Negative effects on family functioning from psychosocial treatments: A recommendation for expanded safety monitoring.

Whereas biomedical products are required to be tested for safety with respect to vulnerable organ systems, psychosocial treatments are not required to be tested for safety with respect to vulnerable social systems such as the family. This article provides some evidence for the need to document the potential negative effects of psychosocial treatments on family-level outcomes. Three randomized controlled trials are reviewed in which independent ratings or self-reports of family functioning were measured. Each of the 3 studies compared the efficacy of a family and a nonfamily treatment. Totally unexpectedly, the nonfamily treatment in each of the 3 trials demonstrated significant declines in family functioning. The authors suggest that psychosocial treatments with vulnerable populations have the potential to produce negative side effects on families. Therefore, it is important to conduct further research to determine whether safety studies should be required for psychosocial treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of Cuban and Anglo-American cultural values in a clinical population.

Attempted to replicate an earlier study investigating cultural differences between Cuban immigrants and Anglo-Americans. Whereas the earlier study used a nonclinical adolescent population, the current study used 52 adults in outpatient treatment. Ss were given a biographical questionnaire and the Value Orientation scales. Results indicate that the groups differed in relational, temporal, and person–nature orientations, confirming previous findings and clinical observations. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the concept of acculturation: Implications for theory and research.

This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the “immigrant paradox,” whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural family versus psychodynamic child therapy for problematic Hispanic boys.

Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concordance among biological, interview, and self-report measures of drug use among African American and Hispanic adolescents referred for drug abuse treatment.

This study examined the concordance among urine assays, interview measures, and self-report measures of marijuana and cocaine use among 190 drug-abusing/dependent African American and Hispanic adolescents and their families at 3 assessment points of an 18-month randomized clinical trial study. Results demonstrated concordance among urine assays, a calendar method self-report measure (Timeline Follow Back [TLFB]), and a noncalendar method self-report measure (Adolescent Drug Abuse Diagnosis Scale). Diagnostic criteria of marijuana and cocaine abuse/dependence from a clinical structured interview (Diagnostic Interview Schedule for Children [DISC]) also converged, albeit weakly, with self-report measures. Adolescent and parent reports on DISC marijuana abuse/dependence diagnostic criteria were related; however, collateral findings for DISC cocaine abuse/dependence diagnostic criteria were equivocal. Differences in concordance among biological and self-report cocaine use measures were found for baseline TLFB assessments among African American participants. Implications for future use and refinement of adolescent drug use assessments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conjoint versus one-person family therapy: Some evidence for the effectiveness of conducting family therapy through one person.

Hypothesized that it would be possible to achieve the goals of family therapy (structural family change and symptom reduction) by working primarily with 1 family member. 37 Hispanic families with a drug-using member were assigned to conjoint or 1-person therapy. Data were analyzed using a mixed-design (repeated measures plus a between-group independent variable) ANOVA, with treatment as the between-group independent variable and time of assessment (intake, termination, and follow-up) as the repeated measure. Results indicate that both conditions were highly effective in improving family functioning and that 1-person family therapy was slightly more effective in reducing identified patient symptomatology. Clinical and practical issues and implications for the current theory and practice of family therapy are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of structural ecosystems therapy with drug-abusing/dependent African American and Hispanic American adolescents.

Many family therapies for adolescent drug use include ecological interventions. The purpose of this randomized clinical trial was to establish whether ecological interventions contribute to the impact of family therapy above and beyond the contributions of family process-only interventions. A family-based ecological approach, structural ecosystems therapy (SET), was compared with family process-only condition (FAM) and community services control (CS). One hundred ninety substance-abusing or dependent African American and Hispanic adolescents were randomized to SET, FAM, or CS. Follow-up assessments were conducted at 3, 6, 12, and 18 months postrandomization. SET was significantly more efficacious than FAM and CS in reducing adolescent drug use. However, these improvements were limited to Hispanic adolescents. The study demonstrates the importance of investigating changes in adolescent drug use as a result of treatment condition across more than 1 racial/ethnic group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of Structural Ecosystems Therapy for HIV medication adherence with African American women.

A systemic family therapy intervention, Structural Ecosystems Therapy (SET; Mitrani, Szapocznik, & Robinson-Batista, 2000; Szapocznik et al., 2004), has been shown to promote adaptation to living with HIV by reducing psychological distress and family hassles. This investigation examines the effect of SET on HIV medication adherence relative to a person-centered condition and a community control condition. Medication adherence was assessed on 156 trial participants. Results of a 2-part model showed that SET was significantly more likely to move women to high levels of adherence (defined as at least 95% adherence) than a person-centered therapy. Family hassles were also significantly reduced by SET, though the effect of SET on medication adherence did not appear related to this change in family hassles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach.

This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of, or was observed, using drugs. Subjects were randomly assigned to a strategic structural-systems engagement (experimental) condition or to an engagement-as-usual (control) condition. Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared with 25% of subjects in the control condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness.

This study reports data on the efficacy of Strategic Structural Systems Engagement (SSSE), which is designed to bring hard-to-reach families into treatment. The study also explores variables that may contribute to differential effectiveness. Participants were 193 Hispanic families, who were randomly assigned to either experimental or control conditions. Several important findings emerged. First, the overall results replicated earlier findings showing the superiority of SSSE: 81% of SSSE families, compared to 60% of control families, were successfully engaged, χ–2(1, N?=?193)?=?7.5, p?N?=?51)?=?7.53, p?=?.006. Third, an analysis of intervention failure suggests a mechanism by which culture and ethnicity influence clinical processes (resistance to engagement) and may result in differential effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)