for Pediatric Chronic Illness

• Author: Ara M. Anspikian,Brian Distelberg,Natacha D. Emerson,Jackie Williams‐Reade,Daniel Tapanes,Deepti Vaswani,Whitney N. Brown,Susanne Montgomery
• Published date: 01 March 2018
• DOI: http://doi.org/10.1111/famp.12288
• Date: 01 March 2018

Prospective Pilot Study of the Mastering Each New

Direction Psychosocial Family Systems Program for

Pediatric Chronic Illness

BRIAN DISTELBERG*

DANIEL TAPANES

†

NATACHA D. EMERSON

‡

WHITNEY N. BROWN

‡

DEEPTI VASWANI

§

JACKIE WILLIAMS-READE

¶

ARA M. ANSPIKIAN

§

SUSANNE MONTGOMERY**

Psychosocial interventions for pediatric chronic illness (CI) have been shown to support

health management. Interventions that include a family systems approach offer potentially

stronger and more sustainable improvements. This study explores the biopsychosocial

benefits of a novel family systems psychosocial intervention (MEND: Mastering Each New

Direction). Forty-five families participated in a 21-session intensive outpatient family

systems-based program for pediatric CI. Within this single arm design, families were mea-

sured on five domains of Health-Related Quality of Life (HRQL) self-report measures;

Stress, Cognitive Functioning, Mental Health, Child HRQL, Family Functioning. Both

survey and biological measures (stress: catecholamine) were used in the study. Results from

multivariate general linear models showed positive pre-, post-, and 3-month posteffects in

all five domains. The program effects ranged from small to moderate (g

2

=.07–.64). The

largest program effects were seen in the domains of cognitive functioning (g

2

=.64) and

stress (g

2

=.27). Also, between disease groups, differences are noted and future implications

for research and clinical practice are discussed. Conclusions suggest that the MEND pro-

gram may be useful in helping families manage pediatric chronic illnesses. Study results

also add to the growing body of literature suggesting that psychosocial interventions for

pediatric chronic illness benefit from a familysystems level of intervention.

Keywords: Family Systems; Chronic Illness; Intervention; Mastering Each New Direction

Fam Proc 57:83–99, 2018

Adolescence is a crucial time for a pediatric patient to adjust and ultimately cope with

his or her chronic illness (CI) (Armstrong, Mackey, & Streisand, 2011; Modi et al.,

2012). In addition to the normal developmental tasks of moving toward independence and

*Loma Linda University Behavioral Medicine Center, Redlands, CA.

†

Department of Counseling and Family Sciences, Loma Linda University Health Behavioral Medicine Center,

Loma Linda, CA.

‡

Department of Psychology, Loma Linda University, Loma Linda, CA.

§

Loma Linda University Health Behavioral Medicine Center, Loma Linda, CA.

¶

Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, CA.

**Behavioral Health Institute, Loma Linda University, Loma Linda, CA.

Correspondence concerning this article should be addressed to Brian Distelberg, Loma Linda University

Behavioral Medicine Center, Redlands, CA. E-mail: bdistelberg@llu.edu.

Funding: None.

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Family Process, Vol. 57, No. 1, 2018 ©2017 Family Process Institute

doi: 10.1111/famp.12288

gaining self-confidence, an adolescent must also integrate their CI management into their

transition into adulthood (Armstrong et al., 2011). Given that proper integration of these

two development trajectories has been linked to better health outcomes in adulthood

(Dashiff, Bartolucci, Wallander, & Abdullatif, 2005; Fiese & Everhart, 2006; Van Cleave,

Gortmaker, & Perrin, 2010), targeted efforts during the adolescent stage can pay large

psychosocial dividends. Unfortunately, this integration can be difficult to achieve for some

families and may result in behavioral difficulties or medical regimen nonadherence

(Pinquart & Shen, 2011).

Fortunately there has been a recent growth of psychosocial programs developed to sup-

port these families (Barlow & Ellard, 2004; Beale, 2006; Eccleston, Palermo, Fisher, &

Law, 2012). Although few have shown sustained effects, the current study continues to

evaluate one such program. This current study uses a quasi-experimental, within-subject,

single arm design to test the pre-, post-, and 3-month posteffects of the Mastering Each

New Direction (MEND) program (Distelberg et al., 2014; Tapanes et al., 2015). While pre-

vious studies of the MEND program (Distelberg et al., 2014) have shown positive effects

pre- and postintervention, this study assesses a new sample to evaluate the sustainability

of these effects 3 months after graduation. In addition, this study measures additional

HRQL domains, inclusive of biological measures of stress. This small-scale pilot study

offers valuable insights for the field as well as future larger scale effectiveness studies.

Family Systems, Psychosocial Interventions for Pediatric Chronic Illness

To our knowledge, three meta-analysis studies offer evidence that psychosocial inter-

ventions can be helpful for pediatric chronic illness (Barlow & Ellard, 2004; Beale , 2006;

Eccleston et al., 2012). In each of these studies, interventions are associated with reduced

negative HRQL outcomes for children with varying chronic illnesses (e.g., chronic pain,

cancer, diabetes, asthma, traumatic brain injuries, or eczema). Of note, these inter-

ventions differed in their conceptual approach (cognitive behavioral, family-based, and

problem-solving modalities among others) as well as by level of intervention (e.g., psycho-

educational vs. more traditional therapy models).

Of these programs, recent research also suggests that multisystemic, family systems

approaches tend to offer greater sustainability (Eccleston et al., 2012; Ellis et al., 2012;

McBroom & Enriquez, 2009), especially when the parent–child relationship is intention-

ally addressed (Distelberg et al., 2014; McBroom & Enriquez, 2009; Scholten et al., 2015).

For example, a version of cognitive behavioral therapy (CBT) which includes parents more

intentionally provided more sustainable effects in a randomized control trial design than

traditional CBT alone (Scholten et al., 2013). Likewise, a version of Multisystemic Ther-

apy (MST) designed for children with type I Diabetes (Ellis et al., 2012) has shown prelim-

inarily strong and sustainable effects.

Unfortunately, family systems approaches are currently the exception rather than the

rule for pediatric populations requiring psychosocial intervention (Eccleston et al., 2012;

Modi et al., 2012). Furthermore, aside from the intervention mentioned above for youth

with Type I Diabetes, there are no published and validated family systems interventions

available. This clearly leaves a significant gap of services for the plethora of patients

dealing with pediatric CI.

MEND Model

To address this need, a 21-session/7-week intensive outpatient family therapy-based

treatment model called MEND was created (Distelberg et al., 2014; Tapanes et al., 2015).

MEND is a principle-based intensive outpatient (IOP) psychosocial intervention for chil-

dren with a CI. MEND is delivered in a behavioral health medical center and, as such,

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