A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

The adapted Family Behavior Therapy has shown early evidence of effectiveness in both controlled and uncontrolled case studies involving coexisting child neglect and drug abuse in home-based settings.

“This modified FBT has demonstrated preliminary efficacy in controlled and uncontrolled case trials specific to coexisting child neglect and drug abuse in home-based settings (Donohue, Romero et al., 2010; Donohue & Azrin, 2002; LaPota, Donohue, Warren, & Allen, 2011; Romero, Donohue, & Allen, 2010; Romero, Donohue et al., 2010).”

• cites Donohue, Romero et al., 2010 sourcePartly supported

  The Abstract reports favorable outcomes from a single case involving substance dependence and child neglect, and the Case Presentation identifies the treatment as in-home FBT. However, Recommendations to Clinicians and Students describes the results as anecdotal and calls for controlled trials; this paper does not demonstrate efficacy in a controlled case trial. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Donohue & Azrin, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites LaPota, Donohue, Warren, & Allen, 2011 sourcePartly supported

  The Abstract and Course of Treatment and Assessment of Progress describe an uncontrolled, home-based case involving child neglect and drug abuse, with improvements in drug use and child maltreatment potential. The paper cites controlled trials for substance abuse and reports some success with child-neglect-related problems, but it does not present a controlled case trial of the modified FBT for coexisting child neglect and drug abuse. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

High risk of HIV and AIDS exists in this population.

“The integration of HIV prevention components in FBT is noteworthy given the high risk of HIV and AIDS in this population (see Nijhawan, Kim, & Rich, 2008).”

• cites Nijhawan, Kim, & Rich, 2008 sourcePartly supported

  The ‘Sexually transmitted infections’ section links drug and alcohol use to sexual risk-taking and notes that STIs can increase HIV transmission. This supports concern about HIV risk, but the paper focuses on people already living with HIV and does not establish a high risk of acquiring HIV or developing AIDS in the FBT population. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

FBT participants worked significantly more hours than TAU participants across time.

“Thus, FBT participants worked significantly more hours compared with TAU participants across time.”

Differences between FBT and TAU in marijuana use were not statistically significant.

“Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant.”

There were no differences between FBT and TAU in number of days children were in CPS custody.

“There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication”

FBT mothers increased time employed from baseline to 6 and 10 months compared to TAU.

“Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6- and 10-month post-randomization.”

There were no differences between FBT and TAU in alcohol intoxication.

“There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication”

Mothers assigned to TAU because of child drug exposure decreased hard drug use more than TAU mothers of children not exposed to drugs and FBT mothers of drug-exposed children at 6 and 10 months.

“However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug exposed children and FBT mothers of drug exposed children at 6- and 10-month post-randomization.”

FBT mothers decreased HIV risk from baseline to 6 months compared to TAU.

“Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6-month post-randomization.”

For hours employed, the Time × Treatment interaction was significant at the 10-month post-randomization assessment (F(1,68)=3.549, p=.032, partial η2=.05).

“and baseline to 10-month post-randomization, F(1, 68) = 3.549, p = .032, partial η2 = .05.”

No other significant differences were found for alcohol intoxication.

“No other significant differences were found for alcohol intoxication.”

FBT mothers showed marginal decreases in incarceration from baseline to 6 months relative to TAU (p = .058).

“although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6-month post-randomization relative to TAU mothers.”

Alcohol intoxication decreased significantly across time.

“indicating that alcohol intoxication was significantly reduced across time.”

For hours employed, the Time × Treatment interaction was significant at the 6-month post-randomization assessment (F(1,68)=3.868, p=.027, partial η2=.054).

“there was a significant Time × Treatment interaction in the number of hours employed from baseline to 6-month post-randomization, F(1, 68) = 3.868, p = .027, partial η2 = .054”

There were no significant time effects for hours of employment from baseline to 6- and 10-month post-randomization.

“There were no significant effects in time for baseline to 6- and 10-month post-randomization in hours of employment.”

A marginally significant main effect for incarceration was found from baseline to 6-month randomization (F(1,68)=2.554, p=.058, partial η2=.036).

“results revealed a marginally significant main effect from baseline to 6-month randomization, F(1, 68) = 2.554, p = .058, partial η2 = .036.”

A significant Time × Treatment × Neglect Type interaction was found for hard drug use from baseline to 6 months and to 10 months post-randomization.

“As hypothesized, hard drug use revealed a significant Time × Treatment × Neglect Type interaction from baseline to 6-month post-randomization, F(1, 68) = 5.577, p = .015, partial η2 = .076, and from baseline to 10-month post-randomization, F(1, 68) = 8.148, p = .003, partial η2 = .107.”

The intra-class correlation coefficient for protocol adherence was 96.4%, indicating the providers' adherence estimates were reliable.

“The intra-class correlation coefficient was 96.4%, suggesting the providers’ estimates of protocol adherence were reliable.”

For marijuana use, participants in both Family Behavior Therapy and treatment as usual had effect sizes ranging from medium to large from baseline to 6 and 10 months.

“Examination of effect sizes in Table 3 shows that FBT and TAU participants demonstrated medium to large effect sizes from baseline to both 6- and 10-month post-randomization.”

There was a significant time effect for marijuana use, which decreased from baseline to 6 months and to 10 months post-randomization.

“When examining reductions in marijuana use, there was a significant main effect for time from baseline to 6-month post-randomization, F(1, 68) = 19.346, p < .001, partial η2 = .221, and baseline to 10-month post-randomization, F(1, 68) = 17.327, p < .001, partial η2 = .203, indicating that marijuana use decreased across time.”

Post-hoc analyses showed that among mothers of non-drug exposed children, those receiving Family Behavior Therapy reduced child maltreatment potential more than Family Behavior Therapy mothers of drug-exposed children and treatment-as-usual mothers (p < .05).

“Post-hoc analyses indicated that FBT mothers of non-drug exposed children reduced their child maltreatment potential more than FBT mothers of drug-exposed children, and TAU mothers (p < .05).”

A significant Time × Treatment interaction from baseline to 6 months suggested that Family Behavior Therapy participants showed relatively greater improvements in HIV risk behavior than treatment-as-usual participants.

“As hypothesized, there was a significant Time × Treatment interaction from baseline to 6-month post-randomization, F(1, 68) = 4.014, p = .03, partial η2 = .056, suggesting that participants in FBT demonstrated relatively greater improvements in HIV risk behavior from baseline to 6-month post-randomization as compared with TAU participants.”

There was a significant time effect for hard drug use, which decreased from baseline to 6 months and to 10 months post-randomization.

“For hard drug use, the repeated measures analyses of variance indicated that there was a significant main effect for time from baseline to 6-month post-randomization, F(1, 68) = 15.424, p < .001, partial η2 = .185, and baseline to 10-month post-randomization, F(1, 68) = 12.484, p < .001, partial η2 = .155, indicating that hard drug use was significantly reduced across time.”

There was a significant time effect for Child Abuse Potential Inventory Abuse scores, which decreased from baseline to 6 months and to 10 months post-randomization.

“There was a significant main effect for time from baseline to 6-month post-randomization, F(1, 68) = 15.820, p < .001, partial η2 = .189 and baseline to 10-month post randomization, F(1, 68) = 12.156, p < .001, partial η2 = .152, indicating that CAPI Abuse scores were significantly reduced across time.”

For hard drug use, both Family Behavior Therapy and treatment as usual had small to medium effect sizes from baseline to 6 months and to 10 months post-randomization.

“Consistent with these results, Table 3 indicates that effect sizes for hard drug use were small to medium for both FBT and TAU from baseline to 6-month post-randomization, and from baseline to 10-month post-randomization assessment.”

A significant Time × Treatment × Neglect Type interaction was found for Child Abuse Potential Inventory Abuse scores from baseline to 6 months and to 10 months post-randomization.

“As hypothesized, there was a significant Time × Treatment × Neglect Type interaction from baseline to 6-month post-randomization, F(1, 68) = 5.977, p = .009, partial η2 = .081, and baseline to 10-month post-randomization, F(1, 68) = 3.329, p = .04, partial η2 = .047.”

There was a significant time effect for HIV risk behaviors, which decreased from baseline to 6 months and to 10 months post-randomization.

“Specific to the RAB total scale, there was a significant main effect for time from baseline to 6-month post randomization, F(1, 68) = 6.010, p = .008, partial η2 = .081 and baseline to 10-month post-randomization, F(1, 68) = 8.480, p = .003, partial η2 = .111, demonstrating that HIV risk behaviors were significantly reduced across time.”

A significant Time × Neglect Type interaction for alcohol intoxication was observed from baseline to 6-month post-randomization (F(1,68)=5.224, p=.01, partial η2=.071).

“A significant Time × Neglect Type interaction was observed from baseline to 6-month post-randomization, F(1, 68) = 5.224, p = .01, partial η2 = .071”

Mothers of non-drug exposed children showed the greatest reductions in alcohol intoxication compared with mothers of drug exposed children.

“indicating mothers of non-drug exposed children, as compared with mothers of drug exposed children, demonstrated greatest reductions in alcohol intoxication.”

A significant main effect for alcohol intoxication was found from baseline to 6-month post-randomization (F(1,68)=6.008, p=.009, partial η2=.081).

“results revealed a significant main effect from baseline to 6-month randomization, F(1, 68) = 6.008, p = .009, partial η2 = .081”

Among mothers of drug-exposed children, those in treatment as usual showed significant decreases in hard drug use compared with Family Behavior Therapy mothers of drug-exposed children and treatment-as-usual mothers of non-drug exposed children.

“Mothers of drug exposed children in TAU demonstrated significant decreases in hard drug use, as compared with mothers of drug exposed children in FBT and mothers of non-drug exposed children in TAU.”

Post-hoc analysis showed that among mothers of non-drug exposed children, those receiving Family Behavior Therapy had significant decreases in hard drug use compared with Family Behavior Therapy mothers of drug-exposed children and treatment-as-usual mothers of non-drug exposed children (p < .05).

“Post-hoc analysis of these interaction effects indicated that mothers of non-drug exposed children in FBT demonstrated significant decreases in hard drug use, as compared with mothers of drug exposed children in FBT and mothers of non-drug exposed children in TAU (p <.05).”

No significant interactions were found for marijuana use (all ps > .05).

“Although hypothesized, there were no significant interactions for marijuana use (all ps > .05).”

A significant Time × Neglect Type interaction from baseline to 6 months indicated that mothers whose children were referred for neglect not involving substance exposure showed greater reductions in child maltreatment potential than mothers referred for neglect involving drug exposure.

“There was a significant Time × Neglect Type interaction from baseline to 6-month post-randomization, F(1, 68) = 6.037, p = .009, partial η2 = .082, indicating mothers of children who were referred for child neglect other than substance exposure demonstrated greater improvements in reducing their child maltreatment potential than mothers referred for neglect due to exposing their child to drugs.”

Individual Family Behavior Therapy interventions had adherence rates between 81% for Self-Control and 99% for Child Management.

“Adherence to individual interventions ranged from 81% (Self-Control) to 99% (Child Management).”

More FBT mothers of non-drug exposed children were below the clinical cut-off for child maltreatment potential at 10-month post-randomization than all other mothers (47% improvement vs 14% improvement for TAU mothers of non-drug exposed children and 10% and 6% decrease for FBT mothers of drug exposed children and TAU mothers of non-drug exposed children, respectively).

“more FBT mothers of non-drug exposed children were below the clinical cut-off score for child maltreatment potential at 10-month post-randomization than all other mothers (i.e., 47% improvement as compared with 14% improvement for TAU mothers of non-drug exposed children and 10% and 6% decrease, respectively, for FBT mothers of drug exposed children and TAU mothers of non--drug exposed children.”

Case management follow through was sometimes missing, limited, or inconsistent.

“case management follow through was sometimes missing, limited or inconsistent.”

The differences in marijuana use were not significantly discrepant.

“These differences, however, were not significantly discrepant.”

No other significant differences were found for DFS custody.

“No other significant differences were found.”

A significant main effect for time on days children were in DFS custody was observed from baseline to 6-month post-randomization (F(1,68)=7.625, p=.004, partial η2=.101).

“a significant main effect for time from baseline to 6-month post-randomization was observed, F(1, 68) = 7.625, p = .004, partial η2 = .101.”

FBT was more efficacious than TAU in hard drug use in mothers of non-drug exposed children from baseline to both 6- and 10-month post-randomization.

“FBT was also more efficacious than TAU in hard drug use in mothers of non-drug exposed children from baseline to both 6- and 10-month post-randomization.”

Mothers of drug exposed children with less risk for future child maltreatment victimization showed greater reductions in hard drug use and child maltreatment potential than FBT mothers referred for exposing their children to drugs.

“mothers of drug exposed children with less risk for future child maltreatment victimization demonstrated greater reductions in hard drug use and child maltreatment potential when compared with FBT mothers who were referred due to having exposed their children to drugs.”

Table 4 means show that TAU participants increased their incarceration.

“examination of means in Table 4 shows TAU participants increased their incarceration.”

TAU mothers showed improvements on a number of treatment outcome measures.

“TAU mothers showed improvements on a number of treatment outcome measures”

The incarceration finding was not maintained 10 months after randomization (p>.05).

“This finding was not maintained 10-months after randomization (p >.05).”

The reduction of HIV risk behaviors in FBT compared with TAU was relatively short-lived.

“Although the reduction of HIV risk behaviors in FBT, compared to TAU, was relatively short-lived”

FBT participants spent significantly fewer days incarcerated than TAU participants from baseline to 6-month post-randomization.

“showing FBT participants spent significantly fewer days incarcerated as compared with TAU participants from baseline to 6-month post-randomization.”

Mothers showed medium (TAU) to large (FBT) effects in significantly decreasing marijuana use.

“Mothers demonstrated medium (TAU) to large (FBT) effects in significantly decreasing marijuana use.”

FBT was more effective than TAU in reducing child maltreatment potential in mothers of non-drug exposed children from baseline to 6- and 10-month post-randomization.

“FBT was more effective than TAU in reducing child maltreatment potential in mothers of non-drug exposed children from baseline to 6- and 10-month post-randomization.”

The DFS custody result was not found from pre- to 10-month post-randomization (p>.05).

“This result was not found pre- to 10-month post-randomization (p >.05).”

A significant Time × Treatment interaction for incarceration was found from baseline to 6-month post-randomization (F(1,68)=3.061, p=.04, partial η2=.043).

“there was a significant Time × Treatment interaction from baseline to 6-month post randomization, F(1, 68) = 3.061, p = .04, partial η2 = .043”

From baseline to 6- and 10-month post-randomization, TAU mothers of drug exposed children showed a greater decrease in hard drug use than TAU mothers of non-drug exposed children and FBT mothers of drug exposed children.

“However, from baseline to 6- and 10-month post-randomization, TAU mothers of drug exposed children demonstrated a greater decrease in hard drug use than TAU mothers of non-drug exposed children and FBT mothers of drug exposed children.”

FBT was more effective than TAU from baseline to 10-month post-randomization in improving days employed.

“FBT was also shown to be more effective than TAU from baseline to 10-month post-randomization in the improvement of days employed.”

Children were significantly more likely to spend more time in DFS custody from baseline to 6-month post-randomization.

“Thus, children were significantly more likely to spend more time in DFS custody from baseline to 6-month post-randomization.”

Mothers often preferred to discuss HIV risk behaviors, days employed, and days incarcerated privately, leading FBT providers to emphasize treatment components for these goals when children were removed by CPS and/or significant others were absent.

“Indeed, mothers often preferred to discuss these problem areas privately, leading FBT providers to emphasize treatment components to address these target goals when children were removed from the home by CPS and/or significant others were absent.”

No other significant differences between experimental conditions were found for incarceration.

“No other significant differences between experimental conditions were found.”

A significant Time × Neglect interaction for incarceration was found from baseline to 6-month post-randomization (F(1,68)=3.395, p=.04, partial η2=.048).

“There was a significant Time × Neglect interaction from baseline to 6-month post-randomization, F(1, 68) = 3.395, p = .04, partial η2 = .048.”

These effects diminished from baseline to 10-month post-randomization, especially for FBT participants.

“These effects were diminished from baseline to 10-month post-randomization, particularly in FBT participants.”

Some mothers were financially and emotionally dependent on significant others who were abusive to them or abused substances.

“some mothers were financially and emotionally dependent on significant others who were abusive to them or abused substances.”

Many available significant others transitioned in and out of the mother's residence.

“Many of the available significant others transitioned in and out of the mother's residence.”

In pilot trials for this study, many referred women did not have supportive significant others who were stable, positive influences permanently living in their homes.

“in our pilot trials for this study we discovered that many of the referred women did not have supportive significant others who were stable, positive influences permanently living in their homes.”

Improvements in secondary outcomes did not appear to be influenced by child neglect type, as hypothesized.

“Improvements in secondary outcomes did not appear to be influenced by child neglect type, as hypothesized.”

The study did not standardize or monitor treatment-as-usual fidelity, in order to compare Family Behavior Therapy with real-world service configurations as routinely delivered.

“no attempt was made to standardize or monitor fidelity of TAU to permit a valid comparison of the proposed experimental condition to “real world” service configurations that are routinely delivered (Rawson et al., 2004).”

• cites Henggeler et al., 2002 sourceNot checked — no full text of the source
• cites Chaffin et al., 2004 sourceNot checked — no full text of the source
• cites Rawson et al., 2004 sourceNot checked — no full text of the source

The results support that Family Behavior Therapy was particularly meaningful for mothers of non-drug exposed children.

“As can be seen in Figure 1, these results corroborate that FBT was particularly meaningful in mothers of non-drug exposed children.”

Treatment as usual consisted of a range of services that varied in provider qualifications, duration, intensity, and type, representing the best available options during the 6-month treatment period.

“TAU reflected a variety of services that vary according to provider qualifications, duration, intensity, and type of services offered, thus reflecting “best available options” during the designated 6-month treatment dose (Galloway et al., 2000).”

• cites Galloway et al., 2000 sourceNot checked — no full text of the source

Treatment integrity reliability and validity were estimated from completed protocol checklists.

“Reliability and validity estimates of treatment integrity were derived from completed protocol checklists (see Intervention Fidelity in the Results section).”

Family-based behavioral treatment programs offer promise for mothers reported to CPS for concurrent substance abuse and child neglect.

“Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children.”

• AssumptionRests on an assumption: The sample of 72 mothers is representative of mothers reported to CPS for concurrent substance abuse and child neglect.

Poor coordination between child welfare agencies and substance abuse treatment providers has hindered the creation of evidence-based programs for this population.

“Unfortunately, lack of integration between child welfare services and substance abuse treatment providers has restricted the development of evidence-based programming for this group (Young, Boles, & Otero, 2007).”

• cites Young, Boles, & Otero, 2007 sourceNot checked — no full text of the source

Treatment of child neglect is far less studied than treatment of child physical abuse.

“However, treatment of child neglect is far less studied (Behl, Conyngham, & May, 2003; Chaffin, 2006).”

• cites Behl, Conyngham, & May, 2003 sourceNot checked — no full text of the source
• cites Chaffin, 2006 sourceNot checked — no full text of the source

No significant baseline differences were found between Family Behavior Therapy and treatment-as-usual participants on the examined demographic and outcome measures (all p > .05).

“These results indicated that there were no significant baseline differences between participants in the respective intervention conditions on the examined demographic and outcome measures at baseline (all p-values > .05).”

No controlled treatment outcome studies have targeted concurrent child maltreatment and drug abuse.

“To date, there have been no controlled treatment outcome studies targeting concurrent child maltreatment and drug abuse”

Family systems behavioral therapies have repeatedly shown better outcomes for parents referred because of physical child abuse.

“Family systems oriented behavioral therapies examined in the few randomized controlled trials that have been conducted have consistently demonstrated improved outcomes in parents referred for child physical abuse (Chaffin et al., 2004; Kolko, 1996; Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew, 2010).”

• cites Chaffin et al., 2004 sourceNot checked — no full text of the source
• cites Kolko, 1996 sourceNot checked — no full text of the source
• cites Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

For treating hard drug use and child maltreatment in mothers who exposed their children to drugs and show relatively low risk for child maltreatment, TAU community services appear supported over FBT.

“However, in treating hard drug use and child maltreatment in mothers who have been found to expose their children to drugs and evidence relatively low risk for child maltreatment, TAU community services appear to be supported over FBT.”

• AssumptionRests on an assumption: Very few controlled treatment outcome studies in child neglect samples indicate that in-situ delivered family-supported treatment programs are relatively efficacious, although results are not universally positive.
• AssumptionRests on an assumption: No controlled trials have demonstrated positive outcomes in parents referred for concurrent child neglect and drug abuse.
• AssumptionRests on an assumption: In uncontrolled trials, Family Behavior Therapy has shown promise in the population of parents with concurrent child neglect and drug abuse.

The study had methodological limitations, including lack of outcome measures specific to direct assessment of behaviors, home conditions, attitudes, and underlying belief systems of participants.

“there were limitations in the methodology of this study, including the lack of outcome measures specific to the direct assessment of behaviors, home conditions, attitudes, and underlying belief systems of participants.”

Mothers of non-drug exposed children had relatively older children who were in the age range typically targeted in parent training child management programs for physical abuse.

“Mothers of non-drug exposed children also had relatively older children who were in the age range typically targeted in parent training child management programs for physical abuse (Chaffin et al., 2004; Kolko, 1996; Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew, 2010).”

• cites Chaffin et al., 2004 sourceNot checked — no full text of the source
• cites Kolko, 1996 sourceNot checked — no full text of the source
• cites Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The FBT intervention components examined in this study are probably more suited to mothers referred for non-drug exposed types of neglect (e.g., lack of supervision, emotional, medical, environmental, physical neglect), which appear associated with relatively higher risk for future child maltreatment.

“The FBT intervention components examined in this study are probably more in line with mothers who are referred for non-drug exposed types of neglect (e.g., lack of supervision, emotional, medical, environmental, physical neglect) that appear to be associated with relatively higher risk for future child maltreatment.”

• AssumptionRests on an assumption: Very few controlled treatment outcome studies in child neglect samples indicate that in-situ delivered family-supported treatment programs are relatively efficacious, although results are not universally positive.
• AssumptionRests on an assumption: No controlled trials have demonstrated positive outcomes in parents referred for concurrent child neglect and drug abuse.
• AssumptionRests on an assumption: In uncontrolled trials, Family Behavior Therapy has shown promise in the population of parents with concurrent child neglect and drug abuse.

Many emergency outcomes (e.g., domestic violence, eviction, financial need, no food) were not formally assessed in this study.

“many of the emergency outcomes (e.g., domestic violence, eviction, financial need, no food) were not formally assessed in this study”

Time spent in crisis management competed with implementation of prescribed treatments aimed at underlying issues perpetuating child neglect and drug abuse.

“time spent in crisis management competed with the implementation of prescribed treatments aimed at addressing underlying issues perpetuating child neglect and drug abuse.”

Relaxing the significant-other residency criterion probably led to inclusion of mothers with a higher proportion of troublesome or superficial relationships.

“This change probably resulted in the inclusion of mothers with a higher proportion of troublesome or superficial relationships.”

Intervention implementation for some secondary measures (HIV risk behaviors, days employed, days incarcerated) appeared relatively less dependent on the influence or presence of family members.

“intervention implementation for some of the secondary measures (i.e., HIV risk behaviors, days employed, days incarcerated) appeared to be relatively less dependent on the influence or presence of family members.”

FBT may have helped prevent future incarceration to some extent.

“Thus, FBT to some extent may have assisted in preventing future incarceration.”