Rebecca McKenzie is a Developmental Psychologist and Associate Professor of Early Childhood Studies at The University of Plymouth in the UK.
Background: Alongside symptoms of autism and maladaptive behaviour, children with autism and their families also report mental health problems. SAFE is a new family oriented intervention drawing upon attachment theory, systemic practice, multi-family therapy and preferences of people with autism.
Aim: A randomised controlled feasibility trial of SAFE was conducted to prepare for a definitive national UK trial to evaluate its effectiveness in promoting positive family change.
1. Demonstrate ability to identify, recruit and randomize eligible families.
2. Verify that outcome measures and follow-up are acceptable
3. Assess adherence to the intervention.
4. Gather quantitative data on outcomes
5. Collect data on experience of SAFE and the study.
Methods: Thirty-four families were recruited (randomised 2:1) to receive either
(i) the intervention plus support as usual (SAFE+SUE) or
(ii) support as usual (SUE). SAFE provided five 3-hour therapy sessions. The primary outcome measure was the Systemic CORE 15 (SCORE-15) assessing perception of family functioning. Secondary and process measures assessed therapists’ adherence to the intervention and families’ experience of the study materials, recruitment, intervention, perceived changes in relationships, wellbeing and coping.
Results: Data was provided at baseline by 34 families (122 individuals), at 24-weeks by 30 families ( 97 individuals). Primary outcome data were available at both time points, for every dimension for 88% Primary Caregivers. There was a marked reduction in negative family function for the SAFE+SUE group only resulting in a mean difference of >3 points on the SCORE 15. Secondary measures and process evaluation showed families receiving SAFE experienced positive change in family dynamics, psychological wellbeing and confidence in managing difficult behaviours. Therapists reported confidence in delivery of SAFE.
Conclusions: Families found the trial acceptable and the intervention helpful. Marked reductions in negative family function
and increases in psychological wellbeing and reciprocal understanding were evidenced from families receiving SAFE. This
study provides potential proof of efficacy for SAFE and will progress to a national UK trial prior to implementation.