Randomized Trial of Family Therapy Versus Nonfamily Treatment for Adolescent Behavior Problems in Usual Care
Randomized Trial of Family Therapy Versus Nonfamily Treatment for Adolescent Behavior Problems in Usual Care
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DOI：
10.1080/15374416.2014.963857
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发表时间：
2015-11-02
影响因子：
4.2
通讯作者：
Morgenstern, Jon
中科院分区：
文献类型：
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作者：
Hogue, Aaron;Dauber, Sarah;Morgenstern, Jon
实施科学的一个主要焦点是发现基于证据的方法是否可以在日常实践中保真和有效地提供。这项随机试验将常规护理家庭治疗 (UC-FT) 与非家庭治疗 (UC-其他) 进行比较，前者在没有治疗手册或外部支持的情况下作为社区诊所的标准护理方法实施，后者则针对青少年行为和物质使用障碍。该研究从社区转介网络招募了 205 名青少年（男性年龄=15.7 岁；52% 为男性；59% 为西班牙裔美国人，21% 为非洲裔美国人），其中 63% 的青少年患有主要的心理健康问题，37% 的青少年患有主要的药物滥用问题。客户被随机分配到 UC-FT 站点或五个 UC-Other 站点之一。实施数据证实 UC-FT 表现出对家庭治疗方法的坚持以及与 UC-Other 的区别。随访在基线后 3、6 和 12 个月完成。治疗出勤率没有组间差异。这两种情况都显示出外化、内化和犯罪症状的改善。然而，UC-FT 使整个样本中青少年报告的外化和内化、物质使用青少年的犯罪行为以及物质使用青少年的酒精和毒品使用有了更大的减少。 UC-FT 优于 UC-Other 的程度与手动家庭治疗模型对照试验的效果大小一致。在常规护理中，非手动家庭治疗可以有效解决不同人群中的青少年行为问题，并且可能优于非家庭治疗。
A major focus of implementation science is discovering whether evidence-based approaches can be delivered with fidelity and potency in routine practice. This randomized trial compared usual care family therapy (UC-FT), implemented without a treatment manual or extramural support as the standard-of-care approach in a community clinic, to nonfamily treatment (UC-Other) for adolescent conduct and substance use disorders. The study recruited 205 adolescents (M age=15.7 years; 52% male; 59% Hispanic American, 21% African American) from a community referral network, enrolling 63% for primary mental health problems and 37% for primary substance use problems. Clients were randomly assigned to either the UC-FT site or one of five UC-Other sites. Implementation data confirmed that UC-FT showed adherence to the family therapy approach and differentiation from UC-Other. Follow-ups were completed at 3, 6, and 12 months postbaseline. There was no between-group difference in treatment attendance. Both conditions demonstrated improvements in externalizing, internalizing, and delinquency symptoms. However, UC-FT produced greater reductions in youth-reported externalizing and internalizing among the whole sample, in delinquency among substance-using youth, and in alcohol and drug use among substance-using youth. The degree to which UC-FT outperformed UC-Other was consistent with effect sizes from controlled trials of manualized family therapy models. Nonmanualized family therapy can be effective for adolescent behavior problems within diverse populations in usual care, and it may be superior to nonfamily alternatives.