Evaluating Supervision Models in Functional Family Therapy: Does Adding Observation Enhance Outcomes?

This study examined the effects of observation-based supervision Building Outcomes with Observation-Based Supervision of Therapy (BOOST therapists = 26, families = 105), versus supervision as usual (SAU therapists = 21, families = 59) on (a) youth externalizing behavior problems and (b) the moderating effects of changes in family functioning on youth externalizing behaviors for adolescents receiving Functional Family Therapy (FFT). Exploratory analyses examined the impact of supervision conditions on youth internalizing problems. In 8 community agencies, experienced FFT therapists (M = 1.4 years) received either BOOST or SAU supervision in a quasi-experimental design. Male (59%) or female (41%) adolescents were referred for the treatment of behavior problems (e.g., delinquency, substance use). Clients were Hispanic (62%), African American (19%), Non-Hispanic White (12%), or Other (7%) ethnic/racial origins. Therapists (female, 77%) were Hispanic 45%, African American (19%), White Non-Hispanic (30%), or other (4%) ethnic/racial backgrounds. Analyses controlled for the presence or absence of clinically elevated symptoms on outcome variables. Clinical outcomes were measured at baseline, 5 months, and 12 months after treatment initiation. Clients with externalizing behavior above clinical thresholds had significantly greater reductions in problem behaviors in the BOOST versus the SAU conditions. Clients below thresholds did not respond differentially to conditions. Supervisors in BOOST had more experience with the FFT model; as such, the observed results may be a result of supervisor experience. The BOOST supervision was associated with improved outcomes on problem behaviors that were above clinical thresholds. The findings demonstrate the importance of addressing client case mix in implementation studies in natural environments.

Este estudio examinó los efectos de la supervisión basada en la observación (terapeutas de BOOST = 26, familias = 105) frente a la supervisión habitual (terapeutas de SAU = 21, familias = 59) en (a) la externalización de problemas de conducta en los jóvenes y (b) los efectos moderadores de los cambios en el funcionamiento familiar sobre la externalización de conductas de los jóvenes en el caso de adolescentes que reciben terapia familiar funcional (FFT). Los análisis exploratorios analizaron el efecto de las condiciones de la supervisión en la internalización de problemas de los jóvenes. En 8 agencias comunitarias, terapeutas experimentados en FFT (M = 1,4 años) recibieron supervisión BOOST o SAU en un diseño cuasiexperimental. Se derivó a adolescentes masculinos (59%) o femeninos (41%) para el tratamiento de problemas conductuales (p. ej.: delincuencia, consumo de sustancias). Los pacientes eran hispanos (62%), afroamericanos (19%), blancos no hispanos (12%) o de otros orígenes étnicos o raciales (7%). Los terapeutas (femeninos, 77%) eran hispanos 45%, afroamericanos (19%), blancos no hispanos (30%) o de otros orígenes étnicos o raciales (4%). Los análisis tuvieron en cuenta la presencia o la ausencia de síntomas clínicamente elevados en los criterios de valoración. Se midieron las variables clínicas al inicio, a los 5 meses y 12 meses después del inicio del tratamiento. Resultados: Los pacientes con externalización del comportamiento por encima de los límites clínicos tuvieron reducciones considerablemente mayores de los comportamientos problemáticos en las condiciones de BOOST frente a las de SAU. Los pacientes por debajo de los límites no respondieron de forma diferencial a las condiciones. Los supervisores de BOOST tenían más experiencia con el modelo de FFT; por lo tanto, los resultados observados pueden ser el resultado de la experiencia de los supervisores. La supervisión BOOST estuvo asociada con mejores resultados en los comportamientos problemáticos que estaban por encima de los límites clínicos. Los resultados demuestran la importancia de abordar la variedad de casos de pacientes en la implementación de estudios en ambientes naturales.

Assertive outreach strategies for narrowing the adolescent substance abuse treatment gap: implications for research, practice, and policy.

In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse will have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered.

Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy.

This study examined treatment outcomes of 86 highly acculturated Hispanic and Anglo substance-abusing adolescents in functional family therapy, testing the hypothesis that ethnic matching of therapist and client is related to better treatment outcomes for clients. Adolescents reported on their substance use pre- and posttreatment on a timeline follow-back interview. Ethnically matched Hispanic adolescents demonstrated greater decreases in their substance use compared with Hispanic adolescents with Anglo therapists. Ethnic match status was not related to treatment outcome for Anglo clients. Thus, the matching hypothesis was supported for Hispanic clients only. The results underscore the importance of greater ethnic diversity among therapists and better cultural competency training for Anglo therapists. More research is needed on individual differences in the effects of ethnic matching.

Evidence-based psychosocial treatments for adolescent substance abuse.

This review synthesized findings from 17 studies since 1998 regarding evaluation of outpatient treatments for adolescent substance abuse. These studies represented systematic design advances in adolescent clinical trial science. The research examined 46 different intervention conditions with a total sample of 2,307 adolescents. The sample included 7 individual cognitive behavior therapy (CBT) replications (n = 367), 13 group CBT replications (n = 771), 17 family therapy replications (n = 850) and 9 minimal treatment control conditions (n = 319). The total sample was composed of approximately 75% males, and the ethnic/racial distribution was approximately 45% White, 25% Hispanic, 25% African American, and 5% other groups. Meta-analysis was used to evaluate within-group effect sizes as well as differences between active treatment conditions and the minimal treatment control conditions. Methodological rigor of studies was classified using Nathan and Gorman (2002) criteria, and treatments were classified using criteria for well-established and probably efficacious interventions based on Chambless et al. (1996). Three treatment approaches, multidimensional family therapy, functional family therapy, and group CBT emerged as well-established models for substance abuse treatment. However, a number of other models are probably efficacious, and none of the treatment approaches appeared to be clearly superior to any others in terms of treatment effectiveness for adolescent substance abuse.

Engaging resistant adolescents in drug abuse treatment.

In the first phase of a two-part treatment development study, families with a treatment-resistant drug-abusing adolescent (n = 42) were offered 12 sessions of Community Reinforcement and Family Training (CRAFT). This parent-focused intervention was designed to help parents facilitate their adolescents' entry into treatment, to support adolescents' subsequent behavior change, and to improve parent and family functioning. In the second phase, successfully engaged adolescents (n = 30) were offered 12 sessions of a multicomponent individual cognitive-behavioral therapy (CBT) targeting substance use and related problem behaviors. For parents and adolescents, measures were collected on pretreatment and posttreatment, with an additional follow-up assessment for parents at 3 months after treatment. Parents on CRAFT intervention experienced a significant reduction in negative symptoms, and 71% of parents were successful in engaging their resistant youths in treatment. The CBT intervention for engaged youths was associated with a statistically significant, but not clinically significant, reduction in marijuana use.

Profiles of drug use behavior change for adolescents in treatment.

This study was designed to replicate and extend previous research on post-treatment responding by identifying trajectories of change on the basis of an empirical classification strategy and to examine predictors of those change trajectories identified. Treatment response was examined for 232 adolescents with substance use disorders who participated in one of two randomized controlled trials evaluating family and cognitive behavioral interventions in an outpatient treatment setting. Cluster analysis was used to identify, empirically, homogeneous groups of individuals who display common internally consistent patterns of change over the course of treatment.

On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse.

AIMS: Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse. METHOD: Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide. FINDINGS AND CONCLUSIONS: Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.