Selecting an Evidence-Based Change Strategy Document This document will include five major sections. Each section is detailed below: Also attached are documents needed to use and reference to complete
Selection of an Evidence-Based Change Strategy Document
Introduction
The Marquez family has recently relocated to the United States from Mexico in pursuit of
a better standard of living. Juan, the father, has obtained higher paying work here, but must also
put in long hours. His wife, Miranda, had little say in the decision to move and has struggled
with the transition. Their 15 year old twin daughters, Rosie and Rosita, have adapted quickly.
Their new social lives keep them out frequently and later than their parents approve of; they have also become defiant and rebellious. The combination of stressors has led to a negative home environment, a breakdown of communication and less time spent together as a family. This intervention will focus on addressing the issue of the twins’ behavior framed as parent adolescent conflict.
Literature Review of Possible Change Strategies
Description of Literature Search Tactics
Using google scholar, the search terms “parent adolescent conflict family therapy" and the
custom time range of 2004-2014 yielded 17,600 results. “Adolescent behavior family
intervention” for the same time range was also used and yielded 17,700 results. These search
terms were used to initiate the identification of interventions, and further references were
obtained by searching by their specific names.
Evaluation of the Evidence
List of Evidence-Based Change Strategies
The treatment modalities most commonly encountered when reviewing the search results are
listed below along with corresponding relevant articles for each modality.
Multidimensional Family Therapy:
Hogue, A., Dauber, S., Samuolis, J., & Liddle, H. A. (2006). Treatment techniques and
outcomes in multidimensional family therapy for adolescent behavior problems. Journal
of Family Psychology, 20(4), 535.
Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2005). Adolescent and parent
alliance and treatment outcome in multidimensional family therapy. Journal of
Consulting and Clinical Psychology, 73(4), 689.
Brief Strategic Family Therapy:
Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., ... & Loew, T.
(2005). 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.
Santisteban, D. A., Suarez‐Morales, L., Robbins, M. S., & Szapocznik, J. (2006). Brief
strategic family therapy: Lessons learned in efficacy research and challenges to blending
research and practice. Family Process, 45(2), 259-271.
Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S. J.,
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.
Triple-P Positive Parenting Program:
Nowak, C., & Heinrichs, N. (2008). A comprehensive meta-analysis of Triple P-Positive
Parenting Program using hierarchical linear modeling: Effectiveness and moderating
variables. Clinical Child and Family Psychology Review, 11(3), 114-144.
Ralph, A., & Sanders, M. R. (2004). The 'teen triple P' positive parenting program: A
preliminary Evaluation. Trends and issues in crime and criminal justice, (282), 1-6.
Familias Unidas:
Coatsworth, J. D., Pantin, H., & Szapocznik, J. (2002). Familias Unidas: A family-centered
ecodevelopmental intervention to reduce risk for problem behavior among Hispanic
adolescents. Clinical Child and Family Psychology Review, 5(2), 113-132.
Pantin, H., Coatsworth, J. D., Feaster, D. J., Newman, F. L., Briones, E., Prado, G.,
Schwartz, S. J., & Szapocznik, J. (2003). Familias Unidas: The efficacy of an
intervention to promote parental investment in Hispanic immigrant families. Prevention
Science, 4(3), 189-201.
Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., Sabillon, E.,
Brown, C.H., & Branchini, J. (2009). A randomized controlled trial of Familias Unidas
for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71(9), 987.
NREPP: SAMHSA’s Registry of Evidence-based Programs and Practices. (2014). Familias
Unidas Preventive Intervention. Retrieved from:
http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=85
Summary of the State of the Evidence
Multidimensional Family Therapy:
Multidimensional Family Therapy (MDFT) has been shown to be effective for adolescent
substance abuse and behavioral issues (Hogue, Dauber, Samoulis, & Liddle, 2006; Shelef,
Diamond, Diamond, & Liddle, 2005). Intervention domains addressing specific aspects of
adolescent and family issues are implemented simultaneously. Focusing on the interplay of
alliances formed between therapist and adolescent and therapist and family in MDFT, Shelef et
al. (2005) found that the strength of the adolescent and therapist connection predicted
improvements in long term substance use. Hogue et al. (2006) demonstrated that the use of
family focused techniques led to improvements in both family function and cohesion and
adolescent issues in the long term. These authors refer to and build upon a substantial backing of randomized control trials on this therapeutic modality. Overall, use of MDFT appears to be most strongly supported in cases of adolescent substance abuse but had also been demonstrated effective when applied to more general behavioral and family issues.
Brief Strategic Family Therapy:
Brief Strategic Family Therapy (BSFT) is supported by a significant body of evidence
and has been tested extensively with Hispanic samples and also applied to a variety of other
family backgrounds. (Santisteban, Suarez-Morales, Robbins, & Szapocznik, 2006). Unlike other
comparable therapies, assessment and diagnosis in BSFT is based solely on family structural
elements as opposed to the incorporation of broader systemic factors (Santisteban, SuarezMorales, Robbins, & Szapocznik, 2006).This modality has primarily been applied and
demonstrated effective for adolescent substance abuse and behavior problems, and has also been effectively engaged resistant family members (Santisteban et al., 2003; Santisteban, SuarezMorales, Robbins, & Szapocznik, 2006). It has also been demonstrated effective in other
applications such as modifying the behavior of girls who engage in bullying (Nickel et al, 2005).
Triple-P Positive Parenting Program:
The Triple-P Positive Parenting Program is an intervention aimed to address a wide range
in severity of child behavior problems within families (Nowak & Heinrichs, 2008) which has
also been modified for use with adolescents (Ralph & Sanders, 2004) as well as for application
to other specific populations and in various cultural contexts. Ralph & Sanders (2004) examined
application of Triple P to families with adolescents with the goal of preventing or reducing
criminal justice involvement. The intervention was delivered in a group format to families with
teens making the transition to high school, targeting a time of anticipated or actual conflict. The
meta-analysis by Nowak & Heinrichs (2008) concluded that Triple P is an effective and well studied intervention for improvement of child behavior and parenting abilities.
Familias Unidas:
Familias Unidas is a behavioral intervention designed to specifically address the
challenges unique to Hispanic immigrant families with adolescents. Coatsworth, Pantin, &
Szapocznik (2002) applied the intervention to Hispanic families with young adolescents (sixth
and seventh graders) and found decreased behavioral issues and improvements in parental
investment. The authors acknowledge that follow up as participants enter high school will be an
important test of the preventative potential of the intervention, as increased risks will enter the
equation at this point. Pantin et al. (2009) specifically extend the model to issues of substance
abuse, externalizing behavior, and risky sexual behavior and found reductions in all three in a
randomized controlled trial. However, the intervention was not shown to have a significant effect
upon academic achievement by Pantin et al. (2003). Because Familias Unidas is designed to be
culturally specific, it has apparently not been extended beyond the Hispanic adolescent
population for which it was created. However, Pantin et al. (2009) acknowledge that the
Hispanic population in the US is heterogeneous, and their sample was not entirely representative.
Justification for Selection of Change Strategy
Though larger bodies of evidence exist for other modalities, Familias Unidas is chosen as
the most appropriate intervention for the Marquez Family. The inclusion and consideration of
nuances and challenges of the immigrant family experience in this intervention provide a
compelling case for its relevance to the specific issues for which the family is seeking therapy.
Though Brief Strategic Family Therapy has also been demonstrated to be effective with Hispanic subjects with similar presenting concerns, the holistic nature of Familias Unidas makes it more suitable for the Marquez Family.
This modality is primarily parent-centered, but also incorporates involvement of the
adolescent children, which will ideally promote greater family cohesion and engagement in the
long run. Improvement to overall family functioning is an expected outcome of the Familias
Unidas. Though the intent is to address the goal of improving the twins’ behavior and
demonstration of respect for their parents, the intervention will also indirectly encourage
Miranda in accessing supports beyond the family and establishing herself in the US, as she will
have the opportunity to participate in the parent group.
Description of Selected Change Strategy
General Description of Selected Change Strategy
The Familias Unidas intervention was created specifically for Hispanic families with
adolescents (ages 12-17) who have recently immigrated to the United States (NREPP, 2014).
These families most typically reside in economically disadvantaged neighborhoods in large
urban areas, and experience difficulty with the process of acculturation in these relatively
resource-poor environments, compounding family issues in a time of transition (Coatsworth,
Pantin, & Szapocznik, 2002). Familias Unidas targets substance use, risky sexual behavior and
externalized behaviors such as violence, aggression or truancy (Pantin et al., 2009). Risk and
protective factors specific to this population are emphasized.
Parents are engaged in “multiparent groups” or “parent support networks (PSNs)” which
meet weekly. These groups are designed to harness the strengths of interdependence and
community characteristic of Hispanic culture, counter the isolation and marginalization families
may initially experience after moving to the US, and empower families to effectively access and
engage with resources. Additional supplementary aspects of the intervention include home visits, adolescent discussion and activity groups, and school meetings (Coatsworth, Pantin, &
Szapocznik, 2002).
Specific Description of the Details/Steps to Be Taken
My first course of action in implementing this intervention with the Marquez family
would be to become trained as a facilitator. The four phases of the process identified by
Coatsworth, Pantin, & Szapocznik (2002) are engagement, group formation, cognitive change
and skill building, and restructuring. The duration of the intervention used by Pantin et al. (2009)
was ten weeks. Initiation and engagement would involve recruiting ten to twelve other recent immigrant families with adolescent children in the community. Initial home visits occur during the
engagement phase. I would then need to conduct a parent support network/multiparent group,
which would meet weekly for two hour sessions. The cognitive change and skill building phase
involves considerable input from participants, de-emphasizing the facilitator’s authority. The
goal is to broaden understandings of the systems and domains within which the families and their children function. Action plans would be created for each family, which would then be carried out in the restructuring phase. This final phase would include the most involvement of the adolescent children (Coatsworth, Pantin, & Szapocznik, 2002) It is likely that Miranda would be a willing and enthusiastic participant, while Juan would not only have trouble making time to meet with the group weekly, but would likely be somewhat reluctant and skeptical of the process. The twins, particularly Rosita, would be likely to willingly participate assuming they were able to see the social benefit: i.e., that peers they were interested in socializing with were also involved.
Evaluation of Selected Change Strategy
Evaluating the efficacy of Familias Unidas in the case of the Marquez family would
require tracking their progress through the course of participation and at certain timepoints after
initiation or “baseline”. Studies of the intervention used timepoints of three, six, and twelve
months (Coatsworth, Pantin, & Szapocznik, 2002; Pantin et al., 2003), while the Pantin et al.
(2009) study also followed up at 18 and 30 months. Since the Marquez twins are 15 years old
and in their first year of high school, it would be ideal to track the family until they are in their
final year of high school; if this is not feasible, at least two years of follow up would provide a
solid picture of how effective the intervention was at modifying or preventing problem behavior.
Since home visits are an integral part of the Familias Unidas intervention process, they would
likely be used as an evaluation tool as well to supplement written or phone conversation based
Self-reporting.
Concerns of substance use did not enter the discussions in family sessions; however, Juan
explicitly expressed concern that his daughters would become pregnant. Statements in this vein
were related to the twins’ dress and the fact that they were spending time outside the home with
male peers. More broadly, Juan and Miranda described behavior changes in terms of “acting
out”, disobeying their parents’ rules and wishes, and conducting themselves in a disrespectful
manner. Evaluation would assess the presence or absence of these behaviors in a qualitative
manner, with conversations around parents’ perceptions of the evolution of these mannerisms
and actions during and after the intervention process. Observation on the part of the
therapist/facilitator would also be employed.