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Theses

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Attachment-based family therapy (ABFT) is an empirically supported treatment that proved to be effective in controlled research conditions to reduce depressive symptoms in adolescents by improving or restoring attachment relationships. It is, however, unclear whether and how ABFT can be implemented in less controlled community-based settings, like in child welfare services. Therefore, the aim of this doctoral project was to evaluate the implementation of ABFT in home-based services of the Flemish child welfare system (CWS). More specifically, we investigated four implementation outcomes. First, we examined the appropriateness of ABFT for CWS youngsters. We explored whether ABFT's focus on depressive symptoms and restoring attachment relationships can be relevant for youngsters referred to the CWS. Second, we investigated whether ABFT could be accepted by CWS providers, and whether these providers' openness for ABFT implementation could be stimulated. Third, we studied whether it is feasible for CWS providers to use ABFT to reduce CWS youngsters' depressive symptoms. Finally, we explored barriers and facilitators to ABFT implementation in CWS home-based care. First, our results showed that 30% of CWS youngsters had elevated levels of depressive symptoms, and that 47% engaged in self-injurious behavior and/or suicidal ideation. These emotional problems linked significantly with low levels of trust in primary caregivers' support. This suggests that ABFT's intervention targets can be relevant for this population. Second, our results showed that CWS providers can accept ABFT, and that training and discussions can stimulate openness towards ABFT implementation. Third, although implementation and research conditions were not optimal, and financial resources lacked to train CWS providers up to the level of ABFT certification, we found preliminary support that it is feasible for CWS providers to use ABFT, or at minimum an ABFT-inspired approach, to reduce depressive symptoms in CWS youngsters. Finally, our results revealed that ABFT implementation in CWS is a complex process. For successful ABFT implementation into CWS settings, various barriers at multiple systemic levels need to be addressed. CWS providers' enthusiasm and belief in the added value of ABFT for CWS, however, contributed to their resilience in facing implementation barriers. Although the data in the current doctoral dissertation do not allow to draw a definitive conclusion about whether ABFT can be implemented in CWS home-based services to increase quality of care, our findings suggest that ABFT implementation has high potential to improve the emotional wellbeing of CWS youngsters.