Daniel A. Santisteban

Efficacy of Brief Strategic Family Therapy in Modifying Hispanic Adolescent Behavior Problems and Substance Use

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample.

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 <.001. Second, SSSE interventions were more successful with non-Cuban Hispanics (97% successfully engaged) than with Cuban Hispanics (64% successfully engaged), χ 2 (1, N = 51) = 7.53, p =.006. Third, an analysis of intervention failures suggests a mechanism by which culture and ethnicity influence clinical processes (resistance to engagement) and may result in differential effectiveness.

Interplay of advances between theory, research, and application in treatment interventions aimed at behavior problem children and adolescents

This article examines the important role that the interplay between theory, research, and application has in fostering breakthroughs in the treatment of clinical problems. This issue is presented in the context of an ongoing program of psychotherapy research that targets for intervention Hispanic behavior problem youth and their families. Findings and breakthroughs in structural family therapy, the measurement of family and child psychodynamic functioning, the development of culturally appropriate interventions, the role of attrition as a measure of outcome, and the investigation of theoretically postulated mechanisms in behavior change are discussed. Recommendations for future research directions are made. Progress in an applied science is fostered through the continuous interplay between theory, research, and application. Psychotherapy is presumably the application of a set of theoretically derived scientific principles. In the ideal case, psychotherapy research is the process by which these scientific principles are tested through their application to real-life situations. This article illustrates how the interplay between theory, research, and practice can result in important breakthroughs in the treatment of clinical problems. This issue is discussed in the context of an ongoing program of psychotherapy research that targets for intervention Hispanic behavior problem youth and their families. In our work, the interplay of theory, research, and application takes place at several levels. The theoretical orientation of our research program is systemic and draws on both the structural (Minuchin, 1974) and strategic (Haley, 1976; Madanes, 1981) traditions in systems theory. With respect to application, our main thrust over the past decade has been on applying systems theory to what has emerged as a remarkably recalcitrant clinical problem, viz., behavior problems and drug abuse among children and adolescents. Finally, the research program described in this article is a direct outgrowth of our efforts to investigate novel, theoretically based interventions that can be used in the prevention and treatment of these problems. In this article we describe five major challenges that had to be tackled in order to make progress either in the treatment of adolescent drug abuse and problem behavior or in its investigation. We refrained these challenges into research questions and chose to pursue answers within the framework of a rigorous program of systematic research. In translating these challenges

Brief structural/strategic family therapy with African and Hispanic high-risk youth

Brief Strategic/Structural Family Therapy was implemented as an indicated prevention intervention to reduce the likelihood that African American and Hispanic youth initiated drug use. The intervention was designed to impact two important risk factors for initiation, namely behavior problems and poor family functioning. One hundred twenty-two youth, 12–14 years of age and exhibiting behavior problems, were assigned within a basic one-group pretest/posttest/follow-up design. The first important finding was that the prevention intervention was effective in significantly modifying both high-risk factors, reducing behavior problems [F(2, 120) × 32.92; p < .000] and improving family functioning [F(1, 121) × 41.8; p < .000]. A second important finding was that both high-risk variables targeted were statistically significant predictors of initiation nine months later. A third important finding was that for a small subset of youth who entered the program already using, overall use was significantly decreased [t(22) × 2.11, p < .05].

Beyond acculturation: an investigation of the relationship of familism and parenting to behavior problems in Hispanic youth.

In the adolescent research literature, acculturation processes have been linked to the development of serious behavior problems in Hispanic adolescents, but not enough is known about how that process takes place. This article reports an investigation that sought to shed light on empirically plausible mechanisms by which family processes (i.e., familism and parenting practices) may operate as mediators of acculturation-related factors on adolescent problem behaviors among 167 Hispanic sixth- or seventh-grade early adolescents. SEM analyses identified an empirically plausible mediated pathway through which parenting practices may operate as a mediator of the effects of acculturation-related variables on adolescent problem behaviors. Second, although the role of familism as a mediator was not supported, the results did provide support for familism having indirect effects on behavior problems also through parenting practices. The findings are discussed in the context of existing research and clinical developments in the treatment of Hispanic adolescents and families.

Addressing immigration-related separations in Hispanic families with a behavior-problem adolescent.

This article presents specialized family therapy intervention strategies for Hispanic families with behavior-problem adolescents who have experienced an immigration-related separation. Such specialized interventions correspond to a philosophy of customized treatment delivery for Hispanic families. Interactional and cognitive/affective features are presented, and guidelines for building therapeutic alliances, identifying core family processes/themes, and transforming interactions are offered.

An Efficient Tool for Screening for Maladaptive Family Functioning in Adolescent Drug Abusers: The Problem Oriented Screening Instrument for Teenagers

The assessment of maladaptive family functioning among adolescent drug abusers is particularly important because maladaptive family functioning has been linked to adolescent drug abuse/delinquent behaviors, and there are now highly effective family interventions available for treating these family dysfunctions. The purpose of the study reported in this article was to investigate the degree to which the Problem Oriented Screening Instrument for Teenagers screen for the family domain provides useful information regarding family functioning when used with clinic-referred youths with behavior problems. Participants in this study were 135 Hispanic and African-American youth referred for the treatment of severe behavior problems, including drug use. Our findings provide support for the usefulness of the 11-item POSIT family functioning screen. Data supporting the criterion validity of the POSIT Family screen, its ability to classify families correctly in terms of their family functioning, and its significant loading on the latent variable resulting from a confirmatory factor analysis all lend support to the usefulness of this screen of family functioning. In addition, analyses designed to explore the relationships between gender and race/ethnicity and the POSIT Family subscale showed that differences in scores by gender and race/ethnicity are not unique to the POSIT, but rather reflect similar differences in family functioning reported by the adolescent on more extensive family measures.

Self-harm Among Hispanic Adolescents: Investigating the Role of Culture-Related Stressors

PURPOSE Suicide is the third leading cause of death among adolescents. Research shows Hispanic adolescents report disproportionate rates of both suicidal ideation and attempts. The purpose of the present study was twofold. First, the present study aimed to document the presence of suicidal ideation and self-harm behavior in a large heterogeneous sample of Hispanic adolescents. Second, this study sought to identify specific and unique culturally relevant stressors that were associated with the higher self-reported suicidal thoughts and self-harm among Hispanic males and females separately. METHODS Data were collected on 1,651 Hispanic adolescents who completed the Hispanic Stress Inventory-Adolescent Version. RESULTS Results of both rates and culture-related stressors that associated with the high rates of suicidal ideation are presented. Of the eight subscales measured in the Hispanic Stress Inventory-Adolescent, four subscales were predictive of either suicidal ideation or self-harm. For males, Acculturation Gap Stress was associated with suicidal thoughts and Discrimination Stress was associated with both suicidal thoughts and self-harm behavior. For females, Family Drug Stress was associated with suicidal thoughts. Acculturation Gap Stress, Family Drug Stress, and Immigration Stress were all significantly associated with self-harm behaviors. CONCLUSIONS Findings are discussed as they inform future culturally competent prevention interventions and future research studies.

Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk

PURPOSE This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children. METHODS Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs. RESULTS The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on childrens risk for obesity consistent with Socio-Ecological Framework. CONCLUSIONS Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.

Psychiatric, Family, and Ethnicity-Related Factors That Can Impact Treatment Utilization Among Hispanic Substance Abusing Adolescents

SUMMARY There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ2 = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ2 = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.