Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments
Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments
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DOI：
10.1080/15374416.2018.1555762
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Southam-Gerow, Michael A.
中科院分区：
文献类型：
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作者：
Hogue, Aaron;Bobek, Molly;Southam-Gerow, Michael A.
家庭治疗在治疗青少年行为和药物使用问题方面具有最有力的证据基础，然而，在社区环境中广泛采用这种方法仍然存在实质性障碍。本研究旨在通过实证提炼三种手工治疗的核心实践要素，促进家庭干预在常规护理中实施的可行性。该研究从196例患者中选取了302个高保真治疗疗程，这些患者被纳入了3种手动家庭治疗模式中的一种：多维家庭治疗（102次/56例）、简短战略家庭治疗（100次/94例）或功能家庭治疗（100次/46例）。青少年中男性占57%；41%为非洲裔美国人，31%为非西班牙裔白人，9%为西班牙裔美国人，6%为其他种族/民族，13%为未知。所有三个模型的观察保真度测量被用于编码所有302个会话。通过对一半样本进行探索性因素分析，分析保真度评级以获得模型共享处理技术；然后通过验证性因素分析对衍生因素进行验证，并对其余一半进行贝叶斯结构方程建模。因子分析提炼出4个具有较强内部一致性的临床连贯实践要素：交互性改变（6项治疗技术，Cronbach’s alpha = 0.93）、关系重构（7项技术，alpha = 0.79）、青少年参与（4项技术，alpha = 0.68）和关系强调（4项技术，alpha = 0.67）。这4个经验推导的因素代表了3种针对青少年行为问题的手动家庭治疗模式的核心要素，为在常规实践环境中提供基于证据的家庭干预奠定了更可持续的选择基础。公共卫生意义：增加以家庭为基础的高保真干预措施的实施，将提高针对青少年行为和药物使用问题的治疗服务质量。
Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's alpha = .93), Relational Reframe (7 techniques; alpha = .79), Adolescent Engagement (4 techniques; alpha = .68), and Relational Emphasis (4 techniques; alpha = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings. Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems.