Brief Strategic Family Therapy
OVERVIEW
Brief Strategic Family Therapy (BSFT) is a clinic-based therapy program based on the Strategic Structural-Systems Engagement (SSSE) model. It is designed to improve the therapy contact and engagement rates of adolescents with behavior and/or drug problems. The model does this by involving the adolescent's family in the therapy process. Brief Strategic Family Therapy is a therapy system whereby the family is restructured through the help of a trained therapist to prevent problem interactions that contribute to the adolescent's behavior problems. Experimental evaluations of the programs show that SSSE is highly effective in getting adolescents and their families to attend therapy sessions, and thus in increasing completion rates for therapy. BSFT was found to be effective in reducing externalizing behavior and drug and alcohol abuse. BSFT was also found to be effective in improving family functioning and cohesion.
DESCRIPTION OF PROGRAM
Target population: adolescents who exhibit behavior problems or are suspected to be abusing alcohol or drugs
Strategic Structural-Systems Engagement is a manualized model which therapists can use to identify and engage families who are resistant to or are not likely to attend therapy sessions. In initial contacts, therapists can utilize six levels of different strategies which may help engage those families who have individual members who prevent them from attending therapy. Brief Strategic Family Therapy is a family-systems approach which is designed for adolescents with behavior or drug related problems. Through family therapy, therapists identify and change maladaptive relationship patterns within families. Family therapy sessions are also manualized and are designed to be attended weekly for up to six months.
Cost of training for the program ranges from approximately $7,500 to $60,000 for varying degrees of training and varying amounts of trainees. Promoteprevent.org recommends a budget of $80,000 for year one.
According to www.Promoteprevent.org, the cost of treating one family for 24 sessions in 2008 was $3,200 ($132 per session)
EVALUATION(S) OF PROGRAM
Szapocznik, A. P., Brickman, A. L., Foote, F. H., Santiteban, D., Hervis, O., & Kurtines, W. M. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology, 56, 552-557.
Evaluated population: 108 families of Hispanic adolescents suspected of and observed using drugs. The families were all drawn from Miami-Dade County Florida and reflected the Hispanic population of the area with 82% being of Cuban descent. 14% of parents were unemployed and most had less than high school education. The adolescents were between the ages of 12 and 21 and consisted of 67% males. 93% of the adolescents were using drugs at the time of intake into the study. 82.5% of participants were using marijuana and 80% were using cocaine.
Approach: To enter the program, a family member had to call in to a hot line to ask for help with their troubled adolescent. In order to qualify for the study, the family member had to have direct evidence that their adolescent was using drugs. Then, the Drug Abuse Syndrome List checklist was administered to the caller to help determine the extent of the behavior problem. The adolescent had to have exhibited at least four or more problem behaviors on the checklist.
Families were then randomly assigned to either the strategic structural-systems engagement group (SSSE) (n=56) or the engagement as usual group (EAU) (n=52). Both groups were assigned to therapists with whom they attended therapy sessions. The experimental SSSE group received an intervention based on the Brief Strategic Family Therapy model which attempts to restructure the family of the adolescent. The EAU group received a treatment that was designed to mimic treatment received at local clinics in the area, which relied on the family to take responsibility for continuing treatment.
Therapists' strategies for engaging clients were categorized into six levels. Level 0 was showing concern and scheduling intake appointments; level 1 interactions involved encouraging the caller to involve family in the treatment; level 2 involved deeper inquiries into the problems and more requests of the family to commit to treatment; level 3 interactions began checking up on families to ensure that they would make all intake appointments; level 4 interactions were the first to start restructuring the family of the problem adolescent; level 5 was comprised of special interactions such as out-of-office visits with family members and involving family members in the restructuring process. In terms of the evaluation, the SSSE group therapists were allowed to engage in all levels of interactions while the EAU group therapists were only allowed to employ levels 0-1. In both conditions, the therapist was given three weeks in which to attempt to get the family in for treatment sessions. If the family had not attended therapy by this time, they were defined as engagement failures.
Adolescents were evaluated using the Psychiatric status Schedule (PSS) and the Client Oriented Data Acquisition Process (CODAP). The PSS assesses psychiatric and psychosocial functioning and measures subjective distress, behavioral disturbance, impulse control, reality testing, and drug abuse. It was administered by a therapist at the initial intake interview and by a graduate student who was blind to conditions at termination of therapy. The CODAP measures the amount and type of drug abuse as reported by the client. The CODAP was administered by the therapist both at intake and termination of therapy.
Results: To measure the fidelity of treatment, the researchers computed an engagement score for each participant, in the experimental condition, participants received an average level of 2.8 on the engagement scale defined above (0 to 5) while the control condition received 0.8. Partipcants in the experimental condition were far more likely to attent therapy sessions (92.9%) than those in the control condition (42.3%). Participants in the SSSE condition were also far more likely to reach completion of therapy (77%) compared with those in the EAU condition (25%). Treatment also had significant impacts on the subscales and total scale of the PSS. Participants were substantially less likely to abuse drugs (20%) at the conclusion of treatment, compared with at the outset of treatment (93%).
Santiteban, D., Szapocznik, A. P., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & LaPerriere, A. (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10(1), 35-44.
Evaluated population: 193 families of Hispanic adolescents who were suspected of or at risk for using drugs. The adolescents were between 12 and 18 years of age and were 70% male. 34% of parents in the sample had not completed high school. 54% of the adolescents were of Cuban descent, and the other 46% consisted of a mix of Nicaraguan, Columbian, Puerto Rican, Peruvian, Mexican, and Salvadorian.
Approach: This paper focuses on engaging adolescents
with drug problems and their families in therapy. Participants were
received when a family member called in to the
The therapists had four weeks in which to attempt to make contact with a family and bring critical members of the family in for an intake therapy session. Having all critical members of the family at the initial intake was defined as engagement of the family. Families were measured on both engagement and maintenance in therapy (at least 8 hours and finishing assessments at the end).
Results: In the EFT condition, 81% of families were engaged, a significant difference from the FT and GT control conditions, which had 57% and 62% engagement, respectively. Among those who engaged, non-experimental analyses found that the EFT condition had a 69% successful completion rate for those families who were engaged. This did not differ from the completion rates of the FT (71%) and GT (63%) conditions. Additional findings suggested that therapist engagement in levels 2-4 of the engagement hierarchy was most effective in getting families to attend. Level 5, however, was found t be equally as effective as level 2-4. Cuban families were much more likely to resist treatment than non-Cuban Hispanics.
SOURCES FOR MORE INFORMATION
http://www.ncjrs.gov/pdffiles1/ojjdp/179285.pdf
References:
Santiteban, D., Szapocznik, A. P., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & LaPerriere, A. (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10(1), 35-44.
Szapocznik, A. P., Brickman, A. L., Foote, F. H., Santiteban, D., Hervis, O., & Kurtines, W. M. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology, 56, 552-557.
Program categorized in this guide according to the following:
Evaluated participant ages: 12-21
Program age ranges in the guide: Adolescence, Youth
Program components: Counseling/Therapy, Clinic/Provider-Based, parent or family component
Measured outcomes: social and emotional health and development; behavioral problems
KEYWORDS: Adolescence (12-17), Young Adulthood (17-24), Clinic-based, Adolescents (12-17), Youth (16+), Young adults (18-24), Family Therapy, Counseling/Therapy, Aggression, Externalizing Problems, Conduct Problems, Violence, Delinquency, Substance Use, Alcohol Use, Marijuana Use, Illicit Drugs, Hispanic or Latino, manual, cost, co-ed.
Program information last updated on 1/12/09.
|
|
|
© Child Trends 2003 |
|
|
|
