RESUMO
Effective family-based interventions are needed for youth who are experiencing emotional and behavioral difficulties and who are impacted by powerful environmental stressors. Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a manualized and evidence-based, multicomponent family-based treatment that has been shown to be efficacious in research settings. The purpose of this paper is to report on the effectiveness of implementing CIFFTA for the treatment of Latino and Black youth and families in community settings. Utilization of services offered and changes in youth presenting problems and family functioning were used to evaluate the program. Two hundred thirty-two youth (11-18 years of age) and their caregivers were recruited over 2 years and CIFFTA was delivered by experienced masters-level family therapists over a 12-16-week period. Seventy-six percent met the 8-session criteria for retention in treatment and 71% completed treatment. Results showed significant improvements in youth behavioral and emotional presenting problems, reduction in family conflict and improvement in family cohesion and communication. Caregiver well-being such as reductions in parental stress, relational frustration, and improvement in parental confidence also showed significant improvement. Analyses of reliable change indices showed a substantial improvement in youth who entered the program in the clinical range of presenting problems. The findings point to CIFFTA's ability to retain youth and families who tend to underutilize needed services, to significant reductions in presenting problems, and to improvements in family functioning when implemented in a community setting.
Assuntos
Relações Familiares , Terapia Familiar , Pais , Adolescente , Humanos , Pais/psicologia , Criança , Negro ou Afro-Americano , Hispânico ou LatinoRESUMO
Rigorous randomized trials that test promising culturally centered treatments for Latino youth and families are needed. This study adds to the knowledge base by comparing the efficacy of Culturally Informed and Flexible Family Treatment for Adolescents (CIFFTA) to an Individually Oriented Treatment-As-Usual (ITAU) in its ability to retain Latino youth and families in treatment, reduce internalizing and externalizing child symptoms, and improve family functioning. CIFFTA uses an adaptive/flexible approach to deliver individual therapy, family therapy, and psycho-educational modules tailored to each family's unique clinical and cultural characteristics. Two hundred Latino adolescents 11-14 years of age completed a baseline assessment, were randomly assigned to CIFFTA or ITAU, then were assessed again after 16 weeks of intervention. Results show that CIFFTA had significantly higher retention (83%) than ITAU (71%), OR = 2.05, p = .036. Youth in both conditions showed significant reductions in youth and parent reported externalizing and internalizing behaviors, and there were no differences in change between conditions. Parents in CIFFTA reported significantly greater reductions in family conflict, d = 0.38, p = .025 than in ITAU. In CIFFTA, children of less acculturated Latino parents showed more improvement than the children of more acculturated parents. In ITAU, the reverse was true, children of more acculturated parents reported more improvement. This evidence of CIFFTA's impact on retention, family conflict, and differential effect depending on cultural values and behaviors, has important implications for the field of Latino psychology and family treatment.
Assuntos
Hispânico ou Latino , Pais , Adolescente , Criança , Conflito Familiar , Terapia Familiar/métodos , Humanos , Lactente , Pais/psicologia , PsicoterapiaRESUMO
In early adolescence, Hispanics self-report higher drug use rates compared to White and African American peers. Among adolescent users, heavy users have more negative behavioral and health consequences. The purpose of this cross-sectional study is to examine whether psychiatric symptoms, parental attachment, and reasons for use predict heavy alcohol and illicit drug use (more than 10 times in the past three months) among Hispanic adolescents. METHODS: This study examines baseline data from a study evaluating a family based substance abuse treatment program for Hispanic adolescents. Participants were 14-17 years old (N = 156, 44% female). Adolescent reports on the Diagnostic Interview Schedule for Children Predictive Scales measured psychiatric symptoms of major depressive disorder, attention deficit hyperactivity disorder, conduct disorder, and anxiety. The Personal Experiences Inventory measured type and amount of drug use, as well as perceived social and psychological benefits of drug use. The Inventory of Parent and Peer Attachment measured trust, communication, and alienation between adolescents and their mothers. Logistic regression identified correlates of heavy alcohol use and heavy illicit drug use among Hispanic adolescents. RESULTS: Higher social benefits were associated with increased likelihood of heavy alcohol use. Conduct disorder, higher levels of maternal attachment, lower levels of acculturation, and higher levels of psychological benefits of use were associated with an increased likelihood of heavy illicit drug use. CONCLUSION: These findings support the assumption that substance use treatment among Hispanic adolescents must be capable of addressing co-occurring psychiatric disorders, familial relationships, and the individual reasons/motivators to use.
Assuntos
Hispânico ou Latino/psicologia , Transtornos Mentais/complicações , Relações Pais-Filho , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adolescente , Alcoolismo/epidemiologia , Alcoolismo/etiologia , Alcoolismo/psicologia , Estudos Transversais , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
OBJECTIVE: The comorbidity of psychiatric disorders and substance abuse disorders among adolescents and adults is well-documented in the literature. The current study investigates the relationship between psychiatric and substance use disorders in a sample of treatment-seeking Hispanic adolescents. METHODS: The study uses baseline data (N = 190) from a randomized control trial testing the effectiveness of a family-based treatment for Hispanic adolescents with substance abuse disorder to examine the relationship between psychiatric disorders and substance use patterns at baseline, including types of substances used (both lifetime use and past-month use) and age at onset of substance use, controlling for age and gender. RESULTS: Linear regression models were used to examine predictors of age at onset, while logistic regression models examined predictors of lifetime substance use. Significant findings predicting age at onset for marijuana and alcohol are discussed. In addition, psychiatric profiles were differentially associated with lifetime use of sedatives, stimulants, and hallucinogens, but not alcohol or marijuana. CONCLUSIONS: Findings from this study can be used to help inform the treatment of adolescents seeking mental health and substance use services.
Assuntos
Hispânico ou Latino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Entrevista Psicológica , Modelos Lineares , Modelos Logísticos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
In this study, we examined data from 200 families to investigate whether family functioning and adolescent psychiatric symptomatology were associated with differential attendance in a family-based or individually focused intervention for Latino adolescents. Latent profile analysis was used to identify families, and regression models were used to examine whether profiles exhibited differential attendance. Overall, three latent profiles were observed. The first described families where parents and adolescents reported discrepancies on psychiatric symptoms and family conflict. The second profile described families with elevated adolescent psychiatric symptoms but no family conflict. The third profile described families with low family cohesion and high levels of adolescent psychiatric symptoms. For this third profile, attendance in family-based treatment was significantly higher than in individual treatment. Results indicate that a family-based intervention may be better able to address issues of poor family cohesion.
RESUMO
Prescription opioid use has grown rapidly, but few studies examined whether users have similar treatment responses as heroin users. Participants were 1,648 opioid users in Florida Access to Recovery (2004-2007). Participants engaged in methadone or buprenorphine maintenance had better retention than those in nonmaintenance treatment. Heroin only users (HO) had better engagement in nonmaintenance treatments and had worse retention than prescription opioid only users (PO). In methadone maintenance, PO were more likely to report opioid abstinence during treatment than heroin and prescription opioid users (H&P). Future research should focus on understanding and improving the treatment experience of opioid use subgroups.
Assuntos
Dependência de Heroína/psicologia , Adesão à Medicação/psicologia , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Medicamentos sob Prescrição/efeitos adversos , Adulto , Buprenorfina/uso terapêutico , Feminino , Dependência de Heroína/tratamento farmacológico , Humanos , Masculino , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pesquisa Qualitativa , Resultado do TratamentoRESUMO
Hispanic adolescents have been shown to have high prevalence of sexually transmitted infections and HIV, and substance abuse has been linked to risky sexual behaviors. The literature indicates that good parent-adolescent communication about sexual risk and safe sexual behaviors may help protect youth, yet little is known about this type of communication in Hispanic families. This article reports data on adolescent and parent factors associated with communication about moral and birth control talk between 108 Hispanic substance abusing adolescents and their parents. Results indicate that Hispanic parents who had older adolescents, reported more involvement, were less concerned of possible negative reactions from their child, and felt more knowledgeable and confident regarding sex and birth control also reported greater frequency of birth control talk. Hispanic parents with a daughter, who reported more involvement, or whose child reported more communication were more likely to report greater frequency of talking about moral issues.
RESUMO
Family interventions have been shown to be effective for adolescents with behavior problems. Current literature supports both adaptive treatments and technology-assisted interventions as highly promising innovations for treating at-risk adolescents. The purpose of this investigation was to develop and test the efficacy of a computer-assisted version of an established office-based multicomponent family therapy. Eighty Hispanic and Black Non-Hispanic adolescents and their families participated in the study and were randomized to either Immediate Computer-Assisted CIFFTA or Delayed Computer-Assisted CIFFTA. Significant between-groups effects were found from baseline to posttreatment showing the superiority of the Immediate CA CIFFTA condition on both the Conduct Disorder (B = -5.17, SE = 1.73, p < .01, CI [-8.55, -1.79]) and Socialized Aggression (B = -2.04, SE = .83, p < .05, CI [-3.67, -.41]) subscales of the Revised Behavior Problem Checklist, on the Youth Self Report Externalizing scale (B = -4.22, SE = 1.40, p < .01, CI [-6.95, -1.48]), and on both the parent (B = 1.34, SE = .50, p < .01, CI [.36, 2.32]) and adolescent (B = 1.31, SE = .46, p < .01, CI [.41, 2.21]) 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. Results highlight that adolescent behavior problems can be significantly impacted by a computer-assisted intervention that replaces psychoeducational face-to-face meetings with computer-delivered modules.
Assuntos
Terapia Comportamental/métodos , População Negra/psicologia , Terapia Familiar/métodos , Hispânico ou Latino/psicologia , Transtornos Mentais/etnologia , Grupos Minoritários/psicologia , Terapia Assistida por Computador , Adolescente , População Negra/estatística & dados numéricos , Criança , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/terapia , Grupos Minoritários/estatística & dados numéricos , Medição de Risco , Resultado do TratamentoRESUMO
Motivation is a prominent target for substance use interventions because it is theorized to increase engagement in therapy and predict treatment outcomes. Establishing the validity of measures relevant to motivation among Hispanic/Latino adolescents will improve the resources available for screening and measuring change processes in a multicultural population. We examined the structure of the Problem Recognition Questionnaire (PRQ; Cady, Winters, Jordan, Solberg, & Stinchfield, 1996) with Hispanic/Latino adolescents. Participants were adolescents (n=191) in a randomized controlled trial for substance abuse. Data were collected during a baseline pre-treatment time point and post-treatment time point that was four-months post-baseline. Confirmatory factor analysis (CFA) showed that the three-factor structure proposed by Cady et al. (1996) had a poor fit with pre-treatment data. Follow-up exploratory analyses with principal axis factoring identified an alternate three-factor structure with pre-treatment data (problem recognition, readiness, and treatment resistance). A second CFA showed this three-factor model fit data from participants at the post-treatment time point (n=155). The results provide preliminary evidence for using our proposed factor structure for the PRQ subscales with Hispanic/Latino adolescents. We discuss the dimensions we identified in the context of similar measures and the implications for measuring problem recognition, readiness, and treatment resistance.
Assuntos
Hispânico ou Latino/psicologia , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Psicometria/instrumentação , Transtornos Relacionados ao Uso de Substâncias/etnologia , Inquéritos e Questionários/normas , Adolescente , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ2 = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ2 = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.
RESUMO
OBJECTIVE: The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. METHODS: Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes. RESULTS: Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. (PsycINFO Database Record
Assuntos
Terapia Comportamental/métodos , Transtorno da Personalidade Borderline/reabilitação , Transtorno Depressivo/reabilitação , Terapia Familiar/métodos , Delinquência Juvenil , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do TratamentoRESUMO
There is growing interest in identifying interventions that have been tested and found efficacious with minority families. This interest is fueled in part by the growth of Hispanics in the U.S. as well as by research findings that suggest that Hispanics have better outcomes when treatments are adapted to their unique experiences, and risk and protective factors. Family-based treatments for culturally diverse populations require the integration of advances from both the cultural and family systems domains. Current intervention research has begun to move towards developing and advancing individualized interventions for patients/clients. Adaptive interventions, tailored interventions, adapted interventions, and targeted interventions have all been identified in the literature as appropriate for addressing distinct cultural characteristics which generic interventions may not address effectively. To date, research has focused less on tailored or adaptive interventions partly due to the fact that they require decision rules, more careful implementation, and measurement of individualized outcomes. In this article we present evidence for the usefulness of adaptive interventions that can address not only subgroup variability but within group variability as well. Culturally Informed and Flexible Family-Based Treatment for Adolescents is presented as an adaptive treatment that allows for the tailoring of treatment to the unique clinical and cultural variations of individual adolescents and families, but that does so in a systematic and replicable fashion. By building decision-making processes into the manualized treatment, the transportability of the treatment may be enhanced as family therapists appreciate it's flexibility to address the complexity of clinical work.
RESUMO
A small randomized trial investigated a new family-based intervention for Hispanic adolescents who met DSM-IV criteria for substance abuse disorder. The Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components. The study used an "add on" design to isolate the effects on substance abuse, behavior problems, and parenting practices attributable to the newly developed components. Twenty-eight Hispanic adolescents and their families were randomized either to the experimental treatment or to traditional family therapy (TFT) and were assessed at baseline and 8-month follow-up. Despite the small sample, results revealed statistically significant time × treatment effects on both self-reported drug use (marijuana + cocaine), F(1, 22) = 10.59, p < .01, η² = .33 and adolescent reports of parenting practices, F(1, 22) = 9.01, p < .01, η² = .29. Both sets of analyses favored CIFFTA participants. There was a significant time × treatment effect, F(1, 22) = 6.72, p = .02, η² = .23, favoring CIFFTA on parent report of parenting practices using a composite that matched the variables used for adolescents, but only a nonsignificant trend, F(1, 22) = 2.43, p = .13, η² = .10, with a composite that used all parenting subscales. Parent reports of adolescent behavior problems did not show a significant time or time × treatment effect. These results show the promise of this adaptive treatment for substance abuse in Hispanic adolescents and suggest the need for a larger randomized trial to fully investigate this treatment.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/reabilitação , Terapia Familiar/métodos , Abuso de Maconha/reabilitação , Relações Pais-Filho , Poder Familiar/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Análise de Variância , Transtornos Relacionados ao Uso de Cocaína/psicologia , Feminino , Hispânico ou Latino/psicologia , Humanos , Masculino , Abuso de Maconha/psicologia , Pais/psicologiaRESUMO
The increasing utilization of evidence-based treatments has highlighted the need for treatment development efforts that can craft interventions that are effective with Hispanic substance abusing youth and their families. The list of evidence-based treatments is extremely limited in its inclusion of interventions that are explicitly responsive to the unique characteristics and treatment needs of young Hispanics and that have been rigorously tested with this population. Some treatments that have been tested with Hispanics do not articulate the manner in which cultural characteristics and therapy processes interact. Other treatments have emphasized the important role of culture but have not been tested rigorously. The value of well designed interventions built upon an appreciation for unique patient characteristics was highlighted by Beutler et al. (1996) when they argued that "psychotherapy is comprised of a set of complex tasks, and practitioners need comprehensive knowledge of how different processes used in psychotherapy interact with patient characteristics in order to make treatment decisions that will maximize and optimize therapeutic power" (p. 30). A focus on how treatment processes interact with patient characteristics is particularly relevant in the Hispanic population because of the considerable heterogeneity beneath the Hispanic umbrella. Our new program of clinical research focuses on articulating how the varied profiles with regard to immigration stressors, acculturation processes, values clashes, sense of belonging to the community, discrimination, and knowledge about issues important to adolescent health can be more effectively addressed by a culturally informed treatment.
Assuntos
Aculturação , Prática Clínica Baseada em Evidências , Terapia Familiar/métodos , Hispânico ou Latino/psicologia , Relações Pais-Filho/etnologia , Adaptação Psicológica , Adolescente , Terapia Comportamental/métodos , Humanos , Pesquisa , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
With the growing acceptance of the borderline personality disorder diagnosis for adolescents has come a need for specialized treatments for this challenging population. Further, because of the prominence of the family system during early and later adolescence, family treatments are particularly needed. The purpose of this article is to present the integrative borderline adolescent family therapy (I-BAFT) model that emerged from a National Institute on Drug Abuse-funded (Stage 1) treatment development and enhancement effort. I-BAFT integrates (a) key interventions from the family treatment of adolescent drug abuse (D. A. Santisteban et al., 2003; J. Szapocznik & W. Kurtines, 1989), (b) skills training shown effective with adults with borderline personality disorder (M. Linehan, 1993a) and adapted for adolescents, and (c) individual treatment interventions that promote motivation for treatment and enhance the integration of the 3 treatment components.