Objective Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study. Method Participants were 480 adolescents (age 12–17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis, & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies. Results Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Conclusions Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy.
Brief Strategic Family Therapy (BSFT) for Adolescent Drug Abuse clinical trial of 480 adolescents boys and girls age 12 to 17 and their parents was designed to maximize the chance that a sufficient number of Hispanic and Black adolescents would be included to allow valid subgroup comparisons. Examination of measurement invariance is an important step to ensure valid analysis. Two construct areas important to the analysis of trial results, adolescent problem behaviors and family functioning showed a high degree of measurement invariance, which allowed valid comparisons of mean baseline differences across groups. Results showed that Black families had significantly higher initial levels of family functioning and lower levels of adolescent externalizing than either Hispanic or White nonHispanic families. This pattern is consistent with an increased likelihood of referral of Black adolescents with more severe problems to restricted setting rather than to outpatient drug abuse treatment. This possibility highlights the importance of considering differing baseline characteristics of subgroups prior to assessing differential treatment effectiveness to prevent confounding. Keywords Measurement Invariance; Ethnic Minorities; Racial/Ethnic Variability; Adolescent problem behaviorsThe most recent data from the US Bureau of the Census (2000Census ( , 2004 indicates that racial/ ethnic minorities are projected to account for one third of the US population as soon as 2010. The adolescent population is even more diverse, with 36% of 10-19 years-old coming from racial/ethnic minority backgrounds, compared to 28% of the general population (US Census Bureau, 2000).Understanding racial/ethnic variation in important adolescent outcomes such as substance use has historically been overlooked. For example, Hall and Maramba (2001) report that © 2010 Elsevier Inc. All rights reserved.Address correspondence to Daniel J. Feaster, Ph.D., Center for Family Studies, Miller School of Medicine, University of Miami, 1425 NW 10 th Avenue, Miami, Florida 33136; dfeaster@med.miami.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public AccessAuthor Manuscript J Subst Abuse Treat. Author manuscript; available in PMC 2011 June 1. Published in final edited form as:J Subst Abuse Treat. 2010 June ; 38S1: S113-S124. doi:10.1016/j.jsat.2010.01.010. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript "Publications involving cross-cultural issues represented 1% and racial/ethnic minority issues represented 3% of all the publications in the English language in the PyscINFO datab...
Brief strategic family therapy™ (BSFT) is a manualized treatment designed to address aspects of family functioning associated with adolescent drug use and behavior problems (J. Szapocznik, U. Hervis, S. Schwartz, (2003). Brief strategic family therapy for adolescent drug abuse. (NIH Publication No. 03-4751). Bethesda, MD: National Institute on Drug Abuse). Within the National Institute on Drug Abuse’s (NIDA’s) Clinical Trials Network, BSFT is being compared to treatment as usual (TAU) in a multisite, prospective randomized clinical trial for drug using adolescents and their families in outpatient settings. The effectiveness of BSFT is being compared to TAU in reducing adolescent drug use, conduct problems, and sexually risky behaviors as well as in improving family functioning and adolescent prosocial behaviors. This paper describes the following aspects of the study: specific aims, research design and study organization, assessment of primary and secondary outcomes, study treatments, data analysis plan, and data monitoring and safety reporting.
People with HIV experience elevated levels of co-occurring psychosocial concerns, which can interfere with HIV-related self-care behaviors, such as medication adherence. We recently developed transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing psychotherapy to address interrelated psychosocial problems (syndemics) that can interfere with medication adherence and selfcare among people with uncontrolled HIV (i.e., a detectable viral load). Through completion of a field trial that included development, clinical supervision, treatment, and administrative coordination of this project, we identified recommendations for engaging, retaining, and delivering transdiagnostic cognitivebehavioral therapy/motivational interviewing to individuals with HIV and experiencing psychosocial and structural barriers to mental and physical health. We describe these recommendations, which include (a) building the relationship; (b) addressing HIV in the context of syndemics; (c) attending to the impact of stigma on health; (d) being flexible in delivering the treatment; (e) managing emergent crises with relevant skill material; (f) tailoring the treatment to education, language, and sociocultural context; (g) implementing problem-solving skills for structural barriers; (h) scheduling flexibly and following up; (i) colocating mental health services and coordinating among providers; and (j) providing a comfortable and affirming physical space. In addition to describing these recommendations, we provide clinical examples and highlight empirical research to illustrate and support using these recommendations. Clinical Impact StatementQuestion: What strategies can therapists use to engage, retain, and provide transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing to underserved clients with HIV? Findings: For therapists working with underserved clients with HIV, there are strategies that may increase clients' likelihood of using and staying in transdiagnostic CBT/MI treatment and can help to ensure that treatment is useful and relevant to clients' lives. Meaning: Despite the psychosocial, interpersonal, and structural challenges facing underserved clients with HIV, a variety of strategies may improve engagement and delivery of evidence-based mental health services using the strategies identified and may help to offset the impact of these challenges on clients' health and well-being. Next Steps: Future research might continue to explore the effects of using the strategies identified here on client outcomes, both in terms of mental health and HIV health, for example, through a randomized trial of this treatment.
Rigorous randomized trials that test promising culturally centered treatments for Latino youth and families are needed. This study adds to the knowledge base by comparing the efficacy of Culturally Informed and Flexible Family Treatment for Adolescents (CIFFTA) to an Individually Oriented Treatment‐As‐Usual (ITAU) in its ability to retain Latino youth and families in treatment, reduce internalizing and externalizing child symptoms, and improve family functioning. CIFFTA uses an adaptive/flexible approach to deliver individual therapy, family therapy, and psycho‐educational modules tailored to each family's unique clinical and cultural characteristics. Two hundred Latino adolescents 11–14 years of age completed a baseline assessment, were randomly assigned to CIFFTA or ITAU, then were assessed again after 16 weeks of intervention. Results show that CIFFTA had significantly higher retention (83%) than ITAU (71%), OR = 2.05, p = .036. Youth in both conditions showed significant reductions in youth and parent reported externalizing and internalizing behaviors, and there were no differences in change between conditions. Parents in CIFFTA reported significantly greater reductions in family conflict, d = 0.38, p = .025 than in ITAU. In CIFFTA, children of less acculturated Latino parents showed more improvement than the children of more acculturated parents. In ITAU, the reverse was true, children of more acculturated parents reported more improvement. This evidence of CIFFTA’s impact on retention, family conflict, and differential effect depending on cultural values and behaviors, has important implications for the field of Latino psychology and family treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.