title: Randomized Trial of Family Therapy Versus Nonfamily Treatment for Adolescent Behavior Problems in Usual Care.
abstract: 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.
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hogue
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dauber
authors.affiliation: b Department of Psychology , Sam Houston State University.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Henderson
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Molly
authors.initials: M
authors.lastname: Bobek
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Candace
authors.initials: C
authors.lastname: Johnson
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Emily
authors.initials: E
authors.lastname: Lichvar
authors.affiliation: a The National Center on Addiction and Substance Abuse at Columbia University.
authors.forename: Jon
authors.initials: J
authors.lastname: Morgenstern
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D005196:Family Therapy; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome