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Objective: The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Methods: Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes. Results: Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Conclusions and Implications for Practice: Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. [ABSTRACT FROM AUTHOR]

A small randomized trial investigated a new family-based intervention for Hispanic adolescents who met DSM-IV criteria for substance abuse disorder. The Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components. The study used an "add on" design to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components. Twenty-eight Hispanic adolescents and their families were randomized either to the experimental treatment or to traditional family therapy (TFT) and were assessed at baseline and 8-month follow-up. Despite the small sample, results revealed statistically significant time x treatment effects on both self-reported drug use (marijuana + cocaine), F(1, 22) = 10.59, p < .01, η² = .33 and adolescent reports of parenting practices, F(1, 22) = 9.01, p < .01, η² = .29. Both sets of analyses favored CIFFTA participants. There was a significant time x treatment effect, F(1, 22) = 6.72, p = .02, η² = .23, favoring CIFFTA on parent report of parenting practices using a composite that matched the variables used for adolescents, but only a nonsignificant trend, F(1, 22) = 2.43, p =. 13, η² =. 10, with a composite that used all parenting subscales. Parent reports of adolescent behavior problems did not show a significant time or time x treatment effect. These results show the promise of this adaptive treatment for substance abuse in Hispanic adolescents and suggest the need for a larger randomized trial to fully investigate this treatment. [ABSTRACT FROM AUTHOR]

This article presents specialized family therapy intervention strategies for Hispanic families with behavior-problem adolescents who have experienced an immigration-related separation. Such specialized interventions correspond to a philosophy of customized treatment delivery for His- panic families. Interactional and cognitive/affective features are presented, and guidelines for building therapeutic alliances, identifying core family processes/themes, and transforming interactions are offered. [ABSTRACT FROM AUTHOR]

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample. [ABSTRACT FROM AUTHOR]

This study reports data on the efficacy of Strategic Structural Systems Engagement (SSSE), which is designed to bring hard-to-reach families into treatment. The study also explores variables that may contribute to differential effectiveness. Participants were 193 Hispanic families, who were randomly assigned to either experimental or control conditions. Several important findings emerged. First, the overall results replicated earlier findings showing the superiority of SSSE: 81% of SSSE families, compared to 60% of control families, were successfully engaged, X² (1, N =193] = 7.5, p < .001. Second, SSSE interventions were more successful with non-Cuban Hispanics (97% successfully engaged) than with Cuban Hispanics (64% successfully engaged), X² (1, N = 51 ) = 7.53, p = .006. Third, an analysis of intervention failures suggests a mechanism by which culture and ethnicity influence clinical processes (resistance to engagement) and may result in differential effectiveness. [ABSTRACT FROM AUTHOR]