Program

Oct 10, 2013

OVERVIEW

 The Strategic Structural-Systems Engagement (SSSE) model is designed to improve the therapy contact and engagement rates of adolescents with behavior and/or drug problems and their families.  The model does this by involving the adolescent’s family in the therapy process.  Experimental evaluations of the programs show that SSSE is highly effective in getting adolescents and their families to attend therapy sessions and in increasing completion rates for therapy.

DESCRIPTION OF PROGRAM

Target population: Adolescents who exhibit behavior problems or are suspected to be abusing alcohol or drugs and their families

Strategic Structural-Systems Engagement (SSSE) is a therapy model which aims to engage families who are resistant to or unlikely to attend therapy sessions for their adolescent. Although SSSE has a narrower scope, it shares a framework with Brief Strategic Family Therapy (BSFT); namely, although the adolescent may be the one exhibiting symptoms, therapy must focus on the entire family in order to identify and change maladaptive relationship patterns that contribute to their symptoms.  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.  Level zero is showing concern and scheduling intake appointments; level one interactions involve encouraging the caller to involve family in the treatment; and level two involves deeper inquiries into the problems and more requests of the family to commit to treatment.  Level three interactions involve beginning to check up on families to ensure that they will make all intake appointments; level four interactions are the first to start restructuring the family of the problem adolescent; and level five is comprised of special interactions such as out-of-office visits with family members and involving family members in the restructuring process.  The model is manualized, but estimates of training costs were not available online; cost information specific to a particular site’s staff can be obtained by emailing the Family Therapy Training Institute of Miami (see contact information below).

EVALUATIONS 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: The sample consisted of one hundred eight 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 percent being of Cuban descent.  Fourteen percent of parents were unemployed and most had less than a high school education.  The adolescents were between the ages of 12 and 21 and 67 percent of the adolescents were male.  Ninety-three percent of the adolescents were using drugs at the time of intake into the study.  Eighty-three percent of participants were using marijuana and eighty percent 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 SSSE (n=56) or engagement as usual (EAU) (n=52).  Both groups were assigned to therapists with whom they attended therapy sessions.  The experimental group received an SSSE intervention, while 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.

The SSSE group therapists were allowed to engage in all six levels of interactions while the EAU group therapists were only allowed to employ levels zero and one.  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 two and eight tenths out of five possible points on the engagement scale while the control condition averaged less than one.  Families of participants in the experimental condition were far more likely to attend therapy sessions (93%) than those in the control condition (42%).  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 did not have significant impacts on the total scale of subscales 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%).

Santisteban, 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: A total of 193 families of Hispanic adolescents who were suspected of or at risk for using drugs served as the sample.  The adolescents were between 12 and 18 years of age, and 70 percent were male.  Thirty-four percent of parents in the sample had not completed high school.  Fifty-four percent of the adolescents were of Cuban descent, and the other 46 percent consisted of a mix of Nicaraguan, Colombian, Puerto Rican, Peruvian, Mexican, and Salvadorian.

Approach: Potential participants were identified when a family member called in to the Spanish Family Guidance Center for help with their troubled adolescent.  Participants were screened using the Drug Abuse Syndrome List.  Families qualified for the study were randomly assigned to the treatment condition, Engagement Family Therapy (EFT), or one of two control conditions. Family Therapy (FT) and Group Therapy (GT).  The EFT treatment condition consisted of BSFT with SSSE, in which therapists restructure the family to encourage family commitment to treatment.  The FT condition consisted solely of Brief Strategic Family Therapy, a therapy system which is described in more detail here (i.e., without the SSSE component) and did not include any attempts to modify family structure.  In the GT control condition, therapists provided the normal treatment patients would have received from outpatient centers.

The therapists had four weeks to attempt to make contact with participants’ 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 eight hours and finishing assessments at the end).

Results: In the EFT condition, 81 percent of families were engaged, a significant difference from the FT and GT control conditions, which had 57 percent and 62 percent engagement rates, respectively.  Among families who were engaged, non-experimental analyses found that the EFT condition had a 69 percent successful completion rate.  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 five, however, was found to be equally as effective as levels two through four.  Cuban families were much more likely to resist treatment than non-Cuban Hispanics.

SOURCES FOR MORE INFORMATION

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.

For additional information about SSE, please visit: http://www.brief-strategic-family-therapy.com/other-programs-a-services-/engagement.html.

For additional information about BSFT, please visit: http://www.brief-strategic-family-therapy.com/training/bsft-certification-program.html.  For BSFT cost information estimates, please visit: http://sshs.promoteprevent.org/publications/ebi-factsheets/brief-strategic-family-therapy-bsft

Contact Information

For site-specific cost information:

Olga E. Hervis

Family Therapy Training Institute of Miami

1221 Brickell Ave

Miami, Fl 33131

888-527-3828

info@bsft-av.com

www.bsft-av.com

KEYWORDS: Adolescents (12-17),  Youth (16+), Young Adults (18-24), Males and Females (Co-ed), High-Risk,  Hispanic/Latino, Clinic/Provider-based, Cost Information Is Available, Manual is Available, Counseling/Therapy, Home Visitation, Parent or Family Component, Family Therapy, Marijuana/Illicit/Prescription Drugs, Alcohol Use, Aggression, Bullying, Other Behavioral Problems.

Program information last updated on 10/10/2013.

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