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.

中文翻译：

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青少年行为健康问题家庭治疗的核心要素：社区环境中的有效性概括

摘要

客观的

针对青少年心理健康和药物滥用问题的家庭治疗的核心要素最初是从专家临床医生进行的高保真会议中提炼出来的，并在社区治疗师在常规环境中进行时进行了有效性泛化测试。

方法

该研究从参与三个治疗池之一的 161 例病例中抽取了记录的会话：功能家庭治疗的实施试验（98 次/50 例/22 名治疗师）、多系统治疗的适应试验（115 次/59 例/2 名治疗师），以及常规护理中非手动家庭治疗的自然主义试验（107 次会议/52 例/21 名治疗师）。青少年中男性占 60%，女性占 40%，平均年龄 15.4 岁；49% 是拉丁裔，27% 是非拉丁裔白人，15% 是非裔美国人，3% 是其他种族/民族，6% 是未知种族/民族。每个病例的会议录音 (n = 320) 都是随机选择的，并针对 21 种离散家庭治疗技术进行编码。收集了一年临床结果的存档数据。

结果

验证性因素分析复制了原始蒸馏研究的因素结构，保留了由所有 21 种技术组成的所有四个临床连贯治疗模块：交互变化（ICC = .77，Cronbach's α = .81）；关系重构（ICC = .75，α = .81）；青少年参与度（ICC = .72，α = .78）；关系强调（ICC = .76，α = .80）。探索性分析发现，更多地使用核心技术可以预测一种治疗池的症状改善。

结论

从青少年行为健康问题的手动治疗中提炼出来的家庭治疗的核心技术显示出强有力的有效性泛化证据，以及在社区环境中与客户结果联系的初步证据。