Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA)
About This Program
Target Population: Youth 11-18 years of age and their family members of all ages (including siblings)
For children/adolescents ages: 11 – 18
For parents/caregivers of children ages: 11 – 18
CIFFTA is a 12–24-week outpatient treatment for adolescents 11 to 18 years old and their family/caregivers. CIFFTA incorporates content relevant to diverse adolescents (e.g., race, ethnicity, LGBTQ) and is designed to engage marginalized communities, reduce symptoms of behavioral and mental disorders and substance use, and to improve family functioning (e.g., increase parental involvement and cohesion and reduce conflict). CIFFTA uses an adaptive and flexible modular design to tailor treatment to unique clinical and cultural characteristics. CIFFTA includes individual adolescent treatment, family treatment, and psychoeducational components. Its Social Ecological and Human Development foundation means it focuses on 1) sharing information, building skills, and increasing motivation at the individual child level; 2) creating more adaptive and healthy interactions in the family; 3) empowering parents to work more effectively with school, health, welfare and juvenile justice systems; and 4) buffering destructive societal messages and forces. Materials are available in Spanish and English.
The goals of Culturally Informed and Flexible Family-Based Treatment for Adolescents are:
- Reduce substance use
- Reduce externalizing problems, conduct problems, and peer-based delinquency
- Reduce anxiety and depression
- Reduce conflict with family members
- Improve relationships with family members
- Improve communication with family
- Increase motivation to live healthy lives
- Engage and retain family members into family services
- Improve parenting practices
- Reduce family conflict
- Reduce culture-related stressors within the family
View the Logic Model for Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA).
The essential components of Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) include:
- Adolescent Therapy component works with one adolescent at a time and includes a focus on:
- Motivational Interviewing and Motivation Enhancement
- Setting of goals in multiple domains (Peer, Work, School, Family)
- Generalization of skills learning in psychoeducational modules (e.g., Emotion Regulation, Distress Tolerance)
- Coaching to increase success of interactions with peers, adults, and the family
- Monitoring of any harmful behaviors (e.g., substance use, self-harm/cutting, risky sexual behavior)
- Family Therapy component works with one family at a time and includes a focus on:
- Engagement of family members, especially those reluctant to enter treatment
- Increasing family motivation to enter treatment
- Instilling hope and validating distress/stressors
- Buffering race/ethnicity-related concerns or stressors
- Repairing ruptured relationships
- Reunification of separated family members
- Increasing protective, supportive, and caring interactions
- Reducing risky, conflictual, and harmful interactions
- Generalizing skills learning in psychoeducational modules (parenting, validation)
- Psychoeducational Module component can work with the adolescent, parents, or the family together and includes a focus on:
- Providing important information/knowledge to youth and parents (e.g., drug use risk, risky sexual behavior, depression, acculturation/immigration stressors, self-harm risk factors, juvenile justice system components, medication pros and cons
- Teaching skills to youth and parents (e.g., Emotion Regulation, Distress Tolerance, Interpersonal Effectiveness, Mindfulness, Parenting, Validation, Use of Diary Cards)
- CIFFTA parameters:
- Number of sessions per week: 1–2 depending on severity of presenting problems and family complexity
- Length of treatment: 3–6 months
- A mix of individual sessions with the youth and family sessions, some of which are therapy and some of which are psychoeducational
- Session with outside systems (e.g., health, school, juvenile justice, child welfare), as needed
- Use of specific modules (chosen from approximately 20) is based on the tailoring of the treatment to unique cultural and clinical needs
- Unique system for training, coaching and implementation support by an implementation group (Training and Implementation Associates International: TIA International)
- Fidelity tools are available for providers to self-report and for independent raters
Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) directly provides services to children/adolescents and addresses the following:
- Disruptive behaviors, substance abuse, depression, anxiety, lack of motivation, risky behaviors, including sexual behavior, concerns and stressors related to race/ethnicity, emotion dysregulation, juvenile justice system involvement.
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: As needed: Meet with juvenile justice, teachers and school counselors, healthcare providers, and specialty clinics (e.g., trauma).
Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) directly provides services to parents/caregivers and addresses the following:
- Parent/caregiver of an adolescent with disruptive behaviors, substance abuse, depression, anxiety, lack of motivation, or engaging in risk sexual behavior, deficient parenting practices, lacking knowledge of youth development and vulnerabilities, reluctance to engage, concerns and stressors related to race/ethnicity, immigration/acculturation stressors
One or two 50-minute session(s) per week depending on the severity of the presenting problem and the complexity of the family
3–6 months depending on the severity of the presenting problems and family complexity
This program is typically conducted in a(n):
- Birth Family Home
- Outpatient Clinic
- Community-based Agency / Organization / Provider
Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) includes a homework component:
Homework is not mandatory but at times we recommend the use of diary cards to be filled out between sessions to monitor triggers, urges to use substances or to self-harm, and at times we recommend viewing some of our psychoeducational videos from home.
Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) has materials available in a language other than English:
For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
Rooms large enough for family sessions, computers, Masters-level counselors.
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Masters-level counselors trained in Social Work, Counseling, Psychology, or related field.
There is a manual that describes how to deliver this program.
Santisteban, D. A., & Mena, M. P. (2021). Culturally Informed and Flexible Family Based Treatment for Adolescents (CIFFTA): A treatment manual.
There is training available for this program.
- Training and Implementation Associates International
phone: (305) 804-6070
Training and Implementation Associates International (TIA International) provides the online and in-person training, and implementation coaching. The first phase of training is done using an online adaptive training platform that includes simulated/animated clients. The platform provides knowledge, quizzes, and opportunities for practice of skills using simulation and animated families. In-person sessions are used for higher- level coaching and for organizational readiness work.
Number of days/hours:
Online training can vary depending on knowledge and skills of trainees. It can range from 15-20 hours.
Coaching can range from 20–50 total hours depending on skills and experience
There are pre-implementation materials to measure organizational or provider readiness for Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) as listed below:
TIA International has developed a set of instruments (which are all optional for organizations that wish to do agency readiness work) for directors, supervisors, and counselors that ask about interest in the new EBT, forces inside and outside the organization that support or hinder adoption of a new EBT, the fit of the EBT with client needs, the supervisor and "EBT champion" structures, etc. These tools allow us to increase readiness in the organization prior to training and coaching. All tools are available from our contact person. The Director version can be seen using this link: https://www.surveymonkey.com/r/MPCN7YR
Formal Support for Implementation
There is formal support available for implementation of Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) as listed below:
Training and Implementation Associates International (TIA International) was founded to facilitate training, implementation, coaching, fidelity, and organizational readiness work that will facilitate adoption and sustainment. TIA created an online CIFFTA training system to help with staff turnover training, adaptive coaching, and remote/virtual coaching systems. Implementation support is provided via a combination of site visits and tele-conferencing. The implementation support is available for one year and more can be added if needed.
There are fidelity measures for Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) as listed below:
There is a self-report version of the fidelity tool so that therapists can report on the CIFFTA interventions used in a session and there is a version that is designed for independent raters to rate audio/visual recorded therapy sessions. Each measure covers the core interventions/areas of focus of the CIFFTA via individual therapy, family therapy, and psychoeducational modules. These measures have been submitted and are also available through the program contact.
Implementation Guides or Manuals
There are no implementation guides or manuals for Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA).
There are no studies of the costs of Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA).
Research on How to Implement the Program
Research has been conducted on how to implement Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) as listed below:
Gattamorta, K., Mena, M. P., McCabe, B. E., & Santisteban, D. A. (2016). A latent profile analysis investigating factors impacting Hispanic adolescents' attendance in treatment. The Counseling Psychologist, 44(6), 871–894. https://doi.org/10.1177/0011000016642843
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Santisteban, D. A., Mena, M. P., & McCabe, B. E. (2011). Preliminary results for an adaptive family treatment for drug abuse in Hispanic youth. Journal of Family Psychology, 25(4), 610–614 https://doi.org/10.1037/a0024016
Type of Study:
Randomized controlled trial
Number of Participants: 28
- Age — 14–17 years old
- Race/Ethnicity — 100% Hispanic
- Gender — Not specified
- Status — Participants were referred by a local Juvenile Addictions Receiving Facility and by Department of Juvenile Justice Diversion programs.
Location/Institution: Not specified
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components of the Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA). Participants were randomized to either CIFFTA or to traditional family therapy (TFT). Measures utilized include the Revised Behavior Problems Checklist, the Youth Self-Report, and the Parenting Practices Questionnaire. Results indicate statistically significant time X treatment effects on both self-reported drug use (marijuana + cocaine), and adolescent reports of parenting practices. Both sets of analyses favored CIFFTA participants. There was a significant time X treatment effect, favoring CIFFTA on parent report of parenting practices using a composite that matched the variables used for adolescents, but only a nonsignificant trend, 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. Limitations include the small sample size; the add-on design that included more individual and psychoeducational sessions did not permit the investigators to rule out the possibility that more dosage alone was responsible for improvement; and length of follow-up.
Length of controlled postintervention follow-up: Approximately 4 months.
Santisteban, D. A., Czaja, S. J., Nair, S. N., Mena, M. P., & Tulloch, A. R. (2017). Computer informed and flexible family-based treatment for adolescents: A randomized clinical trial for at-risk racial/ethnic minority adolescents. Behavior Therapy, 48(4), 474–489. https://doi.org/10.1016/j.beth.2016.11.001
Type of Study:
Randomized controlled trial
Number of Participants: 80
- Age — Adolescents: 12–15 years old (Mean=13.6 years), Parent figure: Mean=42.2–44.8 years
- Race/Ethnicity — Adolescents: 64 Hispanic and 16 Non-Hispanic Black, Parent figure: 64 Hispanic and 6 Non-Hispanic Black
- Gender — Adolescents: 45 Male and 35 Female, Parent figure: 72 Female and 8 Male
- Status — Participants were families that reported at least two areas of behavioral or mental health problems
Location/Institution: Not specified.
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to develop and test the efficacy of a computer-assisted version of the Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA). Participants were randomized to either Immediate Computer-Assisted CIFFTA or Delayed Computer-Assisted CIFFTA. Measures utilized include the Revised Behavior Problems Checklist, the Youth Self-Report, the Diagnostic Interview Schedule for Children Predictive Scales (DPS), the Parenting Practices Questionnaire, and the Family Environment Scale (FES). Results indicate significant between-groups effects were found from baseline to posttreatment showing the superiority of the Immediate CA CIFFTA condition on both the conduct disorder and socialized aggression subscales of the Revised Behavior Problem Checklist, on the externalizing scale of the Youth Self-Report, and on both the parent and adolescent reports of the Family Environment Scale's family cohesion subscale. Baseline to 6-weeks posttreatment (T1-T3) analyses showed that these significant within-subjects effects were sustained for the treatment group. Limitations include small sample size; study utilized a no-treatment delay condition; study was delimited to Hispanic and Black non-Hispanic youth and may not generalize to adolescents and families from other racial and ethnic groups; and length of follow-up.
Length of controlled postintervention follow-up: 6 weeks.
Santisteban, D. A., & Mena, M. P. (2009). Culturally Informed and Flexible Family-Based Treatment for Adolescents: A tailored and integrative treatment for Hispanic youth. Family Process, 48(2), 253–268. https://doi.org/10.1111/j.1545-5300.2009.01280.x
Santisteban, D. A., Mena, M. P., & Abalo, C. (2013). Bridging diversity and family systems: Culturally informed and flexible family-based treatment for Hispanic adolescents. Couple and Family Psychology: Research and Practice, 2(4), 246–263. https://doi.org/10.1037/cfp0000013
Santisteban, D. A., Muir-Malcolm, J. A., Mitrani, V. B., & Szapocznik, J. (2002). Integrating the study of ethnic culture and family psychology intervention science. In H. A. Liddle, D. A. Santisteban, R. F. Levant, & J. H. Bray (Eds.), Family psychology: Science-based interventions (pp. 331–351). American Psychological Association. https://doi.org/10.1037/10438-016
- Daniel A. Santisteban, PhD
- Agency/Affiliation: TIA International
- Website: TIAInternational.org
- Email: danielsantisteban@TIAinternational.org
- Phone: (305) 804-6070
Date Research Evidence Last Reviewed by CEBC: July 2021
Date Program Content Last Reviewed by Program Staff: September 2021
Date Program Originally Loaded onto CEBC: September 2021