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.