Danielson 2012.
| Methods | Randomised trial of family therapy vs treatment as usual | |
| Participants |
Included (n = 30) Treatment‐seeking adolescents who could recollect ≥ 1 childhood unwanted/forced contact sexual abuse. Mean age: 14.8 years. Female: 88%. African American 46%, white 37.5%, Native American 4.2%, bi‐racial 8.3% and Hispanic 4%. Age at first/only abuse: 4 to 15 years. Mean time since most recent assault: 3.7 years; 23 reported other traumatic events Excluded Adolescents with mental retardation Setting Therapy was delivered through the outpatient clinic and by an outreach programme at an urban clinic specialising in treatment of trauma in the USA |
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| Interventions |
Risk reduction through family therapy (RRFT) (n =15) RRFT was developed to reduce the risk of substance use, other high‐risk behaviours and trauma‐related psychopathology in adolescents who had experienced child sexual abuse. RRFT was built upon the principles and interventions applied in multi‐system therapy (MST) and trauma‐focused cognitive‐behavioural therapy (TF‐CBT). The protocol has 7 components: psychoeducation, coping, family communication, substance abuse, PTSD, healthy dating and sexual decision making and re‐victimisation risk reduction. Strategic family therapy is utilised to help the family define problems and work together to find solutions. Weekly sessions of 60 to 90 minutes with the therapist were held, with adolescents and caregivers individually and as a family. The order of and time spent on each component was determined by the needs of each youth and family. A mean of 23 sessions were completed Treatment as usual (TAU) (n =15) No single treatment emerged as consistently delivered across youth and families assigned to the TAU group. The mean number of sessions was 13 Therapists Participants in both groups were treated by clinical psychology graduate students completing a predoctoral internship. RRFT adherence was assessed by review of randomly selected audiotaped sessions (2 per client per month), weekly individual supervision by the treatment developer (a licenced clinical psychologist) and an RRFT adherence checklist completed by therapists immediately after completion of each session. TAU therapists were supervised by other licenced psychologists in the clinic |
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| Outcomes |
Trauma symptoms Scale: UCLA PTSD Index Rater: adolescent, parent Depression Scale: CDI Rater: adolescent Behaviour Scale: Behavioral Assessment System for Children (BASC‐2) Rater: adolescent, parent When Post therapy and at 3‐ and 6‐month follow‐up |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were randomly assigned by computerised block randomisation |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants (performance bias | High risk | Participants probably were aware of whether they had been allocated to treatment or no treatment groups |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Outcome assessment could not be blinded, as all were self‐reported or parent report |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Post therapy, 7% were lost to follow‐up, but imputed data appear to have been used, and none were lost to follow‐up at 3 months |
| Selective reporting (reporting bias) | Unclear risk | Parent‐rated BASC‐2 scores were not reported |
| Other bias | Low risk | No other bias was apparent |