T p p chi Khoa boc D H Q G H N : Nghien cim G i i o d u e . T ? p 3 0 . Sd 2 ( 2 0 1 4 1 1 - I O
NGHIEN ctru
Cac yeu to anh huong den hieu qua tri heu da he thong tren tre vi thanh nien bi roi loan hanh vi
Tran Thanh Nam*', Bahr Weiss'
Tnrdng Dgi hgc Gido due. Dai hgc Quoc gia Hd Ngi.
144 Xudn Thay. Cdu Gidy. Ha Ndi, Viet Nam 'Dai hgc Vanderbilt. Naslnille, Tennessee. Hoa Ky
Nhan ngay 22 thang 4 nam 2014
Chinh siia ngay 29 ihang 5 nSm 2014: chip nhan dang ngay 25 thang 6 nam 2014 Tom tat: Tri lieu da be thong iTLDIfT) hien dugc danh gia rat cd hieu qua tiong can thiep roi loan hanh vi o tre vj thanh nieiL Tuy nhien. v^n chua cd nhieu n^ii£n cuu chi ro trong nhung dieu Iden oao llu T I ^ H T phat huy dirge hieu qua toL N ^ ^ ciiu niiy duoG lien hanh de kiem Ha cac yeu to anh hudng den hieu qua cua TLDHT. Ket qua phan ti'ch da xac dinh dugc mot so yeu to anh hiTong nhu tuoi cua tre. thti nhap ciia gia dinh. unh uang hon nhan oia cha me bay ^ c khoe tam t h ^ cua cha me. Tre vi thanh nien (VTN) se dugc hudng Itri nhieu han lii T U ) H T neu cac em co mot gia dinh hoat dong cbuc nang hieu qua. Boi le. 7 urmg 12 yeu td anh huong den lu^u qua tri lifu deu lien quan den hoat dpng chuc n&ng cua gia £ n h va hanh vi ctia cha me. Ket qua nghien cuu ggi y rang cac nha TLDHT nen can nhic danh gia hoat dong chuc nang cua gia dinh va ph(Mig each hanh vi cua cha me tnrdc khi quylt dinh cd su dung TLDHT cho bo hay kbong.
Tir khoa: Roi loan hanh vi: tri lieu da he thdng: hanh \i lam cha me: chuc nang gia £ n h .
1. Dat van de va cac khai niem cong cu chuan muc xa hdi (phu hop vdi lua tudi) hay cac luat Ie bi xam pham. Tre em va vi thanh Tri lieu da he ibdng a U > H D hien duoc danh nien (VTN) cd rdi loan hanh vi thudng diam gia gia rated hieu qua trong can diiep roi loan hanh \i i^t nhilu vao cac \'u Su da, bit nat bgn be, cd d tre vi tKmh nien. Tuy nhien, \-an chua cd nhieu b^nii vi doc ac vdi ddng vat, pha hoai ciia cdng nghien cuu cfai rd mmg nhimg dieu kien oao du hoac do dac cua ngudi khac, gay chay, trdm TLDHT 1*1^ huy dUoc hi?u qua Idt Nghien cuu cip. ndi ddi, trdn hpc hoac bd nha ra di. Roi nay dupc tidn hanh dl kilm tia cac ylu id anh loan hanh vi la mdt uong nhiing vin dk tdn hudng din hieu qua cua TU)HT- thuong sue khde tam thkn cd ti Ie pbd biln Rdi logn hdnh vi dupc dinh nghia la cac trong gidi tre (khoang 10 %) vdi ti Ie m4c phai bilu hien hanh vi va cam xuc ciia tre em va \i & nam cao hon nu va d dianh prfid phd bien hon thanh nien duoc lap di lap lai nhilu I5n vS d dd. ndng thdn. Cac n ^ e n cuu cung chi ra rdi loan cac quyln co ban cua ngudi khac cGng nhu cac hanh vi anh hudng den khoang 2 5 ^ tre em trong dp tudi den tnrdng. Tie em va vi dianh men cd rdi loan hanh vi drndug cd nguy co cao
^ "., ", ." _ ., chat trien cac hanh vi didng ddi xa bdi, pham
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,, B Wa.sWTop dn Khon IIQCDHQGHN t\);hicn cm, Guio due. Tap 30. S6 2 I20I4) 1-10
phdp. bao luc %a nghien chdt khi trudiig thanh Kinh phi hang nam cbi ua cho nhixng thiel hai xa hoi ma Ire cd roi loan hanh \ i gay ra ciing vdi chi phi cho cac dich MI cham soc cd lien quan udc unh cao g5p 6 lin long chi phi cho cac \ a n de ton ihirong siic khoe lani thdn khac [2],
0 Viet Nam. iheo mot di^u tra nam 2007 cua Benh vien Tam i h k Mai Hucmg phoi hop vcri Trung lam Sirc khoe Tam than Qudc le. Dai hpc Melboume. Vc tren tre tir dp luoi 1 0 - 1 6 Ihi ti le CO cac van de \ e hanh vi ung xir la 9.237f [8], Con theo Dang Hoang Mmh, Hoang Cam Tu (2009) thi ti le nay la 6.09'7r [3]. Day la nhung con so dang Io ngai va la nguyen nhan iryc uep dan den cac van de bao luc trong hpc dudng \ a xa hoi dang ga\ nhieu hue xuc trong du luan hien nay. Do \ a \ , viec phat trien cac chuong trinh can ihiep co hieu qua cho cac van de rdi loan himh vi d thanh thieu men nhu"
TLDHT ciing nhu cac yeu td giiip TLDHT trd nen hieu qua Hon la het siic can thiel
Trj lieu da hi thong (multi-systemic therapy) la mo hinh can ihiep uen ihl gidi dupc danh sia cd hieu qua cao cho tre em \ a VTN co rdi loan hiinh vi. TLDHT la mpi chiln logc can Ihiep dua \ao gia dinh. tap trung lam thay ddi hanh vi Cmg xii cua ire uong cac mdi tnidng hoan canh khac nhau nhu trong gia dinh. tai trudng hpc bang each thuc ddy cac hanh vi duoc xa hpi chap nhdn va loai u d cac hanh vi khdng phii hop. TLDHT dupc phat iriln tren quan diim sinh thai hpc xa hpi ciia Bronfenbrenner. xem hanh vi cua ca nhan la he qua ciia mot he thdng mang luoi cac luons tac
\ a hpi phirc lap ma ca nhan dang ldn Iai trong dli. TLDHT dupc van hanh va giam sat bdi 9 nguyen tac co ban nen co tinh linh hoat cao.
TLDHT tap irung vao lal \iec Irao quvin cho cha me trong quan li gia dinh \ a hanh \l cua tre bang cdch tan dung nhimg ihl manh ciia time gia dinh de khai thac nhimg ngudn hd tro tir ben ngoa,: (b) giup cha me loai bo cac rao can co
the gay can Ud viec thuc hien cac chien lupc hanh vi lam cha me bieu qua n h u nhimg kho khan va cang thang trong gia dinb, mau thuan
\ p chdng; (c) huan luyen kT nang lam cha me.
nhiiTig each thuc de duy iri nhdng nguyen tac trong gia dinh de giup tre xa dan nhdm ban xau
\ a tang cudng mdi quan he vdi nhirng nhdm ban tich cue; va (d) giup cha me quan li nhtmg su kien tieu cue xay ra tai mdi trudng song cua tre (hang xdm Idng gieng) nhu nhiing hoat dpng bao luc, tpi dc. Ddi tugng chinh ma TLDHT h u d n g ldi la nhung tre vi ihanh nien (tu 14- 16 ludi) CO cac bieu hien rdi loan hanh vi nang va trudng dien. Mpt quy trinh TLDHT thdng thudng dien ra Irong 4 thang \ d i nhieu budi gap ga vdi cdc nha tri lieu trong timg tudn [6].
So vdi cdc tiep can tri lieu gia dinh va hanh vi khdc, T L D H T xac djnh rat ro rang nhiing muc tieu can ihiep trong he thdng cac moi quan he xa hpi va gia dinh co lien quan den roi loan hanh vi. Cac nghien ciiu cua Henggeler (1997).
Henggeler (20061, Timmons-Mitchell (2006).
Ogden & Hagen(2006). Slambaugh (2007), Letoumeau (2009) deu dua ra nhiing kel ludn thong nhdt ve hieu qua ciia T L D H T lam giam dang ke ti le cac hanh vi lien quan den tpi pham. nghien hut, ngoi tii. xam hai tinh due, trdn hpc va bo nha ra di | 4 ] . | 5 ] . [6]. [7], [9].
[ l l ] , [12]. Ben canh do. T L D H T cung duac khang dinh mang lai hieu qua kinh te. thich img cao vdi cdc nhom dan lpc. van hoa do can thiep linh hoat \'a lap trung vao tirng ca nhan theo 9 n g u \ e n tac co ban cua T L D H T chu khong rap khudn theo cam nang hoac sdch hudng ddn thirc hanh nhu cdc c h u o n g trinh can thiep khdc. Tuy nhien. phan ldn cdc nghien cdu tren deu cd sir tham gia ciia chi'nh n h u n g ngudi phat trien lieu phap nay nen khdng the loai t n i yeu td chti quan irudc nhung ket qua nghien ciiu ling hp cho hieu qua cua T L D H T . Ngoai ra, chua co ket ludn thdng nhdt v l viec T L D H T dap irng tdi hon vdi nhom khach the nao va trong nhimg
T.T. Sam. B. Weiss / Tap chi Khoa hoc DHQGHN: Nghien cuu Giao due. Tdp 30. So 2 (2014) I -10
dieu kien cu thi ra sao. Nghien cuu dugc tiln hanh de dua ra cau tra ldi cho khoang trdng kien thin: do.
2. Khach the va cong cu nghien cuu Khach the nghien cuu gdm 164 VTN cd rdi loan hanh vi va gia dinh cac em. Cac gia dinh dupc lua chgn ngiu nhidn vao nhdm ddi chiing (80 gia dinh) va nhom TLDHT (84 gia (finh).
Nhdm TLDHT dupc can thiep trong 18 thang va dugc ngudi nghien cuu danh gia lai 4 thdi diem la khi bdt dau can thiep, 3, 6, 18 thang sau khi bat dau can thi?p. Nhung ngudi can thiep dugc trai qua tap huan vk can thi^p dudi sir giam sat vh trao ddi hang tudn. Nhdm ddi chung hoan toan khdng dugc nhan bat cu mdt can thiep nao.
Tai thdi diem b3t dau can thiep, tudi trung binh cua khach the nghidn cihi la 14,6 (do lech chuan 1,3). 83% la nam. Dp tudi trung binh cua me (hoac ngudi cham sdc chinh) la 40,8 (dg lech chuan la 8,8). Trinh dp hpc van trung binh ctia cha me la tdt nghiep THPT. 61% gia dinh h than, li dj ho^c gda bua. Tbeo ket qua danh gia khi bat d^u can diiep, cd 87% khach thi cd diem tren muc nguy co rdi loan hanh vi va 66%
khach the cd diem tren muc nguy co rdi loan cam xuc.
Cac cdng cu va bien sd chinh dugc do trong nghien cuu nay gdm:
(i) He thdng danh gia hanh vi cam xuc cua Achenbach (I99I) [1] gdm thang YSR do Ue tu khai bao, thang CBCL do cha me khai bao va thang TRF do giao vien khai bao phan anh sir thay ddi diem sd rdi loan hanh vi cam xiic ciia
tre qua thdi gian, phan anh hieu qua can thiep TLDHT.
(ii) Cac yen td anh hudng den hieu qua can thiep gdm cac thang do (a) phong each hanh vi lam cha me (thang PAQ va thang CRPBI)^; (b) chuc nang gia finh (thang Faces-Ill) ; va (c) van de sdc khde tam th^n cua cha me PAT.
Chien luge phan tich dugc tien banh theo Raudenbush & Bryk (2002) [10] md binh hdn hgp xu h' sd lieu nghien ciiu trudng dien. Hieu qua tri Ueu dugc bieu thi bang diem tren thang rdi loan hanh vi cila tre (do b4ng CBCL, TRF va YSR) qua thdi gian, dudi su anh hudng ciia cac bien du bao. Pbin tiep theo se trinh bay hieu qua ndi chung cua TLDHT va phan tich anh hudng ciia cac bien dir bao nhu tudi, thu nhap, tinb trang bdn nhan cua gia dinh, sue khde tam thdn ciia cha me va phong each hanh vi Iam cha me den hieu qua tri Ueu. O tdng bien du bao, chiing tdi so sanh nhdm tren 1 dp lech chuan vdi nhdm dudi i dg lech chuan de dua ra ket luan ve sir anh hudng cua tung bien sd.
3. Ket qua nghien cun
Nhin chung, sau qua trinb can thiep, nhom TLDHT cd diem sd thang hudng ngoai do cha me va tre khai (do bang CBCL va YSR) deu giam dang ke so vdi diem sd ciia nhdm ddi chdng vdi he sd F va muc y nghia thdng ke lan lupt la (F(1,I30)= 4.99, p<0,05 va F(I,I1I)=
5,47. p<0,05). Ngugc Iai, diem sd thang hudng ngoai do giao vien khai (do bang TRF) ciia nhdm can thiep khdng cd su khac biel cd y nghia Ihdng ke vdi nhom ddi chiing (F(I,I82)=
' YSR: Thang do hanh vi do tre tij khai; CBCL: Bang k]£m cic h ^ h vi do cha m; khai; TRF: Thanh do hanh \i ctia tre do giao vini khai. Cac thang tren gom c6c Deu thang do (a) van dk buong npi. lo au. tram cam. thu ndnh va \an de huong ngo^i (hanh vi xara khich. hanh vi pham phap... I
" PAQ: Thang do ve ti'nh doc doan cua cha me (gom 3 tieu thang do: dia me dpc doan, cha me dan chii, cba me dl dai). CRI%L Thang do hanh vi ciia cha me do tie khai (do tren 3 khia canh: nhat quan, kiem soat tam li va nong am).
^ F.ACES-ni: Thang ddnh gia tiiih cd kit va du'ch ung oia gia £nb (gom 2 tbang tmh co ket va su thich ihig).
'' PAl- Thang danh siic khoe tam thdn danh cbo cha me.
T. T Nam. B. Weiss / Tap chi Khoa UQC DHQGHN: Nghi u Giao dvc Tap 30. So 2 (2014) l-W
0,17, p>0,05). Co mdt sd If do giai thich sy khac biet nay. Thu nhlt \k tre va cha me deu dau tu nhieu cdng sdc vao qua trinh can thiep nen nhay cam hon vdi nhiing tbay ddi hanh vi d tre con giao vien cd the danh gia thidn lech do nhinig an tugng cii ve tre nen khdng nhay cam vdi nhdng thay ddi nhd. Thu hai, vi chuong trinb can thidp tap trung vao gia dinh chu khdng theo nam hpc nen hanh vi cua mdt sd tre cd the dugc danh gid bdi 2 giao vien khac nhau. Dieu n&y cd the tao nen sai sd neu hai giao vien kbac nhau cd the khdng cd ciing mpt tieu chuan danh giS ve hanh vi d Ue.
3.1. Anh hirdng cua do tudi den hieu qud tri lieu da he thdng
Nghien cdu hieu qua TLDHT vdi nhdm tudi, chdng tdi so sanh nhdm + I dp I?ch chuan (15 tudi) vk - I dp lech chuan (13 tudi) tai thdi diem bat dau can thiep. Ket qua cbo tbay diem
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thang hudng ngoai do gido vien khai (TRF) va do cha me khai (CBCL) ciia nhom can thiep khdng khac biet mgt cdch co J nghia vdi nhdm ddi chung. Tuy nhien, diem sd thang YSR do tre tir khai ciia nhdm can thiep giam d ^ g kl so vdi nhdm ddi chung (F [1,109] = 4,04; p
<0,05). Tren bieu dd 1, cd the thay vdi nhdm tre CO dp tudi trung binh 13, diem sd thang hanh vi hudng ngo^i sau 18 thdng deu giam khoang 0,3 dd lech chuSn. Ngugc l^i, vdi nhdm tre cd dp tudi trung binh la 15, diem sd thang hudng ngoai ciia nhdm chung giam rat it Uong khi diem sd cua nhom Ui lieu giam m&nh dang kl.
Dieu nay chung to TLDHT cd hiSu qua hon vdi nhdm tre co dp tudi trung binh Ih. 15. Ket luan nay bgp Ii bdi ndi dung cua TLDHT dp dung nhieu ki thuat tri Ueu nhan thdc va kha nang nhan thdc ciia nhdm tre ldn hon giiip cbiing thuc hidn tdt hon cac nhiem vu va tien bp nhieu bon.
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Bleu do 1: Hieu qua cua TLDHT theo nhdm w6i.
3.2. Anh hudng cua thu nhdp den hieu qud rn li^u da he thdng
Kit qua phan tich vdi biln thu nhap cho thay dilm thang hudng ngo^i do cha me khai (CBCL) ciia nhdm can thiep khac biet mdt each CO y nghia vdi nhdm ddi chung (F[I,I29] = 4,71; p <0,05). Vdi TRF vh YSR sy khac bigt khdng cd J nghia didng ke. Bilu dd 2 cho thSy
vdi nhdm tbu nhap tren I dp lech chuSn cd sy khdc biet ldn gida nhdm ddi chung vk nhdm can thiep. Vdi nhom thu nhap dudi I dp lech chuin thi sy khac biet khdng nhilu. Dilu nay chdng td rdng hieu qu^ cua TLDHT tdt hon vdi nhdm tre cd tbu nhap binh quan gia ^nh cao hon. Cd the vdi nhihig gia dinh c6 thu nhap binh quan cao hon sd cd nhieu ngudn lyc hon de giiip VTN tiln triln trong vin dl hknh vi.
7". T. Nam. B. Weiss / Tap ch, Khoa hoc DHQGHN: Nghie, V Gido due. Tap 30. So 2 (2014) I-10
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Bieu do 2: Hieu qua cua TLDHT va thu nhap.
3.3. Anh hirdng cua tinh trgng hon nhdn gia dinh den hiiu qud tri lieu da hi thong
Vdi bien tinh trang hdn nban gia dinh, chiing Idi so sanh sy kbac biet giira nhdm gia dtnh ket hdn va sdng chng va gia dinh don than, gda bua hoac Ii dj. Ket qua nghien ciiu cho thdy CO sy khac biet trong hieu qua tri heu gida gia
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dinh cd dii bd me va gia dinh chi co bd hoac me (F(I,II1)= 4,28; p<0,05). Li giai cho kit qua nay cd the la do viec thyc bien cac chien lupc hanh vi Ikn cba me d nhung gia dinh cd dii bd va me cd hieu qua bon dan dSn hieu qua TLDHT cao hon. Vdi TRF va CBCL sy khac biet khdng cd y nghia thdng ke.
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Bilu do 3: Hieu qua cua TL£)HT va dnh trang hon nhan gia dinh.
3.4. Anh hudng vdn di sue khde tam thdn cda cha me den hieu qud tri lieu da he thdng
Vdn dl hanh vi ciia cha me (dupc danh gid qua thang PAI gdm nhiing hknh \i nhu nghien rugu. chdng ddi xa hdi, hoang tudng va cdc bilu hien rdi loan nhan each) anh hirdng tdi hieu qua ciia TLDHT. 0 nhung gia dinh bd me CO muc dp rdi loan cao, sy tien bd cua nhdm
can thiep Idn hon nhieu so vdi nhdm chiing trong khi d nhihig gia dinh bd me cd mdc dp rdi loan thdp khdng cd sy khac biet gida nhdm can thiep va nhdm chung. Dieu nay khang djnh vdi nhiing gia dinh bd me cd rdi loan hanh vi, hg va con cdi se khdng the ty tien bd dugc neu khdng tham gia cac chuong trinh can thiep nhu TLDHT. TU)HT khdng nhiing chi gidp ire vi
T.T. Nam. B. Weiss/Tap chi Khoa hoc DHQGHN: Nghiin cuu Gido dye. Tap JO, S6 2 (2014) I-10
thanh nien ma ca cha me chung. Ket qua phan tich vdi bien dy bao la thang van de hanh vi hudng ngoai ciia cha me cho thay (PAI - van de
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Bieu do 4: Hieu qua ciia TLDHT va sdc khoe tam than ciia cha me.
3.5. Anh hirdng phong cdch hdnh vi ldm cha me din hieu qud tri lieu da he thdng
Ket qua pban U'ch cho thdy khdng cd sy khdc biet cd y nghia thdng ke vdi phong each Iam cha me ddc dodn, nuong chieu va hanh vi Idm cha me kiem sodt tam h'. Kian tich chi cho thSy hieu qua cua TLDHT khac nbau vdi nhung gia dinh ap dung phong cdch Iam cha me dan cbii, sd dung cac hanh vi ndng am va nhit quan.
Ket qua cho thdy nhdm cha me su dung phong each dan chii cao (do bing PAQ) dap ung tdt hon vdi TLDHT. Dilu nay dupc thi bien qua diem sd thang hanh vi hudng ngoai ciia nhdm tri lieu do ca cba me va ue khai diu
giam ddng ke so vdi diem sd cua nhdm chung.
H? sd F va mdc y nghia thdng ke dya Uen ket qua cua thang CBCL va YSR Ian lugt la (F(1,I19)= 3,94, p<0,05) va (F(I,IOO)= 4,06, p<0,05). Phong cdch dan chii the hien qua viec cha me cd kiem sodt tre bang cdch thiet lap cac luat le, nguyen tdc ung xu phii hgp vdi sy phat trien lua tudi va cd sy tham gia ciia ue. Viec tre dupc tbam gia Uong cac quyet dinh va hinh thanh cac dieu Iu4t giiip chiing cam thay minh la mpt phan ciia gia dinh va co trach nhiem hon trong viec khdng che banh vi ciia minh theo nhihig nguyen t3c ma chung da cam ket. CThi tiet dugc trinh bay trong Bieu dd 5a dudi day.
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T.T. Nam. B. Weiss / Tgp chi Khoa hoc DHQGHN: Nghien cuu Gido due. Tdp 30. So 2 (2014) I-10
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Bieu do 5a: Hi§u qua ciia TLDHT va phong each 15m cha me dan chu.
Su ndng am (chii ^, chdp nhdn va hd trp Ue vl mdt cam xiic) ta mdt ylu td Iam tang hieu qua ciia TLDHT. Kit qua phan ti'ch cho thdy sy cuong quy6t cao ctia ngudi me cd lien quan dang kd din viec giam ti le cdc hanh vi hudng ngoai cua nhdm trd tham gia Ui Ueu so vdi ue nhdm chdng. F(I,63)= 6.92, p<.05 theo CBCL
va F(l,24d)= 4.99, p<.05 theo YSR. Cd the mdi quan h? ndng am gida cha m? va con cai cao da duy tri trang thai tam Ii ti'ch cue d Ue, dieu nay giup tr6 khdng ty nhien cd nhiJng phan ung tieu cyc trudc nhimg nguydn tdc mdi ma cha me dua ra va giiip chiing 1km quen nhanh hon vdi cac nguyen tdc cua TLDHT.
Bieu do 5b; Hieu qua ciia TLDHT va tihnh vi nong am.
7", T. Nam. B. Weiss / Tgp chi Khoa hgc DHQGHN: Nghien cuu Gido dye. Tgp 30, So 2 (2014) 1-10
Tuong ty, hanh vi nhit qudn (kien dinh thuc hien nhung nguyen ldc da dupc de ra ciing nhu hau qua cbo hanh vi khdng thich nghi) dupc do bdng tbang CRPBI ciing giup tdng hiSu qua cita TLDHT. Kit qua phan ti'ch cbiing minh rdng
cha me cd cang nhieu hanh vi dng xu nhdt qudn vdi con cai dii hieu qua TLDHT cang cao. Kit qua kilm dinh cd y nghia thdng ke vdi CBCL vdi F [1, 63] = 6,92 p <0,05 va TRF vdi F [I, 117] = 5,44; p<0,05. Xem chi tilt Bilu dd 5c
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Bieu d6 5c: Hieu qua ciia TLDHT va h&nh vi nhit quan.
3.6. Anh hirdng hogt ddng chirc ndng cua gia dinh din hieu qud tri lieu da he thdng
Ho^t dgng chuc ndng cua gia dinb dupc phdn dnh qua hai tieu thang do la tinh cd kit giiJa cdc thanh vien Uong gia dinh va sy thich ling cua cdc thanh vien Uong gia dinh. Kit qua pban ti'ch Idn lupt cho tiidy rdng hieu qua cua TLDHT cao hon vdi nhimg gia dinh co tinh co
ket gida cac thanh vien cao hon cung nhu su thich ling ciia cac thanh vien vdi tinh huong mdi cao hon. Ket qua trdn thang CBCL vdi tinh cd kit (F [1,126] = 5,30; p <0,05); thang YSR vdi su thich ung (F [1,104] = 7,94; p<0,01) diu co y nghia thdng ke. Hay ndi each khac, nhdng ^a dinh cd ho?i ddng chirc nang tdt hon se gdp phin tang hieu qua TLDHT. Xem them Bieu dd 6.
T.T. Nam. B. Weiss / Tap chi Khoa Ape DHQGHN: Nghiin cuu Gido due. Tdp 30. SS 2 (2014) 1 -10
0 1 2 4 5 G 7 8 IC 11 12 13 14 16 17 1B 2 4 5 6 7 8 1011 12 13 14 16 17 1!
ThKh inig -ISO Thich ung+1SO
0 1 2 4 5 6 7 S 10 11 12 13 14 IG 17 18 • 8 1011 12 13 -4 16 17 18
Bieu do 6: IBeu qua cua TLDHT va bo^ dong chiic nang gia dinh.
4. Ket luan cfainh
Ket qua n ^ e n cuu tai khdng dinh hieu qua ciia TLDHT trong viec giam bieu hien rdi loan hanh vi ciia VTN. Ket qua cung chi ra cac yeu td nhu nhdm tudi. thu nhap, tinh trang hdn nhan gia dinh va sue khde tam thdn cua cha me cd anh hudng tryc tiep den hieu qua tri Ueu. Yeu td gidi tinb khdng anh hudng den ket qud tri lieu.
Nghien ciiu ciing nhan manh cdc yeu td chuc nang gia dinh va phong cdch hdnh vi Iam cha me dong vai tro quan trpng Uong trj Ueu.
Trong cac bien dy bao dugc dua ra, cd den 7 bien khang dinh hieu qua ciia TLDHT se tdt hon khi viec thyc hien chuc ndng gia dinh tdt hon. Cu the la nhirng gia dinh co dii cha me, khdng bi ton tbinmg sue Idide tam than, dp dung pbong cdch Iam cha me dan cbu, ap dung hanh \"i Iam cha me nhdt quan va ndng am, duy ui tinh cd ket va thich ung trong gia dinh se gop
phan tdng cudng hieu qua tri lieu. Phong cdch Iam cha me doc doan, va nuong chieu; hanh vi ling xu ciia cha me kiem sodt con cdi khdt khe ve tam h' va tinh cam khdng cd anh hudng tich cyc den hieu qua tri Ueu. Nhdng ket qua tim dugc ciia nghien cuu ggi y cho cdc nha TLDHT nen danh gia sang lpc ve boat ddng chuc ndng ciia gia dmh tre ciing nhu pbong cdch hanh vi Iam cha me de quyet dinh xem co nen dp dung can thiep TI^HT cho VTN do bay khdng.
Ghi chu: Nghien cihi nay dugc tai trg bdi quy NIH Fogarty International Center (D43 TW007769) cho PGS. Bahr Weiss.
Tai lieu tham khao
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Stephens, R, L.; et al. Outcomes from Wraparound and Multisystemic Therapy in a Center for Menial Health Services System of Care Demonstrauon Site. Joumal of Emouonal and Behavioral Disorders, 15 (3) (2007) 143.
[121 Timmons-Mitchell, J., Bender, M.B.. Kishna, M.A., & Mitchell, C C , An independent effectiveness tnal of multisystemic therapy with juvenile justice youth. Joumal of Clinical Child and Adolescent Psychology, 35, (2) (2006) 227.
Factors Affecting the Efficiency of Multisystemic Therapy for Adolescents with Behaviour Disorders
TrAn Thanh Nam', Bahr Weiss^
'VNV University of Education. 144 Xudn Thiiy. Cdu Gidy, Hanoi, Viemam '^Vanderbilt University, Nashville, TN, USA
Abstract: Multi-systemic therapy (MST) is now evaluated as effective for the treatment of behaviour disorders in adolescents. However, there are not yet many studies showing in what conditions the MST could promote die good results. This smdy has been earned out to examme tbe factor that could affect the efficiency of MST. Analytical results have determined a number of effecting factors such as die child age, family income, parents' marital status and parents' mental health. Adolescents will enjoy more benefits from MST if they have the family with effective functional activities, becasue 7 out of 12 factors affecting the therapy efficiency are related to the fimctional activities of famiUes and behavior of their parents. Tbe results of the study suggest that tbe multi-systematic therapists had better consider their evaluation of the fimctional activities of famihes and the parents' behaviors before deciding if MST can be apphed to them or not.
Keywords: Behaviour disorders; multi-systemic therapy; parenting behavior; family functioning.
