Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings

ABSTRACT

Objective

The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings.

Method

The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered.

Results

Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach’s α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool.

Conclusions

Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.

Acknowledgments

The authors acknowledge the dedicated work of the observational coders for this project (in addition to authors MB and NP): Gaby Aisenberg, Alison Bloomgarden, Fran Ferayorni, Genoveva Garcia, Cori Hammond, Naomi Krohner, Alexis Nager, Christopher Tapia, and Kenia Valentin. We also acknowledge the contributions of members of the Expert Review Panel to conceptualizing and interpreting study data: Sarah Berland, Guy Diamond, Genoveva Garcia, Olga Hervis, Suzanne Levy, Annie Niermann, Silvia Kaminsky, and Michael Robbins.

We thank our colleagues for providing session recordings and client data from their respective trials: Ashli Sheidow for the MST pool (R01DA025616) and Holly Waldron and Michael Robbins for the FFT pool (R01DA029406). A portion of these data was presented at the 2018 Addiction Health Services Research conference in Savannah, Georgia. We dedicate this study to our recently deceased colleague Charles W. Turner, whose research legacy shaped this work and inspires the field.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Preparation of this article was supported by the National Institute on Drug Abuse (R01DA037496; PI: Hogue).