DEVELOPING A CULTURALLY ROOTED ADOLESCENT FAMILY THERAPY

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DESCRIPTION: (Applicant's Abstract) This application proposes to conduct a Stage I treatment development study that targets Hispanic drug abusing adolescents and their families, who have unique values and acculturation/ immigration related life experiences that can be shown to directly impact engagement, retention, drug use, and the efficacy/effectiveness of drug treatment. Although the importance of culture related factors have been generally acknowledged, treatment models have failed to link specific culturally derived interventions to specific treatment change mechanisms central to drug abuse treatment. The proposed model, Culturally Rooted Adolescent Family Therapy (CRAFT), will include psycho-educational modules that directly address these culture related factors and are designed to enhance treatment alliance and facilitate the work of family therapy change mechanisms. The proposed model is divided into three AIMs each designed to produce findings that inform the subsequent AIM's work. AIM I consists of a basic research study that investigates the independent contribution of specific immigration and acculturation-related stressors in disrupting family therapy mechanism of change. AIM II consist of: 1) the development of a "working" CRAFT manual, 2) a set of single-case experiments designed to enhance the impact on family change mechanism and CRAFT's feasibility/acceptability, 3) the manualization of the refined CRAFT model, and 4) the development of an adherence checklist and therapist selection and training guidelines. AIM III focuses on pilot testing the efficacy of the manualized intervention using a small randomized trial design in which subjects are randomized to either CRAFT or Family Therapy as Usual. AIM I analyses of the basic research study and the AIM II single-case experiments series are intended to provide data that will inform the refinements of the CRAFT intervention. AIM III analyses of the randomized trial are designed to determine effect sizes for the analyses that would be required in a Stage II efficacy trial, viz., HLM on outcomes (drug abuse and other delinquency problems); HLM analyses of postulated change mechanisms (parent practices, parent-adolescent attachment, parent-ecology interactions, and therapeutic alliance). Moreover, analyses of clinical significance will be used to identify subgroups for whom the interventions work best, and growth curve analyses using Hierarchical Linear Modeling, will be used to compare the trajectory of change in mechanisms of action between successful and unsuccessful cases.