Quality of Research
Documents Reviewed
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.
Study 1Santisteban, D. A., Szapocznik, J., 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, 35-44. Study 2Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S., LaPerriere, A., et al. (2003). The efficacy of Brief Strategic Family Therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121-133.  Study 3Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Mitrani, V., Jean-Gilles, M., & Szapocznik, J. (1997). Brief Structural/Strategic Family Therapy with African American and Hispanic high-risk youth. Journal of Community Psychology, 25(5), 453-471. Study 4Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313-332. Study 5Szapocznik, J., Rio, A., Murray, E., Cohen, R., Scopetta, M., Rivas-Vazquez, A., et al. (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Journal of Consulting and Clinical Psychology, 57(5), 571-578. Study 6Szapocznik, J., Perez-Vidal, A., Brickman, A. L., Foote, F. H., Santisteban, D., Hervis, O. E., et al. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Counseling and Clinical Psychology, 56(4), 552-557. Study 7Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., et al. (2006). Bullying girls--Changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy and Psychosomatics, 75(1), 47-55.
Outcomes
| Outcome 1: Engagement in therapy |
|
Description of Measures
|
Engagement was defined as attendance by the adolescent and at least one adult family member at the intake session and one therapy session within a 4-week period following initial contact.
|
|
Key Findings
|
In one study, families who received BSFT were significantly more engaged in therapy than families in the comparison groups, who received standard family therapy or standard group therapy (p < .006). Two other studies resulted in similar findings, with families receiving BSFT being significantly more engaged in therapy than control families receiving individual and family therapy (p < .05) and control families receiving standard family therapy (p < .0001), respectively.
|
|
Studies Measuring Outcome
|
Study 1, Study 4, Study 6
|
|
Study Designs
|
Experimental
|
|
Quality of Research Rating
|
3.4
(0.0-4.0 scale)
|
| Outcome 2: Conduct problems |
|
Description of Measures
|
Conduct problems were measured using the Conduct Disorder subscale of the Revised Behavior Problem Checklist (RBPC). The subscale consists of 22 items that focus on physical aggression, difficulty controlling anger, open disobedience, defiance, and oppositionality. For each adolescent, an informed observer, such as a parent or guardian, rated the severity of each behavior on a 3-point scale (0 = no problem, 1 = mild problem, 2 = severe problem).
|
|
Key Findings
|
In one study, adolescents who participated in BSFT showed a significantly greater reduction in conduct problems than adolescents in the comparison condition, who received a participatory-learning group intervention (p < .01). In another study, adolescents receiving BSFT showed a significant reduction in conduct problems (p < .001).
|
|
Studies Measuring Outcome
|
Study 2, Study 3
|
|
Study Designs
|
Experimental, Preexperimental
|
|
Quality of Research Rating
|
3.4
(0.0-4.0 scale)
|
| Outcome 3: Socialized aggression (delinquency in the company of peers) |
|
Description of Measures
|
The Socialized Aggression subscale of the RBPC was used to assess adolescents' delinquent behaviors in the company of peers. The subscale consists of 17 items that focus on conduct-disordered behaviors in the company of others, including substance use, truancy from school, gang membership, stealing, and lying. For each adolescent, an informed observer, such as a parent or guardian, rated the severity of each behavior on a 3-point scale (0 = no problem, 1 = mild problem, 2 = severe problem).
|
|
Key Findings
|
In one study, adolescents who participated in BSFT showed a significantly greater reduction in socialized aggression than adolescents in the comparison condition, who received a participatory-learning group intervention (p < .01). In another study, adolescents receiving BSFT showed a significant reduction in socialized aggression (p < .001).
|
|
Studies Measuring Outcome
|
Study 2, Study 3
|
|
Study Designs
|
Experimental, Preexperimental
|
|
Quality of Research Rating
|
3.4
(0.0-4.0 scale)
|
| Outcome 4: Substance use |
|
Description of Measures
|
Alcohol and other drug use was measured using the following instruments:
- Items from the Addiction Severity Index (ASI) measuring the number of days respondents used various drugs during the month prior to assessment
- The Alcohol and Drug Use scale of the Adolescent Drug Abuse Diagnosis (ADAD), a 150-item structured interview instrument with a 10-point severity rating for each of nine life problem areas
- The Drug Use subscale of the Adolescents' Risk-taking Behavior Scale (ARBS), with scores ranging from 0 to 4 on each scale, 4 indicating the most marked risk-taking behavior
|
|
Key Findings
|
In one study, adolescents who participated in BSFT showed significantly greater reductions in marijuana use than adolescents in the comparison group, who received a participatory-learning group intervention (p < .05). In another study, adolescents receiving BSFT showed a significant reduction in overall substance use (p < .05). In a third study, adolescent girls who participated in BSFT showed significantly greater reductions in substance use at posttest (p < .001) and at the 1-year follow-up (p < .05) than adolescent girls in the comparison group, who received an intervention consisting of structural, detailed question sessions.
|
|
Studies Measuring Outcome
|
Study 2, Study 3, Study 7
|
|
Study Designs
|
Experimental, Preexperimental
|
|
Quality of Research Rating
|
3.0
(0.0-4.0 scale)
|
| Outcome 5: Family functioning |
|
Description of Measures
|
Family functioning was measured using the following instruments:
- The adolescent- and parent-reported Cohesion and Conflict scales from the Family Environment Scale (FES). The Cohesion scale measures the extent to which the adolescent and parent view the family as harmonious and close. The Conflict scale measures the extent to which the adolescent and parent view the family as characterized by frequency of quarrels and disagreements.
- The General Scale of the Family Assessment Measure, which consists of 50 items focusing on the family as a system and provides an overall score of family functioning, rated by any member of the family.
- The Structural Family Systems Rating (SFSR), a measure of family interactions as reported by an observer (i.e., a clinical psychologist or other trained staff). It consists of five scales: structure (the family's organizational system and flow of communication), resonance (closeness, distance, and boundaries between family members), developmental stage (age appropriateness of family members' behaviors), identified patienthood (the extent to which a family member, usually the adolescent, is labeled as the family's "problem"), and conflict resolution (the extent to which the family is able to resolve differences of opinion).
|
|
Key Findings
|
In one study, adolescents who participated in BSFT reported significantly better family functioning on the FES Cohesion scale than adolescents in the comparison group, who received a participatory-learning group intervention (p < .05). Families in the BSFT group also showed significantly greater improvement on overall SFSR scores than families in the comparison group (p < .05).
In another study, reports by both parents and adolescents who received BSFT showed significant improvements in family functioning on the General Scale of the Family Assessment Measure (p < .001 for both parents and adolescents). The effect sizes were medium for the parent report (Cohen's d = 0.58) and small for the adolescent report (Cohen's d = 0.42).
In a third study, families receiving BSFT demonstrated significantly better family functioning on the SFSR at the 1-year follow-up than families assigned to either an individual psychodynamic child therapy group or a recreational control condition (p < .02).
|
|
Studies Measuring Outcome
|
Study 2, Study 3, Study 5
|
|
Study Designs
|
Experimental, Preexperimental
|
|
Quality of Research Rating
|
3.2
(0.0-4.0 scale)
|
Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
|
Study
|
Age
|
Gender
|
Race/Ethnicity
|
|
Study 1
|
6-12 (Childhood)
13-17 (Adolescent)
|
70% Male
30% Female
|
100% Hispanic or Latino
|
|
Study 2
|
6-12 (Childhood)
13-17 (Adolescent)
|
75% Male
25% Female
|
100% Hispanic or Latino
|
|
Study 3
|
6-12 (Childhood)
13-17 (Adolescent)
|
66.4% Male
33.6% Female
|
84.4% Hispanic or Latino
15.6% Black or African American
|
|
Study 4
|
6-12 (Childhood)
13-17 (Adolescent)
|
75% Male
25% Female
|
76% Hispanic or Latino
24% Black or African American
|
|
Study 5
|
6-12 (Childhood)
|
100% Male
|
100% Hispanic or Latino
|
|
Study 6
|
6-12 (Childhood)
13-17 (Adolescent)
|
67% Male
33% Female
|
100% Hispanic or Latino
|
|
Study 7
|
13-17 (Adolescent)
|
100% Female
|
Data not reported/available
|
Quality of Research Ratings by Criteria (0.0-4.0 scale)
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.
|
Outcome
|
Reliability
of Measures
|
Validity
of Measures
|
Fidelity
|
Missing
Data/Attrition
|
Confounding
Variables
|
Data
Analysis
|
Overall
Rating
|
|
1: Engagement in therapy
|
3.5
|
3.5
|
3.5
|
3.5
|
3.0
|
3.5
|
3.4
|
|
2: Conduct problems
|
4.0
|
3.8
|
3.3
|
2.8
|
2.8
|
3.8
|
3.4
|
|
3: Socialized aggression (delinquency in the company of peers)
|
4.0
|
3.8
|
3.3
|
2.8
|
2.8
|
3.8
|
3.4
|
|
4: Substance use
|
3.3
|
2.8
|
3.0
|
3.3
|
2.5
|
3.4
|
3.0
|
|
5: Family functioning
|
3.5
|
3.5
|
3.3
|
2.8
|
2.5
|
3.5
|
3.2
|
Study Strengths Most of the studies were well designed and involved random assignment of subjects to the study conditions. Attrition was minimal, and there were few compelling confounding variables that could reasonably account for the overall positive pattern of findings. For most of the studies, the investigators sufficiently addressed the psychometric properties of the measures, the analyses, and the study limitations.
Study Weaknesses Results might have been more compelling if the authors had used an intent-to-treat model and more sophisticated methods to document engagement strategies. One of the studies used a weak design. Another study did not provide enough detail regarding the psychometric properties of the instruments or the fidelity of implementation.
|
|
Readiness for Dissemination
Materials Reviewed
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.
BSFT for Adolescents--Adherence Form (ADH), Version 2.15
BSFT for Adolescents--Clinical Supervision Checklist (CSC), Version 2.15
BSFT for Adolescents--Overall Supervision Evaluation Checklist (OSC), Version 2.15
BSFT for Adolescents--Videotape Certification Rating Checklist (VRC), Version 2.15
Robbins, M. S., Perez, G. A., Hervis, O., & Santisteban, D. (n.d.). Overall supervision evaluation checklist: Procedure and rating manual. Miami, FL: University of Miami Center for Family Studies.
Robbins, M. S., Perez, G. A., Hervis, O., & Santisteban, D. (n.d.). Weekly clinical supervision checklist: Procedure and rating manual. Miami, FL: University of Miami Center for Family Studies.
Robbins, M. S., Perez, G. A., Mayorga, C. C., Hervis, O., & Santisteban, D. (n.d.). BSFT adherence checklist: Procedures and rating manual. Miami, FL: University of Miami Center for Family Studies.
Robbins, M. S., Perez, G. A., Mayorga, C. C., Hervis, O., & Santisteban, D. (n.d.). Videotape certification rating checklist: Procedure and rating manual. Miami, FL: University of Miami Center for Family Studies.
Szapocznik, J., & Hervis, O. E. (2004). Brief Strategic Family Therapy training manual. Miami, FL: University of Miami Center for Family Studies.
Szapocznik, J., Hervis, O. E., & Schwartz, S. (2003). Brief Strategic Family Therapy for adolescent drug abuse (NIDA Therapy Manuals for Drug Addiction, Manual 5, NIH Publication No. 03-4751). Rockville, MD: National Institute on Drug Abuse.
University of Miami Center for Family Studies. (2004). Brief Strategic Family Therapy: An empirically validated therapy [PowerPoint slides]. Miami, FL: Author.
University of Miami Center for Family Studies. (2004). BSFT curriculum. Miami, FL: Author.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
|
Training and Support
Resources
|
Quality Assurance
Procedures
|
Overall
Rating
|
|
3.3
|
3.0
|
3.5
|
3.3
|
Dissemination Strengths The clinical manual presents a clear theoretical and conceptual base for understanding the clinical components and sequencing of intervention phases. Guidance is provided for using the intervention with diverse and complex family systems. A detailed training curriculum is provided and is supplemented by ongoing weekly clinical supervision to support implementation. Four highly detailed instruments with manuals are available to document clinician competency.
Dissemination Weaknesses The intensive supervision and clinical consultation components necessitate additional guidance for assessing and bolstering organizational readiness for implementation. The required level and sequence of training is unclear. The training manual is very dense, and its content and sequencing do not clearly correspond with training slides. It is unclear who administers some quality assurance instruments. No guidance is provided to implementers for clinical outcomes measurement.
|
|
