Intervention Summary
Brief Strategic Family Therapy: Family Therapy Training Institute of Miami
See Brief Strategic Family Therapy (BSFT) for past. Brief Strategic Family Therapy® (BSFT®) is designed to (1) prevent, reduce, and/or treat adolescent behavior problems such as drug use, conduct problems, delinquency, sexually risky behavior, aggressive/violent behavior, and association with antisocial peers; (2) improve prosocial behaviors such as school attendance and performance; and (3) improve family functioning, including effective parental leadership and management, positive parenting, and parental involvement with the child and his or her peers and school. BSFT® is typically delivered in 12–16 family sessions, but may be delivered in as few as 8 or as many as 24 sessions, depending on the severity of the communication and management problems within the family. Sessions are conducted at locations that are convenient to the family, including the family's home in some cases. While early studies were conducted mainly with Hispanic families, the effectiveness study included African American and White American families. BSFT® considers adolescent symptoms to be rooted in maladaptive family interactions that do not permit the family to achieve its own goals, such as inappropriate alliances between family members, overly rigid or permeable family boundaries, and parents' tendency to blame all family problems on a single individual (usually the adolescent). BSFT® operates according to the assumption that transforming how the family functions will help improve the teen's presenting problem. BSFT®'s therapeutic techniques fall into four categories: joining; tracking, eliciting and diagnosing; reframing; and, restructuring. The therapist initially "joins" the family by encouraging family members to behave in their normal fashion. The therapist then diagnoses repetitive patterns of family interactions. Reframing interventions reduce negativity and create a motivational context for change, which act as springboard for change-producing restructuring interventions that promote new, more adaptive patterns of interactions.
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted. Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., Miller, M., Burlew, K. A., Hodgkins, C., Carrion, I., Vandermark, N., Schindler, E., Werstlein, R., & Szapocznik, J. Brief Strategic Family Therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713–727. Robbins, M. S., Feaster, D. J., Horigian, V. E., Puccinelli, M. J., Henderson, C., & Szapocznik, J. Therapist adherence in Brief Strategic Family Therapy for adolescent drug abusers. Journal of Consulting and Clinical Psychology, 79(6), 43–53. Family functioning was assessed using a composite scale created from two separate scales. The Parenting Practices Questionnaire was completed by adolescents and their parents to identify positive and negative parenting behaviors in four domains: (a) positive parenting, (b) discipline effectiveness, (c) avoidance of discipline, and (d) monitoring. Discipline effectiveness and avoidance of discipline were assessed only of the parents. The Family Environmental Scale was administered to adolescents and their parents to measure cohesion and conflict.
There were significant differences in the trajectories of parent-reported family functioning (p < .011), suggesting that BSFT was significantly more effective than the control condition in improving family processes. This pattern held true for the parenting practices (p < .023) and family environment subcomponents (p < .033).
Adolescents in both conditions reported significant improvements over time in family functioning; however, no statistically significant differences between treatment conditions were observed.
The following populations were identified in the studies reviewed for Quality of
Research.
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
The outcome instruments were well-established with acceptable levels of reliability and validity. The study was implemented with considerable attention to assuring adherence to the BSFT® protocol, including manuals, training, supervision, and pilot cases that were worked on prior to beginning the study. Random sessions were assessed for adherence, using an instrument with known psychometric properties by independent raters with high interrater reliability across the four principal domains. No differences were found between the two conditions on any of the key demographic variables or baseline levels of the outcomes. Factorial validity was ensured for the family functioning measure across the three major groups, African American, Hispanics and Whites. Families were randomly assigned within each provider agency to study condition using an urn randomization procedure, which was intended to balance participants across conditions on ethnicity/race and level of drug use at baseline. Within each provider agency, therapist randomization was carried out within therapist pairs that were balanced, insofar as feasible, in regard to academic degrees and years of clinical experience. The participants in the treatment-as-usual condition received standard agency services in reducing adolescent drug use, including individual and/or group therapy, parent-training groups, nonmanualized family therapy, and case management. All agencies were expected to provide at least one intervention session per week, which is at least as many sessions as participants in the intervention condition. The analytic strategy was very thorough and appropriate, and included random effects for both sites and therapists, nested within site, to account for these two levels of nesting. These models are robust to data that are missing at random. The researchers acknowledged that some therapists had little or no experience in family therapy and occasionally no experience with adolescents. This, and also allowing BSFT® therapists to have multiple roles beyond BSFT® treatment, may have had a negative impact on the effectiveness of the intervention. Although attrition is expected in longitudinal research, and rates of attrition were comparable across study conditions, the level of attrition was notably high, particularly among African American youths. In addition, 25 percent of the clinicians left the study while it was in process and it is unclear how this impacted the study findings. The researchers mentioned that adolescent drug use was likely depressed in the period preceding treatment and during the intervention itself, which created a floor effect that permitted only the examination of prevention of relapse or escalation of drug use.
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials. Organizational Presentation
2 Workshops PowerPoints BSFT® Curriculum Outline Training Program Description Training Evaluation BSFT® Implementation Information Packet Therapist Eligibility Form Supervision Checklist Therapist Certification Overall Supervision Evaluation Therapist Certification Rating Manual Therapist Videotape Certification Checklist BSFT® Manual Recommendations for Measuring BSFT® Outcomes Outline Organizational Site Visit
Supervisor Week 3
Supervisor Training Outline
Supervisor Trainee Program
Supervisor Trainer Presentation
FAD Subscales
McMaster GF Spanish2
Organizational Booster
Organizational Considerations Chart
Parent Practices Questionnaire
PPQ Spanish2
Recommended BSFT Outcome Measures
Scoring and Interpreting the PPQ and FAD
Supervision Agreement
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria: For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
A number of documents supporting implementation are provided. The BSFT® Implementation Information Packet provides a clear description of implementation documents and process. Of all the documents provided, two methods offer the potential for assuring quality of implementation. First, the supervision agreement noted above offers the best source for ongoing training for supervisors who will be providing training on the approach. Second, the assessment tools provide guidance along with information on measuring outcomes. The specificity of the agreement offers opportunities for improvement in skills, training, and overall implementation of the BSFT. The extent to which both of these methods are employed with fidelity will ultimately determine the quality of the implementation.
The Training Program Description is very thorough and informative, which includes a directory or table of contents that presents the order of implementation by section, with relevant documents in each section.
The assessment tools, the McMaster Family Assessment Device (FAD) and the Parenting Practices Questionnaire (PPQ) are available in both English and Spanish, and are relatively easy to comprehend and administer. The outcome-testing section of the organizational-booster presentation materials recommends that adopters report three dimensions of outcome measures that BSFT has shown to be consistently effective, one of which includes IP measures. Two of the three recommend the outcome measurement tools that are included (FAD and PPQ). In addition, it is very helpful that the link is provided for at least one of the referenced IP-related measurements. Frequently asked questions (FAQs) for the BSFT outcome measures are also included and are a very helpful resource.
The Recommendations for Measuring BSFT® Outcomes is a helpful tool for ensuring the proper assessments are used. Materials are poorly organized. With the exception of the assessment tools and the "Organizational Site Visit" onsite training and presentation, which aligned with the PowerPoint document on "BSFT-An Empirically Validated Therapy," it was difficult to identify the functionality of the other materials and how they related to each other in the context of implementing this particular program.
There is minimal information to support quality assurance of program implementation.
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements. Descriptive Information
Areas of Interest
Mental health promotion
Mental health treatment
Substance use disorder prevention
Substance use disorder treatment
Outcomes
1: Drug use
2: Treatment engagement
3: Treatment retention
4: Family functioning
Outcome Categories
Drugs
Social functioning
Treatment/recovery
Ages
13-17 (Adolescent)
Genders
Male
Female
Races/Ethnicities
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings
Home
Other community settings
Geographic Locations
Urban
Suburban
Rural and/or frontier
Implementation History
NIH Funding/CER Studies
Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations
Originally developed for Hispanic families, BSFT® has been adapted for use with other ethnic populations, including African American, German, and Swedish families.
Adverse Effects
Among 900 individuals, seven adverse events were determined to be related to the delivery of BSFT®. Four events were classified as "runaway." These events were determined to be related to the intervention because the adolescent ran away from home during, or immediately after, a session. For two events classified as "violence (victim/exposure)," a physical altercation between at least two family members occurred during a therapy session when family members became agitated. The single "arrest" event occurred at the conclusion of one of these two events when a family member was arrested and detained by police.
IOM Prevention Categories
Indicated
Documents Reviewed
Study 1
Supplementary Materials
Outcomes
Outcome 1: Drug use
Description of Measures
Adolescent drug use was assessed using the Timeline Follow-Back (TLFB) method, a semistructured, self-report, calendar-based interview that asks participants to retrospectively estimate their drug consumption over the previous month. The TLFB was administered at baseline and at 12 monthly follow-up assessments to establish a pretreatment rate of use and 365 continuous days of data on daily drug use after randomization.
Key Findings
The median number of self-reported drug-use days at 12 months was significantly lower in the BSFT® condition than in the treatment-as-usual condition (p < .02).
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
3.4
(0.0-4.0 scale)
Outcome 2: Treatment engagement
Description of Measures
On a monthly basis, using participants' clinical charts and billing data, therapists reported the number of therapy sessions of any type delivered since the last interview. Participants were considered to be engaged if they participated in two or more sessions.
Key Findings
Participants in the BSFT® condition were significantly more engaged in treatment than those who received treatment-as-usual (p < .001). Adolescents receiving treatment-as-usual were 2.5 times more likely to fail to engage into therapy (rate of failure = 26.8%) than adolescents receiving the BSFT treatment (rate of failure = 11.4%).
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
3.4
(0.0-4.0 scale)
Outcome 3: Treatment retention
Description of Measures
On a monthly basis, using participants' clinical charts and billing data, therapists reported the number of therapy sessions of any type delivered since the last interview. Participants were classified as retained if they attended more than seven sessions.
Key Findings
Participants in the BSFT® condition had lower rates of failure to retain in treatment than those who received treatment-as-usual (p < .02). Adolescents receiving treatment-as-usual were 1.4 times more likely to fail to retain in treatment for at least eight sessions (rate of failure = 56.6%) than adolescents in the BSFT® treatment condition (rate of failure = 40%).
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
3.4
(0.0-4.0 scale)
Outcome 4: Family functioning
Description of Measures
Key Findings
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
3.4
(0.0-4.0 scale)
Study Populations
Study
Age
Gender
Race/Ethnicity
Study 1
13-17 (Adolescent)
78.5% Male
21.5% Female
44.4% Hispanic or Latino
30.8% White
22.9% Black or African American
1% American Indian or Alaska Native
0.4% Asian
0.4% Race/ethnicity unspecified
Quality of Research Ratings by Criteria (0.0-4.0 scale)
Outcome
Reliability
of Measures
Validity
of Measures
Fidelity
Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Drug use
3.5
3.5
3.5
3.0
3.0
4.0
3.4
2: Treatment engagement
3.5
3.5
3.5
3.0
3.0
4.0
3.4
3: Treatment retention
3.5
3.5
3.5
3.0
3.0
4.0
3.4
4: Family functioning
3.5
3.5
3.5
3.0
3.0
4.0
3.4
Study Strengths
Study Weaknesses
Materials Reviewed
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5
3.5
2.6
3.2
Dissemination Strengths
Dissemination Weaknesses
Item Description
Cost
Required by Developer
Implementation, training, and quality assurance materials and resources
Contact developer for cost information
Yes