Therapist adherence in brief strategic family therapy for adolescent drug abusers.

Abstract

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.

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013

“…Robbins, Feaster, Horigian, Puccinelli, et al (2011) tested fidelity effects using observational procedures to identify multiple dimensions of therapist adherence to BSFT. Stronger adherence was associated with decrease in ASU, better engagement and retention in treatment, and improved family functioning.…”

Promoting Healthy Outcomes Among Youth with Multiple Risks: Innovative Approaches

“…However, results for substance use have been mixed (112). Greater adherence to the program model was associated with improved client outcomes (111). BSFT has not received an independent evaluation and currently would be considered promising (65).…”

Brief Strategic Family Therapy: Implementing evidence-based models in community settings

“…Using data from the effectiveness study, Robbins et al (2011a) examined the extent to which BSFT therapists implemented the treatment protocol properly. Adherence (prescribed) items were rated in terms of the four theoretically and clinically relevant expected/prescribed therapist behaviors: joining, tracking and eliciting enactments, reframing, and restructuring.…”

“…For example, an agency director may cite pressure from funders to treat as many adolescents as possible, for the least possible cost, within a given period of time. We would then present evidence indicating that the BSFT approach is more effective in reducing adolescent drug use and behavior problems compared to other approaches commonly used by community agencies (Robbins et al, 2011a; Santisteban et al, 2003), and present evidence from Florida’s Redirection program demonstrating reduced cost to the state (http://www.evidencebasedassociates.com/featured_projects/florida.html). Presenting such evidence helps promote buy-in on every level, making it more likely that the BSFT model will be adopted and supported by funders.…”

“…Research on the BSFT clinical intervention (Robbins et al, 2011a) and other family-based models (e.g., multisystemic therapy; Schoenwald, Sheidow, & Letorneau, 2004) has demonstrated that fidelity is essential to achieve desired outcomes. Our research has demonstrated that independent rated adherence to prescribed BSFT behaviors predicts engaging and retaining families in treatment, improving family functioning, and reducing adolescent drug use.…”