Multi-Family Psychoeducational Psychotherapy (MF-PEP)

About This Program

Target Population: Children aged 8-12 with major mood disorders (depressive and bipolar spectrum) and their parents

For children/adolescents ages: 8 – 12

For parents/caregivers of children ages: 8 – 12

Program Overview

MF-PEP is a manual-based group treatment for children aged 8-12 with mood disorders (depressive and bipolar spectrum disorders). MF-PEP is based on a biopsychosocial framework and utilizes cognitive-behavioral and family-systems based interventions. MF-PEP is an 8-session, 90-minutes-per-session group treatment that begins and ends with children and parents together; the bulk of each session is run separately for parents and children.

There is also an individual version of Psychoeducational Psychotherapy known as Individual Family - Psychoeducational Psychotherapy (IF-PEP) that is listed in this topic area.

Program Goals

The goals of Multi-Family - Psychoeducational Psychotherapy (MF-PEP) are:

  • Learn about the symptoms of mood disorders
  • Effectively manage the symptoms of mood disorders
  • Improve communication
  • Improve problem solving
  • Improve emotion regulation
  • Decrease family tension
  • Improve consumer skills
  • Reduce symptom severity
  • Improve functioning

Logic Model

The program representative did not provide information about a Logic Model for Multi-Family Psychoeducational Psychotherapy (MF-PEP).

Essential Components

The essential components of Multi-Family Psychoeducational Psychotherapy (MF-PEP) include:

  • Group treatment with 5-8 children with 2 therapists (a lead therapist and a co-therapist) and their parents in a separate group with 1 therapist
  • Psychoeducation about mood disorders and their treatment
  • Emotion-regulation skills
  • Cognitive-behavioral skills
  • Problem solving skills
  • Communication (verbal and nonverbal) skills
  • Symptom management skills

Program Delivery

Child/Adolescent Services

Multi-Family Psychoeducational Psychotherapy (MF-PEP) directly provides services to children/adolescents and addresses the following:

  • Major mood disorder (bipolar or depressive), difficulty regulating emotion

Parent/Caregiver Services

Multi-Family Psychoeducational Psychotherapy (MF-PEP) directly provides services to parents/caregivers and addresses the following:

  • Having a child with a major mood disorder

Recommended Intensity:

Weekly 90-minute sessions

Recommended Duration:

8 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

Multi-Family Psychoeducational Psychotherapy (MF-PEP) includes a homework component:

Assignments that extend the lesson-of-the-day are given at each session and reviewed at each subsequent session.

Languages

Multi-Family Psychoeducational Psychotherapy (MF-PEP) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Two rooms of sufficient size to house participants and a contact person

Manuals and Training

Prerequisite/Minimum Provider Qualifications

  • Parent therapist – Master's or Doctoral level trained therapist
  • Child lead therapist – Post-doctoral trainee, Master's or Doctoral-level trained therapist
  • Child co-therapist – at minimum, graduate-level trainee or Bachelor's level therapist

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

This varies depending on organizational need.

Number of days/hours:

Two days of training is given which is 12 hours of total training. (This covers assessment and treatment. An in-service training on assessing bipolar disorder in children can be part of this.)

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Multi-Family Psychoeducational Psychotherapy (MF-PEP).

Formal Support for Implementation

There is formal support available for implementation of Multi-Family Psychoeducational Psychotherapy (MF-PEP) as listed below:

Dr. Fristad is available for consultation.

Fidelity Measures

There are fidelity measures for Multi-Family Psychoeducational Psychotherapy (MF-PEP) as listed below:

There is a MF-PEP Therapist Adherence Checklist that provides a dichotomous (present/absent) review of treatment session components with a section to add descriptive information. It is available for free by contacting program representative – contact information at the bottom of the page.

Implementation Guides or Manuals

There are implementation guides or manuals for Multi-Family Psychoeducational Psychotherapy (MF-PEP) as listed below:

When onsite training is provided, agencies can order “Group-in-a-Box”, which provides all the necessary resources to run the groups other than snacks.

Research on How to Implement the Program

Research has been conducted on how to implement Multi-Family Psychoeducational Psychotherapy (MF-PEP) as listed below:

MacPherson, H. A., Fristad, M. A., & Leffler, J. M. (2014). Implementation of Multi-Family Psychoeducational Psychotherapy for childhood mood disorders in an outpatient community setting. Journal of Marital and Family Therapy, 40(2), 193–211. https://doi.org/10.1111/jmft.12013

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 articles chosen for Multi-Family Psychoeducational Psychotherapy (MF-PEP) are summarized below:

Fristad, M. A., Gavazzi, S. M., & Soldano, K. W. (1998).

Type of Study: One-group pretest–posttest
Number of Participants: 9 families

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children and adolescents prescribed one or more psychotropic medications.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the efficacy of the Multi-Family Psychoeducational Psychotherapy (MF-PEP) program on treating mood disorders in a sample of children and adolescents. Measures utilized include the Expressed Emotion Adjective Checklist (EEAC). Results indicate that at follow-up, parents reported an increase in positive attitudes/behaviors and a decrease in negative attitudes/behaviors toward and from their children. Limitations include small sample size, length of follow-up, and lack of a control group or randomization.

Length of postintervention follow-up: 4 months.

Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2002). Multi-family psychoeducation groups (MFPG) for families of children with bipolar disorder. Bipolar Disorders, 4(4), 254–262. https://doi.org/10.1034/j.1399-5618.2002.09073.x

Type of Study: Randomized controlled trial
Number of Participants: 35 children

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 88% Caucasian, 3% African-American, 3% Biracial, 3% Asian, and 3% Native American
  • Gender — 77% Male and 23% Female
  • Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the efficacy of Multi-Family Psychoeducational Psychotherapy (MF-PEP) in a sample of families with children with mood disorders. Participants were randomly assigned to a MF-PEP plus treatment as usual (TAU) intervention group or to a waitlist control plus TAU control group. Measures utilized include the Children’s Interview for Psychiatric Syndromes – Child and Parent Forms (ChIPS/P—ChIPS), Children’s Depression Rating Scale-Revised (CDRS-R), Mania Rating Scale (MRS), Children’s Global Assessment Scale (C-GAS), Expressed Emotion Adjective Checklist (EEAC), Social Support Scale, and the Child and Adolescent Services Assessment (CASA). Results indicate that at 4-month follow-up, families described having gained knowledge, skills, support, and positive attitudes during treatment. Limitations include audiotaped sessions that were not systematically coded, small sample size, and length of follow-up.

Length of postintervention follow-up: 4 months.

Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2003). Multi-family psychoeducation groups in the treatment of children with mood disorders. Journal of Marital and Family Therapy, 29(4), 491-504. https://doi.org/10.1111/j.1752-0606.2003.tb01691.x

Type of Study: Randomized controlled trial
Number of Participants: 35

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 88% Caucasian, 3% African-American, 3% Biracial, 3% Asian, and 3% Native American
  • Gender — 77% Male and 23% Female
  • Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Fristad et al. (2002). The purpose of this study was to examine the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on parental knowledge of mood disorders, family interaction patterns, perceived social support, and subsequent utilization of clinical services. Participants were randomly assigned to a MF-PEP plus treatment as usual (TAU) intervention or to a waitlist control plus TAU. Measures utilized include the Children’s Interview for Psychiatric Syndromes – Child and Parent Forms (ChIPS/P—ChIPS), Children’s Depression Rating Scale-Revised (CRS-R), Mania Rating Scale (MRS), Children’s Global Assessment Scale (C-GAS), Expressed Emotion Adjective Checklist (EEAC), Social Support Scale, and the Child and Adolescent Services Assessment (CASA). Results indicate that at the 4-month follow-up, intervention group families reported increased parental knowledge about childhood mood symptoms, increased positive family interactions as reported by the parent, increased perceptions of parental support as reported by children, and increased utilization of appropriate services by families. Limitations include small sample size, the sample consisting largely of white males, and length of follow-up.

Length of postintervention follow-up: 4 months.

Fristad, M. A., Verducci, J. S., Walters, K. & Young, M. E. (2009). Impact of Multifamily Psychoeducational Psychotherapy in treating children aged 8 to 12 years with mood disorders. Archives of General Psychiatry, 66(9), 1013–1021. https://doi.org/10.1001/archgenpsychiatry.2009.112

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 92% Caucasian
  • Gender — 74% Male and 26% Female
  • Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the efficacy of Multi-Family Psychoeducational Psychotherapy (MF-PEP) in a sample of families with children with major mood disorders. Participants were randomly assigned to an MF-PEP plus treatment as usual (TAU) intervention or to a waitlist control plus TAU. After one year of treatment, participants in the control group were assigned to the MF-PEP intervention. Measures utilized include the Children’s Interview for Psychiatric Syndromes, Children’s Interview for Psychiatric Syndromes—Parent Version, Children’s Depression Rating Scale—Revised (CDRS-R), Mania Rating Scale (MRS), and the Mood Severity Index (MSI). Results indicate that participants in the MF-PEP treatment group reported improvement in mood symptom severity compared with the control group. Improvements were observed at the 18-month follow-up. When control group participants received MF-PEP treatment after 12 months, they showed a similar pattern of improved mood symptoms. Limitations include the sample consisting primarily of white males, use of a wait-list control group, and a substantial minority (38%) of the participants were self-referred.

Length of postintervention follow-up: 1 year.

Mendenhall, A. N., Fristad, M. A. & Early, T. (2009). Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of Multi-Family Psychoeducation Groups (MFPG). Journal of Consulting and Clinical Psychology, 77(3), 463-473. https://doi.org/10.1037/a0014527

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 92% Caucasian
  • Gender — 74% Male and 26% Female
  • Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Fristad et al. (2009). The purpose of this study was to investigate the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on service utilization and mood symptom severity in children with mood disorders. Parents’ knowledge of mood disorders, beliefs about treatment, and perceptions of children’s need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Measures utilized include the Mental Health Services Grid Interview, the Children’s Interview for Psychiatric Syndromes (ChIPS), the Children’s Interview for Psychiatric Syndromes, Parent Version (P–ChIPS), the Understanding Mood Disorders Questionnaire (UMDQ), the Treatment Beliefs Questionnaire—Parent Form (TBQ–P), and the Caregiver Concordance Interview (CCI). Results indicate that participation in MF-PEP significantly improved quality of services utilized, mediated by parents’ beliefs about treatment. Participation in MF-PEP also significantly improved severity of child’s mood symptoms, mediated by quality of services utilized. Limitations include reliance on secondary data analysis, parent-rated effectiveness of services was problematic, the lack of a long-term follow-up for control group, and length of follow-up.

Length of postintervention follow-up: 6 months.

Nadkarni, R. B., & Fristad, M. A. (2010). Clinical course of children with a depressive spectrum disorder and transient manic symptoms. Bipolar Disorders, 12(5), 494-503. https://doi.org/10.1111/j.1399-5618.2010.00847.x

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years (Mean=9.9 years)
  • Race/Ethnicity — 90% White
  • Gender — 75% Male
  • Status — Participants were children with mood disorders.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Fristad et al. (2009). The purpose of this study was to examine rates of conversion to bipolar spectrum disorder (BPSD) and risk factors associated with conversion in children with depressive spectrum disorders (DSD) and transient manic symptoms (TMS) over 18 months. Approximately one-half of the sample (n=78) received immediate Multi-Family Psychoeducational Therapy (MF-PEP) plus treatment as usual; the remaining participants (n=87) were in a one-year wait-list control condition and received this combination of treatment after their Time 3 assessment. Measures utilized include the Children’s Interview for Psychiatric Syndromes–Child (ChIPS), the Children’s Interview for Psychiatric Syndromes–Parent (P-ChIPS), the Mania Rating Scale (MRS), the Children’s Depression Rating Scale–Revised (CDRS-R), The Coddington Life Events Scale for Children (LES), the Expressed Emotion Adjective Checklist (EEAC), the Hamilton Rating Scale for Depression (HAM-D), and the Kaufman Brief Intelligence Test, 2nd Edition. Results indicate that the scores did not differ significantly between the DSD+TMS, DSD, and BPSD groups. Conversion rates to BPSD were significantly higher for the DSD+TMS group compared to the DSD group. Conversion was significantly more frequent for participants in the one-year wait-list control group compared to the immediate treatment group. Participation in MF-PEP was associated with a four-fold reduction in risk for conversion at the Time 3 assessment when compared to the wait-list control group. Clinical presentation, family environment, and family history did not differ significantly between the small subset of DSD+TMS participants who did convert to BPSD at follow-up and those who did not convert. Baseline functional impairment was greater for the converted group than the nonconverted group. Limitations include small sample size, high attrition rate at follow-up, and limited generalizability due to racial and gender composition.

Length of postintervention follow-up: Varied depending on randomization group.

Cummings , C. M., & Fristad, M. A. (2012). Anxiety in children with mood disorders: a treatment help or hindrance?. Journal of Abnormal Child Psychology, 40(3), 339-351. https://doi.org/10.1007/s10802-011-9568-5

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 90.9% White non-Hispanic, 6.7% African American, 1.8% Mixed Race, and 0.6% White Hispanic
  • Gender — 73% Male
  • Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The study uses the same sample as the Fristad et al. (2009) study. This study examined the role of comorbid anxiety in treatment outcome for children with mood disorders participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Measures utilized include the Children’s Interview for Psychiatric Syndromes–Child Form (ChIPS), the Parent Form (P-ChIPS), the Children’s Depression Rating Scale–Revised (CDRS-R), the Mania Rating Scale, the Mood Severity Index, and the Children’s Global Assessment Scale (C-GAS). Results indicate that participation in MF-PEP did not significantly reduce anxiety symptoms. However, presence of comorbid anxiety did not impede reduction in depressive or manic symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores post-treatment. Limitations include that the limited number of anxiety measures used and that randomization was stratified to ensure relatively equal therapy group composition.

Length of postintervention follow-up: 6, 12, and 18 months.

Boylan, K., MacPherson, H. A., & Fristad, M. A. (2013). Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), 699–708. https://doi.org/10.1016/j.jaac.2013.04.014.

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 90.9% White Non-Hispanic, 6.7% African American, 1.8% Mixed Race, and 0.6% White Hispanic
  • Gender — 73% Male
  • Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Fristad et al. (2009). The purpose of this study was to examine the associations between disruptive behavior disorder (DBD) symptoms and impairment, the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on the severity of DBD symptoms, and whether DBDs affected the response of mood symptoms to MF-PEP. Children were randomly assigned to MF-PEP or a waitlist control group. Measures utilized include the Children’s Interview for Psychiatric Syndromes–Child Form (ChIPS), the Parent Form (P-ChIPS), the Children’s Depression Rating Scale–Revised (CDRS-R), the Mania Rating Scale, the Mood Severity Index, and the Children’s Global Assessment Scale. Results indicate that greater degree of disruptive behaviors was associated with worse mood symptoms and impairment. Analyses examining outcome of disruptive behaviors were nonsignificant. Results also suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder, oppositional defiant disorder, and overall disruptive behavior symptoms, but not conduct disorder symptoms. Severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP. Limitations include the sample lacked diversity and therefore may not be representative of the broader population of children with mood disorders and DBDs and reliance on parent-reported outcome measures.

Length of postintervention follow-up: 12 months.

MacPherson, H. A., Fristad, M. A., & Leffler, J. M. (2014). Implementation of Multi-Family Psychoeducational Psychotherapy for childhood mood disorders in an outpatient community setting. Journal of Marital and Family Therapy, 40(2), 193–211. https://doi.org/10.1111/jmft.12013

Type of Study: One-group pretest–posttest
Number of Participants: 40

Population:

  • Age — 8-12 years
  • Race/Ethnicity — 77% Caucasian, 13% Biracial, 7% African American, and 3% Asian
  • Gender — 53% Male
  • Status — Participants were children with mood disorders that were referred from community clinicians.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the implementation of Multi-Family Psychoeducational Psychotherapy (MF-PEP) in two outpatient community clinics. Measures utilized include the Understanding Mood Disorders Questionnaire, the Parent Group Evaluation Form, and Child Group Evaluation Form. Results indicate that implementation of MF-PEP in outpatient community clinics is possible; and may be associated with improved effectiveness outcomes. Parents also demonstrated significant improvement in knowledge of mood disorders posttreatment. Limitations include small sample size, use of measures developed for this study leading to concerns regarding validity of measures, and the limited examination of treatment outcomes.

Length of postintervention follow-up: None.

MacPherson , H. A., Algorta, G. P., Mendenhall, A. N., Fields, B. W., & Fristad, M. A. (2014). Predictors and moderators in the randomized trial of Multi-Family Psychoeducational Psychotherapy for childhood mood disorders. Journal of Clinical Child and Adolescent Psychology, 43(3), 459-472. https://doi.org/10.1080/15374416.2013.807735

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 90.9% White Non-Hispanic, 6.7% African American, 1.8% Mixed Race, and 0.6% White Hispanic
  • Gender — 73% Male
  • Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as the Fristad et al. (2009) study. This study investigated predictors and moderators of mood symptoms in the randomized controlled trial of Multi-Family Psychoeducational Psychotherapy (MF-PEP) for childhood mood disorders. Measures utilized include the Children’s Global Assessment Scale (CGAS), the Expressed Emotion Adjective Checklist, the Coddington Life Events Scale for Children, the Children’s Interview for Psychiatric Syndromes–Child Form (ChIPS) and Parent Form (P-ChIPS), the Psychiatric Diagnostic Interview–Revised, the Structured Clinical Interview for DSM–IV Axis II Personality Disorders–Patient Questionnaire (SCID-IIPQ), and the Hamilton Rating Scale for Depression. Results indicate that treatment nonresponse was significantly associated with higher baseline levels of global functioning (i.e., less impairment) and lower levels of stress, trauma history in children and Cluster B personality disorder symptoms in parents. Children with moderately impaired functioning who received MF-PEP had significantly decreased mood symptoms compared with the waitlist control group. MF-PEP had the strongest effect on severely impaired children. Limitations include concerns regarding generalizability due to lack of diversity within the sample, the attrition rate at the follow-up timepoints, and the reliance on parent-reported measures.

Length of postintervention follow-up: 6, 12, and 18 months.

Additional References

Fristad, M. A., Davidson, K. H. & Leffler, J. (2007). Thinking-Feeling-Doing: A therapeutic technique for children with bipolar disorder and their parents. Journal of Family Psychotherapy, 18(4), 81-104.

Fristad, M. A., Gavazzi, S. M., & Soldano, K. W. (1999). Naming the enemy: learning to differentiate mood disorder "symptoms" from the "self" that experiences them. Journal of Family Psychotherapy, 10(1), 81-88.

Fristad, M. A., Goldberg Arnold, J. S. & Leffler, J. (2011). Psychoeducational Pyschotherapy (PEP): Treatment manual for children with mood disorders. New York: Guilford Press.

Contact Information

Mary A. Fristad, PhD, ABPP
Agency/Affiliation: The Ohio State University/Nationwide Children’s Hospital
Email:
Phone: (614) 722-6872
Fax: (614) 293-4949

Date Research Evidence Last Reviewed by CEBC: September 2020

Date Program Content Last Reviewed by Program Staff: November 2019

Date Program Originally Loaded onto CEBC: August 2010