Hispanic youth and their families to extend the concept of contextualism. First, it discusses family and culture as literatures that have emerged from a contextualist perspective but are separate from each other. Second, it integrates these literatures by introducing the concept of the embeddedness of the individual within the context of the family within the context of culture. Finally, this concept of the embeddedness of contexts is extended to encompass a view of families embedded within culturally diverse contexts.Editor's note. Articles based on APA award addresses that appear in the American Psychologist are scholarly articles by distinguished contributors to the field. As such, they are given special consideration in the American Psychologist's editorial selection process.

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This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of. or was observed, using drugs. Subjects were randomly assigned to a strategic structuralsystems engagement (experimental) condition or to an engagement-as-usual (control) condition.Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared wiih 25"! of subjects in the control condition.Recent research has suggested that strategic, structural, family interventions are highly effective in the treatment ot multiple substance abusing adolescents (Szapocznik. Kurtines, Foote, Perez-Vidal, & Hervis, 1983. However, although family interventions may be more effective than individual interventions in treating drug abuse (Kaufman* Kaufman, 1979: Stanton, 1980, the engagement of families of drug abusers remains a serious problem. Stanton and his collaborators (Stanton, 1979;Stanton & Todd, 1981) have suggested that the problem of engaging drug abusers in treatment has been one of the most urgent obstacles to service delivery with this population. Our prior research (Szapocznik, Kurtines etal., 1983 has revealed that a substantial proportion of clients are lost prior to the first treatment session, thus confirming the difficulties inherent in engaging drug abusers in treatment. For example, in a project that investigated the treatment efficacy of drug-abusing adolescents, only 250 client families of approximately 650 initial contacts actually came in for a screening interview. Of this number, only 145 completed the intake procedure and only 72 completed treatment. Clearly, our data show that a very large proportion of client families who initially seek treatment are not engaged in therapy. Recognition of the problem of engagement has resulted in a number of attempts to develop strategies for recruiting drug abusers and their families in treatment (e.g..

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre-to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample.Disruptive behaviors and substance use continue to be among the most common presenting problems associated with child and adolescent referrals to mental health services (Kazdin, 1991; Substance Abuse and Mental Health Services Administration [SAMHSA], 2001). These problems are also among the most frequently diagnosed conditions in both outpatient and inpatient mental health facilities for children . As a consequence, scholars and policy makers have asserted that more research is needed on the early treatment of clinical dysfunction in childhood and adolescence, treatment that not only can reduce current dysfunction but also can play a preventive role in later years (Henggeler,

A randomized clinical trial evaluated the therapeutic efficacy of group cognitive-behavioral therapy (GCBT) versus a wait-list control (WLC) condition to treat anxiety disorders in children. Results indicated that GCBT, with concurrent parent sessions, was highly efficacious in producing and maintaining treatment gains. Children in GCBT showed substantial improvement on all the main outcome measures, and these gains were maintained at 3-, 6-, and 12-month follow-ups. Children in the WLC condition did not show improvements from the pre- to the postwait assessment point. These findings are discussed in terms of the need to continue to advance the development of practical, as well as conceptual, knowledge of efficacious treatment for anxiety disorders in children.

This study evaluated the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition relative to an education support (ES) control condition for treating children with phobic disorders. Eighty-one children and their parents completed a 10-week treatment program in which children and parents were seen in separate treatment sessions with the therapist, followed by a brief conjoint meeting. Children in both the CM and SC conditions showed substantial improvement on all of the outcome measures. These gains were maintained at 3-, 6-, and 12-month follow-ups. Interestingly, children in the ES condition also showed comparable improvements at posttreatment and at 3-, 6-, and 12-month follow-ups. Implications of the findings are discussed with respect to knowledge development and clinical practice.

This randomized clinical trial compared cognitive-behavioral therapy (CBT) with minimal parent involvement versus CBT with active parent involvement in a sample of 119 youth (7-16 years; 33.6% Caucasian; 61.3% Latino) with anxiety disorders. The dynamics of change between youth anxiety and parent variables (positive/negative behaviors toward the child, conflict in the parent-youth relationship, and parental anxiety) in both treatment conditions over pretreatment, posttreatment, and 12-month follow-up also were examined. Results indicated that youth anxiety was significantly reduced with both treatments and that the dynamics of change may not solely flow from parent to youth but also from youth to parent. Findings highlight the need for research on directionality and mechanisms of change in order to move from evidence-based treatments toward evidence-based explanations of treatment outcome. Keywordsanxiety; children; treatment; cognitive-behavioral therapy; parent involvement Randomized clinical trial evidence has accumulated for the efficacy of cognitive-behavioral therapy (CBT) in reducing anxiety disorders in children and adolescents when delivered in either individual or group formats relative to waitlist control conditions (e.g., Kendall, 1994;Silverman et al., 1999). In light of the consistent pattern of evidence for the efficacy of CBT coupled with etiologic evidence implicating familial contextual influences in the development and maintenance of childhood anxiety disorders (see Ginsburg, Silverman, & Kurtines,1995;Hudson & Rapee, 2005), a body of literature has evolved evaluating whether family/parent participation in CBTs enhances treatment efficacy relative to individual or group formats (e.g., Barrett, Dadds, & Rapee, 1996;Cobham, Dadds, & Spence, 1998). (Children and adolescents hereafter are referred to as "youth" and these treatments as "parent involvement treatments.") Correspondence concerning this article should be directed to the first author at silverw@fiu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/ccp. Barmish and Kendall's (2005) meta-analysis of individual and parent involvement CBTs for use with youth anxiety disorders concluded that in the absence of a consistent pattern of evidence for a relation between parent involvement and change in youth anxiety outcome, "The clearest and safest conclusion is that additional comparative research is needed and that the acceptance of either approach as superior is not yet justified" (p. 579). Results from other metaanalysis have yielded th...

This study reports data on the efficacy of Strategic Structural Systems Engagement (SSSE), which is designed to bring hard-to-reach families into treatment. The study also explores variables that may contribute to differential effectiveness. Participants were 193 Hispanic families, who were randomly assigned to either experimental or control conditions. Several important findings emerged. First, the overall results replicated earlier findings showing the superiority of SSSE: 81% of SSSE families, compared to 60% of control families, were successfully engaged, ^(1, N = 193) = 7.5, p < .001. Second, SSSE interventions were more successful with non-Cuban Hispanics (97% successfully engaged) than with Cuban Hispanics (64% successfully engaged), x*(l, N = 51) = 7.53, p = .006. Third, an analysis of intervention failures suggests a mechanism by which culture and ethnicity influence clinical processes (resistance to engagement) and may result in differential effectiveness.Family therapy has become recognized as an effective therapeutic modality in general (Gurman, Kniskern, & Pinsof, 1986), and it has been recognized as particularly effective with drug abusing and behavior problem youth (