Multiracial recruitment in the field of family therapy: an innovative training program for people of color

This article describes the creation of a training program designed to increase the number of family therapists of color in the family therapy field. In 1992, a partnership between New York City schools of social work, community agencies, and the Ackerman Institute for the Family created the Diversity and Social Work Training Program. Elements critical to the program's success were recruitment strategies, mentorships, partnerships with outside organizations, provision of a long-term institutional commitment, biracial collaborations, and institutional change. This article describes the design, structure, and process of this program's evolution and its impact 12 years later.     

Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention: An Integrative Family-Based Model for Drug-Involved Juvenile Offenders

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies ( http://www.cjdats.org ). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.     

Community Mobilization and Community-Based Participatory Research to Prevent Youth Violence Among Asian and Immigrant Populations

Many community mobilization activities for youth violence prevention involve the researchers assisting communities in identifying, adapting, and/or tailoring evidence-based programs to fit the community needs, population, and cultural and social contexts. This article describes a slightly different framework in which the collaborative research/evaluation project emerged from the community mobilization activities. As will be discussed, this collaborative, sustained partnership was possible in the context of the Center on Culture, Immigration and Youth Violence Prevention's (UC Berkeley ACE) community mobilization activities that brought the issue of youth violence, particularly among immigrant and minority populations, to the forefront of many of the community partners' agendas. The East Bay Asian Youth Center (EBAYC) was one of the partners that came to the table, which facilitated the community-based engagement/mobilization. UC Berkeley ACE collaborated with EBAYC to evaluate an after-school program and an alternative probation program serving a diverse youth and immigrant population, including African Americans, Asians, and Hispanics. This article describes UC Berkeley ACE's community mobilization activity and the collaborative partnership with EBAYC, discusses how the evaluations incorporated community-based principles in design and practice, and presents some findings from the evaluations.     

Family‐Based HIV and Sexually Transmitted Infection Risk Reduction for Drug‐Involved Young Offenders: 42‐Month Outcomes

This study tested a family‐based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug‐involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two‐site community‐based trial was conducted with 154 youth and their parents. Drug‐involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42‐month follow‐ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family‐based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42‐month follow‐up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9‐month follow‐ups. These intervention differences were evident through the 42‐month follow‐up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group‐based and family intervention in detention and following release may reduce sexual risk among substance‐involved young offenders, and a family‐based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.     

Recruiting and Retaining High-Risk Adolescents into Family-Based HIV Prevention Intervention Research

The purpose of this study was to examine the effectiveness of evidence-based recruitment and retention strategies for a longitudinal, family-based HIV prevention intervention study targeting adolescents in psychiatric care by (1) determining consent rate (recruitment), rate of participation at the first intervention session (retention), and follow-up attendance rate (retention); and (2) examining socio-demographic factors, family-level processes, sexual risk-related indices, and intervention factors (i.e., treatment arm) associated with study retention. Only one-third of the families contacted ultimately enrolled in the study. 81% of those enrolled participated in the workshop and 72% attended the booster sessions with no significant differences between families on any variable based on attendance. Retention over 1?year was 85% and did not differ by treatment arm. Strategies employed were successful at retaining families once they were enrolled. Findings highlight barriers to enrollment for adolescents in psychiatric care and suggest that it may be critical to integrate HIV prevention programs within community-based mental health services in order to counteract recruitment challenges.     

The Role of Families in Adolescent HIV Prevention: A Review

Recent research has highlighted the significant contribution families make in the prevention of HIV risk behaviors among adolescents. As the most proximal and fundamental social system influencing child development, families provide many of the factors that protect adolescents from engaging in sexual risk behaviors. Among these are positive family relations, effective communication about sexuality and safer sexual behaviors, enhancement and support of academic functioning, and monitoring of peer activities. HIV risk behaviors occur in a social context, and it is becoming clear that the earliest and most effective way to intervene is in the context where one initially learns about relationships and behavior—the family. Both the Centers for Disease Control and Prevention and the National Institute for Mental Health have taken steps to support and emphasize research that will further elucidate our understanding of the role of families in HIV prevention. This article uses Ecodevelopmental Theory to guide and organize the findings of this promising research area. Within this context, and with special attention to the comorbidity of adolescent problem behaviors, this article reviews empirical research on the role of families in HIV prevention, discusses current intervention efforts that involve families and ecosystems, and addresses prospects and implications for future research and interventions.     

The effects of HIV-related thought suppression on risk behavior: cognitive escape in men who have sex with men.

This study investigated the relationship between suppressing thoughts about HIV risk and several outcomes related to HIV risk, including sexual risk behavior and HIV prevention service use, in men who have sex with men (MSM). Synthesizing the ironic processing theory (D. M. Wegner, 1994) with a cognitive escape paradigm (D. J. McKiman, D. G. Ostrow, & B. Hope, 1996), it was hypothesized that thought suppression might increase risk by leading MSM to "escape" from sexual safety norms and engage in risky sex behaviors and, via a paradoxical process, increase future use of community prevention services. Results from a sample of MSM (N = 709) indicated that thought suppression was positively related to concurrent sexual risk behavior and to future use of prevention services.     

Diverse Phases of Collaboration: Working Together to Improve Community-Based HIV Interventions for Adolescents

Although alliances between community-based organizations (CBOs) and university-based evaluators provide opportunities to enhance community-based interventions, such partnerships may be fraught with challenges and obstacles. This paper focuses on the "story" behind a collaborative partnership between a Latino-focused CBO and a team of university-based evaluators that was formed to evaluate HIV prevention interventions for Mexican American female adolescents and gay/bisexual/questioning (GBQ) Latino male adolescents. A developmental trajectory of the partnership is detailed, with a focus on the creation and enhancement of a reciprocal and mutually beneficial relationship. In tracing this history, the paper explores challenges that were faced and presents ways in which the partnership attempted to overcome obstacles. Recommendations are offered to assist in the formation and maintenance of collaborative partnerships between CBOs and university-based evaluators/researchers.     

Why Parents Matter!: The Conceptual Basis for a Community-Based HIV Prevention Program for the Parents of African American Youth

The Parents Matter! Program (PMP) is a community-based family intervention designed to promote positive parenting and effective parent-child communication about sexuality and sexual risk reduction. Its ultimate goal is to reduce sexual risk behavior among adolescents. PMP offers parents instruction and guidance in general parenting skills related to decreased sexual risk behavior among youth (e.g., relationship building, monitoring) and sexual communication skills necessary for parents to effectively convey their values and expectations about sexual behavior—as well as critical HIV, STD, and pregnancy prevention messages—to their children. We briefly review the literature concerning parental influences on adolescent sexual risk behavior and present the conceptual model and theoretical foundation upon which PMP is based.     

Engaging high risk families in community based intervention services

Involving high risk families in community based intervention services constitutes a major challenge facing service delivery in the fields of mental health and substance abuse. Mental health and substance abuse programs typically experience high rates of failure to enroll families in services, as well as high rates of drop-outs from treatment. With family-based intervention programs, those involving all the members of the family or household participation by the entire family is a key to having a successful program. The NIDA funded Youth Support Project tests such a home and family based Family Empowerment Intervention in a randomized field trial which targets families of juvenile offenders. This intervention is delivered three times a week by paraprofessionals who are supervised by a licensed clinician. We discuss the guiding principles and success of our enrollment activities and discuss their implications for other family-based services.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.     

Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior Problems and Drug Abuse

This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.     

Therapist-Parent Interaction Patterns in Home-Based Treatments: Exploring Family Therapy Process

At the current stage of development in the family therapy field, exploratory, small-scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist-parent interactions within family-based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.     

Evaluation of an Air Force Child Physical Abuse Prevention Project Using the Reliable Change Index

Three hundred and seventy-nine parents at 25 Air Force bases participated in a collaborative child physical abuse prevention project designed by the United States Air Force Family Advocacy Program and Father Flanagan's Boys' Home (Boys Town). These participants were active duty or civilian employee parents and their spouses who completed the Boys Town Common Sense Parenting ® program as part of a comprehensive prevention effort. We hypothesized that participants would report decreased child behavior problems, improved relationships with family members, and reduced risk for child physical abuse after attending parenting sessions. Results supported this hypothesis. The data were also analyzed to determine the frequencies of individual parents who made statistically reliable changes on the dependent measures using Jacobson's Reliable Change Index. Nineteen to 30% of the participants reported significant improvement in the areas assessed. Parents who improved in abuse risk were at a higher level of risk and were less satisfied with family relationships prior to their participation than those who did not change. Implications for prevention of child physical abuse and future directions for research are discussed.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.