Szapocznik, J., Kurtines, W. M., Foote, F. H., Perez-Vidal, A., & Hervis. O. (1983). Conjoint versus one-person family therapy: Some evidence for the effectiveness of conducting family therapy through one person. Journal of Consulting and Clinical Psychology, 51, 889-899.

Type of Study: Randomized controlled trial
Number of Participants: 37 adolescents and their families

Population:

• Age range — 12-20 years
• Race/Ethnicity — Hispanic (84.4% Cuban American)
• Gender — 29 males, 8 females
• Status — Participants were obtained through court and community agency referrals, public service announcements, and self-referrals

Location / Institution: Spanish Family Guidance Center, University of Miami, FL

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compares the relative effectiveness of two treatments based on Brief Strategic Family Therapy (BSFT): One-person family therapy (OPFT) and conjoint family therapy (CFT). Both developed within the conceptual framework of BSFT, OPFT involves therapy with mainly one family member, whereas CFT involves the whole – or major subsystems of the – family. Participants were randomly assigned to either OPFT or CFT conditions. Measures included the Psychiatric Status Schedule (PSS), which assesses the adolescent’s psychiatric and psychosocial functioning and also includes a Drug Abuse Score, as well as the Behavior Problem Checklist (BPC), which assesses multiple dimensions of problem behavior, including conduct. For both treatment conditions, improvements from pre- to posttreatment were seen for all of the clinical-outcome measures, including the Drug Abuse Score on the PSS. However, OPFT had slightly more of an improvement in drug abuse levels than CFT, though the OPFT condition had slightly more severe pre-assessment drug abuse levels. Behavior problems at follow-up continued to improve for those in the OPFT condition, whereas those in CFT were worse at follow-up than at posttreatment assessment. Overall, both conditions were highly effective in improving family functioning, and OPFT was slightly more effective in reducing identified patient symptomology, including drug abuse. Notable limitations of the study include the lack of a no-treatment control condition, the homogeneity of the sample (all Hispanic), as well as small sample size.

Length of post-intervention follow-up: 6-12 months.

Szapocznik, J., Kurtines, W. M., Foote, F., Perez-Vidal, A., & Hervis, O. (1986). Conjoint versus one-person family therapy: Further evidence for the effectiveness of conducting family therapy through one person with drug-abusing adolescents. Journal of Consulting and Clinical Psychology, 54, 395-397.

Type of Study: Randomized controlled trial
Number of Participants: 35 adolescents and their families

Population:

• Age range — Mean age 14.7 years (SD = 7.3)
• Race/Ethnicity — Hispanic-American (77% Cuban American)
• Gender — Not Specified
• Status — Participants were obtained through court and community agency referrals, public service announcements, and self-referrals.

Location / Institution: Miami, FL/Spanish Family Guidance Center, University of Miami

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The data that was collected for this study was part of a second phase of the study described above (Szapocznik, Kurtines, Foote, et al., 1983). This study compares the relative effectiveness of two treatments based on Brief Strategic Family Therapy (BSFT): One-person family therapy (OPFT) and conjoint family therapy (CFT). Both developed within the conceptual framework of BSFT, OPFT involves therapy with mainly one family member, whereas CFT involves the whole – or major subsystems of the – family. Participants were randomly assigned to either OPFT or CFT conditions. Measures included the Psychiatric Status Schedule (PSS), which assesses the adolescents’ psychiatric and psychosocial functioning and also includes a Drug Abuse Score, as well as the Behavior Problem Checklist (BPC), which assesses multiple dimensions of problem behavior, including conduct. The results of the study showed OPFT to be as effective as CFT in both individual and family functioning and appeared to be somewhat better than CFT at sustaining improved functioning in the families at follow-up. On the PSS, which includes the Drug Abuse Score, termination scores were better than intake scores in both conditions. Notable limitations of the study include the lack of a no-treatment control condition, the homogeneity of the sample (all Hispanic), as well as small sample size.

Length of post-intervention follow-up: 6-12 months.

Szapocznik, J., Perez-Vidal, A., Brickman, A., Foote, F. H., Santisteban, D., Hervis, O. E. & Kurtines, W. M. (1988). Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology, 56(4), 552.

Type of Study: Randomized controlled trial
Number of Participants: 108

Population:

• Age range — 12-21 years
• Race/Ethnicity — All Hispanic (82% of Cuban origin)
• Gender — 67% males, 33% females
• Status — Participants included families of adolescents who were suspected of, or were observed, using drugs.

Location / Institution: Dade County, FL

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Using a two-group experimental design, this study randomly assigned subjects to either strategic structural-systems engagement (SSSE) or engagement as usual (EAU). SSSE was developed within the conceptual framework of Brief Strategic Family Therapy (BSFT) (Szapocznik, Kurtines, et al., 1983, 1986), which is a structural family-systems approach. This study tested the efficacy of the strategic structural systems engagement procedure for engaging hard-to-reach cases and bringing them to therapy completion. To assess the subject’s psychiatric and psychosocial functioning, the Psychiatric Status Schedule (PSS) was one of the measures used. Another measure used was the Client-Oriented Data Acquisition Process (CODAP), which requests information on drug use by type and frequency. Of all the cases that were initially assigned to either EAU or SSSE, 25% in the EAU condition and 77% in the SSSE condition were successfully terminated. A sustained higher level of engagement was found in the SSSE condition vs. the EAU condition. For example, over 57.7% of the families in the EAU condition failed to come to the center for intake, while only 7.1% of families in the SSSE condition were lost. Some limitations of the study were the lack of post-treatment follow-ups, the self-report nature of the CODAP, and the loss of one of the two therapists early in the study due to illness (the study finished with one therapist vs. the initial two).

Length of post-intervention follow-up: None.

Santisteban, D., Coatsworth, J., Perez-Vidal, A., Mitrani, V., Jean-Gilles, M., & Szapocznik, J. (1997). Brief structural/strategic family therapy with African and Hispanic high-risk youth. Journal of Community Psychology, 25(5), 453-471.

Type of Study: One-group pretest/posttest follow-up design
Number of Participants: 122

Population:

• Age range — 12-14 years
• Race/Ethnicity — 103 Hispanic, 19 African American
• Gender — 81 males, 41 females
• Status — Participants included African-American and Hispanic families with children 12-14 years of age, who were showing indications of either conduct problems at home, antisocial behavior with peers, or both.

Location / Institution: Dade County, FL/Center for Family Studies, University of Miami Dept. of Psychiatry and Behavioral Sciences

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Adolescents were assigned within a basic one-group pretest/posttest/follow-up design. Measures included the Revised Behavior Problem Checklist (RBPC), which assesses behavioral problems, the General Scale of the Family Assessment Measure, which assesses family functioning, and the Adolescent Drug Abuse Diagnosis (ADAD), a structured interview that assesses alcohol and drug use. Results showed that Brief Strategic Family Therapy (BSFT) as a prevention intervention was effective in significantly modifying both high-risk factors in that it reduced behavior problems and improved family functioning. In addition, both high-risk variables targeted were statistically significant predictors of substance use initiation nine months later. Finally, for the small subgroup of participants who entered the study having already initiated substance abuse, the BSFT intervention produced a significant decrease in the amount of use. Overall, BSFT resulted in significant improvements on conduct disorder and socialized aggression; in turn, lower levels of conduct disorder, less socialized aggression, and better family functioning each predicted lower rates of future initiation of substance use. BSFT was effective with both African American & Hispanic youth and families. One limitation of the study is the lack of a comparison group during the first four years of the project, as well as the relatively small sample on which the analyses regarding initiation of substance use are based.

Length of post-intervention follow-up: 9 months or less.

Coatsworth, J., Santisteban, D., McBride, C., & 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.

Type of Study: One-group pretest/posttest follow-up design
Number of Participants: 104 families

Population:

• Age range — 12-14 years
• Race/Ethnicity — 79 Hispanic families, 25 African American families
• Gender — 75% male, 25% female
• Status — Families that had an adolescent between the ages of 12-14 about whom the parents or referring school staff reported a presenting complaint that corresponded to one or more of the following criteria were included in the study: 1) externalizing problems (e.g., conduct/behavior problems), 2) internalizing problems (e.g., anxiety, depression), 3) significant academic problems, or 4) initiation of alcohol or drug use.

Location / Institution: Dade County, FL/Center for Family Studies

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study aimed to extend the body of research investigating the effectiveness of Brief Strategic Family Therapy (BSFT) to engage and retain families and/or youth in treatment. The sample reported in this article was part of a large-scale, two-phase demonstration study testing the efficacy of BSFT with high-risk minority youth (first-phase: see above summary of Santisteban, Coatsworth, Perez-Vidal et al., 1997). 104 families were randomly assigned to BSFT or a community comparison (CC) condition selected to represent the common engagement and treatment practices of the community. The Revised Behavior Problem Checklist (RBPC), an empirically derived measure consisting of 89 problem behaviors, was administered. Results indicated that the families assigned to BSFT had significantly higher rates of engagement (81% vs. 61%) and retention (71% vs. 42%) than those assigned to CC. A risk-ratio analysis revealed that families randomized into BSFT were 2.3 times more likely both to engage and to retain than families/participants randomized to CC condition. BSFT was also more effective than CC in retaining more severe cases, specifically cases with high levels of adolescent conduct disorder, and, despite the higher percentage of difficult-to-treat cases, achieved comparable treatment effects on behavior problems. A primary limitation of the study was that an intent-to-treat design was not able to be fully implemented. While the experimenters were able to complete termination assessments for 77% of the families that participated in either treatment, limited resources restricted the ability to track and assess families that did not engage into treatment. Also, the study lacked post-intervention data, aside from the two data points of the pre-post design.

Length of post-intervention follow-up: None.

Santisteban, D., Perez-Vidal, A., Coatsworth, J., Kurtines, W., Schwartz, S., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of Brief Strategic Family Therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121-133.

Type of Study: Randomized controlled trial
Number of Participants: 126 adolescents & their families

Population:

• Age range — 12-18 years
• Race/Ethnicity — Hispanic (various nationalities: Cuban, Nicaraguan, Colombian, Puerto Rican, Peruvian, Mexican, or Other)
• Gender — 75% male, 25% female
• Status — Participants were either self-referred or referred by a school counselor and met the primary inclusion criterion, namely parental or school complaints of externalizing behavior problems.

Location / Institution: Miami, FL/University of Miami

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Hispanic families with a behavior-problem adolescent were randomly assigned to 1 of 2 conditions: Brief Strategic Family Therapy (BSFT) or group treatment control (GC). Measures used include the Revised Behavior Problem Checklist (RBPC), which measures adolescent behavior problems; the Addiction Severity Index (ASI), which measures drug involvement; the Family Environment Scale (FES) and the Structural Family Systems Rating (SFSR), which both measure family functioning. 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. On all three presenting problems targeted in this study (i.e., conduct problems, peer-based delinquency, and self-reported drug use), BSFT was significantly more efficacious than the GC. For example, in the BSFT condition, 41% who had been using at intake were no longer using at termination of treatment, compared to 13% in the GC condition. Limitations of the study include the lack of follow-up assessments, that termination assessments were conducted only with cases that completed treatment, and that a substantial proportion of treatment completers did not have complete observational data (participants’ entire families had to be present at both intake and termination assessments for the participant to have complete observational data).

Length of post-intervention follow-up: None.

Robbins, M. , Szapocznik, J. , Horigian, V. , Feaster, D. , Puccinelli, M., Jacobs, P., … Brigham, G. (2009). Brief Strategic Family Therapy (tm) for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials, 30(3), 269-278.

Type of Study: Multi-site randomized trial
Number of Participants: 377

Population:

• Age range — 12-17 years
• Race/Ethnicity — 44% Hispanic/Latin, 30% White, 23% Black, 3% Other
• Gender — 78.5% Male, 21.5% Female
• Status — Participants were adolescents and their family members. Adolescents included in the study were those who used any illicit drug (other than alcohol and tobacco) in the 30-day period that preceded baseline assessment, or those referred to community agencies for the treatment of problems associated with drug use.

Location / Institution: Bayamón, Puerto Rico/Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA); Cincinnati, OH/The Crossroads Center; Denver, CO/Arapahoe House; Jacksonville, FL/Gateway Community Center; Miami, FL/The Village; Salisbury, NC/Daymark Recovery Services; Tarzana, CA/Tarzana Treatment Centers; and Tucson, AZ/La Frontera.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study builds on emerging research and represents the first examination of the effectiveness of Brief Strategic Family Therapy (BSFT) in real world settings. Adolescent/family participants were randomized to BSFT or treatment as usual (TAU) at eight community treatment agencies. This paper describes the following aspects of the study: specific aims, research design and study organization, assessment of primary and secondary outcomes, study treatments, data analysis plan, and data monitoring and safety reporting. The analyses and subsequent results have yet to be reported.

Length of post-intervention follow-up: 1- 9 months (3-4 month intervention; 4-,8-,12-month follow-ups post-randomization).

Feaster, D. J., Robbins, M. S., Henderson, C., Horigian, V., Puccinelli, M. J., Burlew, A. K., & Szapocznik, J. (2010). Equivalence of family functioning and externalizing behaviors in adolescent substance users of different race/ethnicity. Journal of Substance Abuse Treatment, 38(S1), S113-S124.

Type of Study: Randomized controlled trial
Number of Participants: 480

Population:

• Age range — 12-17 years
• Race/Ethnicity — 44% Hispanic/Latin, 30% White, 23% Black, 3% Other
• Gender — 78.5% Male, 21.5% Female
• Status — Participants were adolescents with problem substance use in the 30 days prior to screening and their family members.

Location / Institution: Eight outpatient community treatment programs across the United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: this study uses the same sample as Robbins, Szapocznik, Horigian et al, 2009 above. The study evaluated the effectiveness of Brief Strategic Family Therapy (BSFT) in reducing externalizing behaviors and drug use in adolescents and measured family functioning across racial/ethnic groups. Adolescents completed the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS), Youth Self-Report (YSR) of the Child Behavior Checklist, and Self-Report Delinquency Scale. Parents completed the Family Environmental Scale (FES) and Parenting Practices Questionnaire. Results indicated that Black families reported significantly lower externalizing and significantly higher family functioning than did Caucasian families regardless of reporter. Black adolescents also reported lower externalizing than Hispanic and Caucasian adolescents, and Black parents reported higher family functioning than Hispanic and Caucasian parents. The major study limitation was the possibility that Black youth with more severe symptoms may be systematically less likely to be given the opportunity to participate in research trials which may affect generalizability and statistical significance.

Length of post-intervention follow-up: Not Specified