Johnides, B. D., Borduin, C. M., Sheerin, K. M., & Kuppens, S. (2025). Secondary benefits of family member participation in treatments for childhood disorders: A multilevel meta-analytic review. Psychological Bulletin, 151(1), 1–32. https://doi.org/10.1037/bul0000462

Key Takeaways

Focus: This multilevel meta-analytic review explored the secondary benefits of family member participation in family-based treatments for childhood disorders.
Aims: The primary goal was to use multilevel meta-analysis to evaluate the overall impact of family-based treatments on secondary clinical benefits for caregivers and siblings of children referred for a wide range of mental health, physical health, and developmental disorders. The secondary goal was to examine the influence of potential moderators on the magnitude of secondary benefits.
Key Findings: Family-based treatments produce small but statistically significant secondary benefits for caregivers and siblings compared to individually focused treatments and conditions. These benefits are consistent across a range of moderators, including characteristics of the participants, clinical interventions, study methods, and measures.
Implications: The findings suggest that family-based treatments offer benefits beyond those for the child receiving treatment, which has implications for researchers, clinicians, policymakers, and administrators in terms of treatment design, implementation, and funding.

Rationale

The research aimed to address the lack of systematic evaluations of the secondary benefits of family-based treatments for childhood disorders.

Previous research has focused primarily on the effectiveness of these treatments for the individual child, without fully considering the potential benefits for other family members.

This gap in the literature has led to an underestimation of the full scope of benefits associated with family-based treatments.

The need for this systematic review is evident from previous research, which has shown that family-based treatments can lead to positive changes in caregivers’ parenting practices and improvements in family functioning.

However, these studies have often focused on specific disorders or populations, limiting the generalizability of their findings.

Additionally, there is a lack of comprehensive data on the secondary benefits for siblings.

This systematic review and meta-analysis aimed to fill these gaps by providing a comprehensive evaluation of the secondary benefits of family-based treatments across a wide range of childhood disorders.

Method

PRISMA Guidelines: The review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, ensuring a rigorous and transparent approach to study selection, data extraction, and reporting.
Databases Searched: The following databases were searched from January 1, 2010, to January 1, 2018:
- APA PsycInfo
- Medline
- Cochrane Central Register of Controlled Trials
Search Terms: The search terms used included a combination of terms related to family-based treatments, childhood disorders, and secondary benefits.
Inclusion Criteria: Studies were included if they met the following criteria:
- Intervention included family members of children (0-17 years) with mental health, physical health, or developmental disorders.
- Prospective research design with at least one comparison condition that did not include family members.
- One or more measures assessed secondary benefits for caregivers and/or siblings.
- Published or unpublished report in English.
Exclusion Criteria: Studies that did not meet the inclusion criteria were excluded.
Number of Studies Included: A total of 128 studies were included in the final review.
Data Extraction: Data were extracted from each study using a standardized coding protocol, including information on participant characteristics, intervention characteristics, methodological characteristics, and measure characteristics.

Statistical Measures

Statistical Methods: The study used a three-level random-effects model to estimate the average effect size across studies while accounting for the dependency between effect sizes within each study.
Purpose of Statistical Measures: The three-level model allowed for the examination of the overall impact of family-based treatments on secondary benefits while considering the variability between studies and the nested structure of the data (i.e., multiple effect sizes within each study).

The random-effects model was appropriate given the expected heterogeneity in the types of childhood disorders and interventions included in the meta-analysis.

Results

Overall Effect of Family-Based Treatments: The meta-analysis showed that family-based treatments produced small but statistically significant secondary benefits for caregivers and siblings compared to individually focused treatments and conditions (d = 0.25).
Moderators: The magnitude of the secondary benefits was relatively consistent across a range of possible moderators, including characteristics of the participants (e.g., age, gender, ethnicity), clinical interventions (e.g., type, duration), study methods (e.g., randomization, follow-up), and measures (e.g., informant, construct).
Caregiver Gender: The only significant moderator was caregiver gender, with male caregivers reporting fewer secondary benefits than female caregivers.

Insight

This meta-analysis provides robust evidence that family-based treatments for childhood disorders offer benefits not just to the child receiving treatment, but also to their caregivers and siblings.

These secondary benefits are observed across a wide range of disorders and treatment modalities, suggesting that family involvement is a key factor in achieving broader positive outcomes.

This finding challenges the traditional focus on individual-centered approaches and highlights the importance of incorporating families in the design and implementation of treatments for childhood disorders.

The consistency of the secondary benefits across various moderators suggests that family-based treatments are effective for diverse populations and clinical presentations.

This finding has implications for the generalizability of the results and supports the widespread adoption of family-based approaches.

However, the study also identified a potential area for future research: investigating the reasons why male caregivers report fewer secondary benefits.

Clinical Implications

The findings of this meta-analysis have significant implications for practitioners and policymakers.

For practitioners, the study provides strong support for incorporating families in the treatment of childhood disorders.

This may involve engaging caregivers and siblings in therapy sessions, providing psychoeducation to families, and teaching caregivers effective parenting skills.

By involving families in the treatment process, practitioners can potentially enhance the effectiveness of interventions and promote broader positive outcomes for all family members.

For policymakers, the study highlights the potential cost-effectiveness of family-based treatments.

By investing in these treatments, policymakers can potentially reduce the economic burden associated with childhood disorders and improve the overall well-being of families.

However, there may be challenges in implementing family-based approaches, such as the need for specialized training for practitioners and the potential for resistance from families who are not accustomed to being involved in treatment.

Strengths

Comprehensive Review: The study included a large number of studies across a wide range of childhood disorders, providing a comprehensive overview of the secondary benefits of family-based treatments.
Methodological Rigor: The study adhered to PRISMA guidelines, ensuring a rigorous and transparent approach to study selection, data extraction, and reporting.
Multilevel Modeling: The use of a three-level model allowed for the examination of the overall impact of family-based treatments while accounting for the dependency between effect sizes within each study.
Examination of Moderators: The study examined a range of potential moderators, providing insights into the factors that may influence the magnitude of secondary benefits.

Limitations

Limited Follow-Up Data: The study primarily focused on short-term outcomes, with limited data on the long-term secondary benefits of family-based treatments.
Heterogeneity of Interventions: The study included a wide range of family-based interventions, which may vary in their effectiveness and their potential to produce secondary benefits.
Publication Bias: The study may have been affected by publication bias, as studies with positive findings are more likely to be published.

References