Comparing individually based and family‐based treatments for internalizing, externalizing, and family symptoms in Latino youth

Abstract

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.

Evaluation of Culturally Informed and Flexible Family‐Based Treatment for Adolescents (CIFFTA) implemented in community‐based settings

“…A total of 232 adolescent‐caretaker dyads participated in the intervention. Of the 232 participants, 177 (76%) met the 8‐session criteria for retention (Santisteban et al, 1996, 2022) and 165 (71%) completed the intervention. For the full sample of 232 participants, the average number of sessions received was 14.24 (SD = 7.94) with an average of 6.7 family therapy sessions, 4.2 individual therapy sessions, and 3.3 psychoeducation sessions.…”

“…CIFFTA integrates Structural Family Therapy (Minuchin & Fishman, 1981), Bronfenbrenner's Ecological Model (1979), specialized engagement of reluctant members (Santisteban et al, 1996), and Motivational Interviewing (Miller & Rollnick, 2012) within its foundations. CIFFTA components include individual adolescent therapy, family therapy, psychoeducational modules, an emphasis on cultural content, and uses a flexible and adaptive manual that includes decision rules based on pretreatment client characteristics that guide therapists’ selection of treatment options (Santisteban et al, 2013, 2022). The tailoring report based on baseline data and the CIFFTA Clinical Interview highlights the most prominent symptoms, and clinical and cultural characteristics that can help guide the selection of psychoeducational modules that best fit the family.…”

“…The average caseload for the therapists ranged from 12 to 16 families. All CIFFTA therapists received either a 3‐day training workshop or an innovative and newly developed 20‐h online training experience on an adaptive training platform (Santisteban et al, 2022). Weekly clinical supervision meetings led by one of the model developers involved review of therapists' recorded sessions for participants who provided consent to be recorded for the purpose of monitoring fidelity to the CIFFTA treatment.…”

“…In a larger randomized trial ( N = 200) that compared CIFFTA to an individually oriented treatment (ITAU), findings showed that both conditions showed reductions in youth behavior problems (Santisteban et al, 2022). A difference between conditions was found on parent‐reported family conflict, b = −0.77, S E = 0.34, p = 0.025, with family conflict decreasing more in CIFFTA ( d = 1.12) than ITAU ( d = 0.58).…”

“…Previous randomized trials of CIFFTA included very narrow inclusion criteria and the samples were more homogenous. Examples include meeting diagnostic criteria for a substance abuse disorder (Santisteban et al, 2011), or requiring symptoms of more than one specific disorder (e.g., depression, ADHD, conduct disorder; Santisteban et al, 2022). Weisz et al (2014) describe the “Implementation Cliff” as a significant drop in impact and benefits to the client when an intervention leaves the university or laboratory setting and is implemented in the frontlines of practice.…”