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Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings. Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems. [ABSTRACT FROM AUTHOR]

This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50 % male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74 %), African American (11 %), multiracial (11 %), and other (4 %). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at 6-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures. [ABSTRACT FROM AUTHOR]

Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases ( n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT. [ABSTRACT FROM AUTHOR]

Summary: In France, the setting of the adolescent''s psychotherapy is mainly conceived on the bifocal model: the psychotherapy is divided in between two professionnals, each of them treating one aspect of reality: intern and extern. In this article, we explore an alternative model of treatment: the therapy of the adolescent with the help of his family. Our propositions are influenced by researches on family therapy evidence-based treatment and on our clinical experiences. [Copyright &y& Elsevier]

This study evaluates the usability and feasibility of a Web-based intervention (Web-MAP) to deliver cognitive behavioral therapy (CBT) to adolescents with chronic pain and their parents. Methods The Web site was evaluated in two stages. In stage one, recovered adolescents and parents (n = 5 dyads), who had completed office-based CBT through a pediatric pain management clinic, completed ratings of Web site content, usability, appearance, and theme. In stage two, treatment-seeking adolescents and their parents (n = 6 dyads) completed the full-length Web program. Program usage data were obtained to assess interaction with the Web site. Results Participants rated moderate to strong acceptability of the program. Usage data indicated that participants interacted with the site and used communication features. Conclusions Feedback from usability testing provided important information in the process of designing a feasible Web-based treatment for adolescents with chronic pain for use in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

The article focuses on a family mode deactivation therapy (MDT) in a residential setting for adolescents with conduct disorder and multi-axial diagnosis. It notes that the efficacy of MDT in treating a variety of adolescent disorders have been proven while case studies show that MDT family therapy has led to a reduction in family disharmony. It discusses a family MDT clinical study of 14 adolescents with problem behaviors in which the treatment as usual (TAU) group presented more incidents of problem behaviors as compared to the MDT group.

Increasing evidence indicates that adolescent behavior problems are related to family functioning. In general, findings have demonstrated the family’s critical role in facilitating developmental outcomes. This study evaluated a 6-week holistic program for at-risk teens and their parents entitled Creating a Responsible Thinker at baseline, post-test, and 3-month follow-up. Results demonstrated gender differences in the program’s effects on self-efficacy, specifically increased self-efficacy for females and reduced self-efficacy among males. Follow-up results suggested that teens reported better communication with their parents. These results underscore the appropriateness of a family-based approach to treatment for at-risk teens and their parents. [ABSTRACT FROM AUTHOR]

Interventions to reduce drug use in young people are often advocated on the basis of expert opinion or selective reviews of the scientific literature. The extent to which these views are fully supported by the scientific literature is unclear. The aim of this article is to indicate the types of secondary prevention interventions for young drug users that have been found to be effective by rigorous scientific inquiry. Some interventions are effective in reducing drug use and associated problems while others have no or mixed effect. Those successful in reducing drug use include behavior therapy, culturally sensitive counseling in residential settings, family therapy, Minnesota 12-step programs, residential care, and general drug treatment. Those with either no effect, or mixed effect, include schools interventions. Involving the family or tackling issues that are relevant to the family is of benefit across a range of interventions including, behavior therapy, family therapy, and those offered in schools. Indeed, family support is integral to the success of some programs. [ABSTRACT FROM AUTHOR]

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

A multiple-baseline across families design examined the effects of therapist exceptions questions on rates of blaming and positive statements in 4 families that were referred to a crisis intervention unit. Following an initial baseline period of standard behavioral family therapy, the therapist began responding to families' blaming statements by inquiring about exceptions to the problems and attending only to reports of positive adolescent behavior. This exceptions questions condition continued into the 1st segment of the 2nd therapy session, after which time the therapist returned to baseline behavioral family therapy. Results revealed that blaming statements decreased and positive statements increased during the exceptions questions condition but returned to baseline levels when the therapist ceased asking for exceptions. [ABSTRACT FROM AUTHOR]

The article focuses on families with adolescents. A case study of a fictitious character named Vince Chandler, a 13-year-old boy has been presented. Chandler had been referred to for the medical evaluation of problems related to school grades and behavior. The first reaction towards the case study of Chandler was that he was a normal adolescent, using healthy adaptation strategies with respect to his family and school. Early views about adolescence were plagued with the assumptions that the adolescent period should be filled with turmoil and familial conflict and be marked by diminished closeness to parents. This storm and stress perspective sparked a tremendous increase in the empirical research on adolescents, which eventually led to a change in the view of adolescent behavior in the family. Current research does not support the notion that adolescence is a tumultuous or troublesome period of development. Instead, it supports the view that adolescence is a period of change and adaptation and is successfully navigated with relatively little turmoil by most adolescents. It is true that adolescence is marked by an increase in familial conflict and a decrease in emotional attachment to parents.

The article discusses the author's experience of encountering a school phobic adolescent as a family psychotherapist in Menomonie, Wisconsin. The author was assigned as a key player in the plan of bringing back the 13-year-old boy to school. The hesitancy of the boy in was a result of many factors such as the separation of his parents, dependence on his mother and his dictatorial father. His mother has been also blamed for refusing to seek out assistance at the community mental health center.