A 5 year comprehensive study using Therapeutic Storytelling Intervention (TSI) in a community mental health setting
This naturalistic outcome study suggests that TSI is successful method of communicating with multi-problem children and adolescents who are hard to reach using many traditional methods. Those attending TSI groups were selected for this study because they formed a coherent and trackable cohort of patients who had received a manualised treatment. While cognisant of the hierarchy of research design with regard to power, sample size and control for confounds, this study make an important contribution to exploring methods of engaging and retaining distressed young people in treatment and provides a foundation on which to build successful clinical interventions. The data in this study form the basis of a randomised controlled trial which is currently being established.
The most outstanding result of this study is that children and adolescents with severe mental health disorders and high rates of co-morbidity were engaged in an outpatient group treatment programme and that the overall retention rate of 60% is significantly higher than found in many similar programmes. TSI is equally successful in retaining boys and girls in treatment. The high rate of retention is of particular interest to clinicians who are attempting to generate creative ways of treating children and adolescents in community mental health settings. Many patients and their families do not share mental health professional views that ongoing follow-up is beneficial to them reflected in compliance rates as low as 20 -30 % with outpatient treatment (Coatsworth, Santisteban, McBride, & Szapocznik, 2001; King, Hovey, Brand, & Wilson, 1997; Rotheram-Borus et al., 1999; Spirito, Plummer, Gispert, Levy, & et al., 1992). Dropout occurs rapidly with a median survival rate of only three sessions (Trautman, Stewart, & Morishima, 1993) compared with average retention of 16 sessions demonstrated in this study.
Pre and post group data suggest that both parents and patients perceive an improvement in their general mental health and behaviour. Parents rated their children as having fewer behavioural problems and less symptoms of depression, anxiety and attention difficulties. Similarly participants rated themselves as more effective with greater enjoyment of life and lower rates of overall depression, suicidality and more positive perceptions of the way in which their family functioned.
Groups are intrinsically attractive from both developmental and service delivery perspectives. However oppositional adolescents and those who have ‘failed’ previous treatment programs strongly resist efforts to utilise their ‘issues’ as material upon which the group session is dependant. Frequently such adolescents will act out in order to disrupt the group and/or terminate their inclusion. TSI precludes the destruction of the group by this route by providing ‘safe’, externalised material for group discussion. TSI rapidly engages resistant, hopeless and depressed adolescents, enabling family and other therapy to proceed with the amelioration of risk factors.