Midtreatment Problems Implementing Evidence‐based Interventions in Community Settings

Abstract

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) are two widely disseminated evidence-based family-based treatments for substance abusing and delinquent adolescents. This mixed-method study examined common implementation problems in midtreatment in MST and FFT. A convenience sample of experienced therapists (20 MST, 20 FFT) and supervisors (10 MST, 10 FFT) from dissemination sites across the United States participated in semistructured telephone interviews. Participants identified retrospectively serious midtreatment process problems they perceived as threats to treatment success. Coders extracted descriptions of problems from interview transcripts and coded them into 12 categories that fell into five major themes: engaging families in treatment; difficulties implementing strategies; family relational and communication problems; complications external to therapy; and youth problem behavior. Analyses examined caregiver, therapist, and youth variables as predictors of these common midtreatment problems and whether treatment outcomes varied depending on the type of problem, therapy model, and race/ethnic match of therapist and family. MST and FFT therapists and supervisors identified many similar problems. There were, however, model-specific differences consistent with differing features of the models (e.g., FFT participants identified more family relational problems and fewer follow-through problems than their MST counterparts). Results underscore the need to consider both common and specific factors in treatment process.

Therapist Strategies for Managing Midtreatment Problems in Evidence‐based Interventions in Community Settings

“…A guiding assumption of this study was that examining midtreatment problems, the contextual obstacles that accompany these problems, and the strategies therapists use to address difficulties in cases that inevitably fail or succeed would provide valuable information to inform future development of FFT and MST and that might also be relevant for other evidence‐ and family‐based models (e.g., Multidimensional Family Therapy, Brief Strategic Family Therapy). Similar to our earlier study (Cunningham et al, 2019), the results indicated that the types of contextual obstacles therapists encountered across success and failure cases and treatment models were quite similar, with only a few exceptions. One clear clinical implication of this finding is that therapist descriptions of treatment problems and the contextual obstacles in which they are embedded (in type, number, or combination thereof) alone may be insufficient to determine case viability.…”

“…The present findings, together with our early work (Cunningham et al, 2019), provide the beginning steps in describing and understanding these treatment obstacles and suggest a possible conceptual framework for future research to examine midtreatment therapy process problems. An organizing principle of such a framework conceptualizes psychotherapy process data as a timeline of within‐ and between‐session events (e.g., parent‐therapist disagreements about clinical goals or tasks, adverse family life events, marital discord) and behaviors of key participants (i.e., clients [e.g., resistance], therapists [confrontation, persuasion], supervisors [therapist fidelity and follow through]).…”

“…We also examined how therapists’ contextual obstacles related to the primary problems (identified for each family based on data described in Cunningham et al, 2019) that they worried would derail treatment. Most therapists reported that the identified midtreatment problem was embedded in additional contextual obstacles.…”

“…Trained graduate student research assistants (RAs) with clinical experience with families conducted the interviews and asked therapists to describe two cases that had terminated in the last year. Because one focus of the parent study was on racial/ethnic differences between therapists and families, therapists described one similar‐race and one differing‐race family (see Cunningham et al, 2019, for a discussion of race/ethnicity). For each case selected, interviewers asked participants to describe the youth and family, problem(s) of concern, strategies used to manage midtreatment problems, and family responses to strategies used.…”

Implementation Issues in Functional Family Therapy: A Narrative Analysis of the Evidence

“…Recent high-quality evidence has challenged the overall FFT: IMPLEMENTATION ISSUES 8 effectiveness of the intervention (Weisman & Montgomery, 2018;Hartnett et al, 2017;Humayun et al, 2017;Darnell & Shuler, 2015). However, some studies suggest that there may be implementation explanations for the heterogeneity of outcome results across studies which is in line with broader psychology trial literature (Cunningham et al, 2018;Gottfredson & Gottfredson, 2002;Hawe, Shiell, & Riley, 2004).…”