Steven M. Kogan

Adolescent and Parent Therapeutic Alliances as Predictors of Dropout in Multidimensional Family Therapy

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response.

The Strong African American Families Program: A Cluster-Randomized Prevention Trial of Long-Term Effects and a Mediational Model.

The Strong African American Families Program, a universal preventive intervention to deter alcohol use among rural African American adolescents, was evaluated in a cluster-randomized prevention trial. This 7-week family skills training program is based on a contextual model in which intervention effects on youth protective factors lead to changes in alcohol use. African American 11-year-olds and their primary caregivers from 9 rural communities (N = 332 families) were randomly selected for study participation. Communities were randomized to prevention and control conditions. Intent-to-treat analyses indicated that fewer prevention than control adolescents initiated alcohol use; those who did evinced slower increases in use over time. Intervention-induced changes in youth protective factors mediated the effect of group assignment on long-term changes in use.

Is Resilience Only Skin Deep? Rural African Americans’ Socioeconomic Status–Related Risk and Competence in Preadolescence and Psychological Adjustment and Allostatic Load at Age 19

Many African American youth may develop high levels of allostatic load, a measure of physiological wear and tear on the body, by developing psychosocial competence under conditions of high risk related to socioeconomic status (SES). The current study was designed to test this hypothesis, which is based on John Henryism theory. In a representative sample of 489 African American youth living in the rural South, cumulative SES-related risks and teacher-reported competence were assessed at ages 11 to 13; depressive symptoms, externalizing behavior, and allostatic load were assessed at age 19. The data revealed that rural African American preadolescents who evinced high psychosocial competence under conditions of high cumulative SES-related risk displayed low levels of adjustment problems along with high allostatic load at age 19. These results suggest that, for many rural African Americans, resilience may indeed be only “skin deep.”

Is Resilience Only Skin Deep

Many African American youth may develop high levels of allostatic load, a measure of physiological wear and tear on the body, by developing psychosocial competence under conditions of high risk related to socioeconomic status (SES). The current study was designed to test this hypothesis, which is based on John Henryism theory. In a representative sample of 489 African American youth living in the rural South, cumulative SES-related risks and teacher-reported competence were assessed at ages 11 to 13; depressive symptoms, externalizing behavior, and allostatic load were assessed at age 19. The data revealed that rural African American preadolescents who evinced high psychosocial competence under conditions of high cumulative SES-related risk displayed low levels of adjustment problems along with high allostatic load at age 19. These results suggest that, for many rural African Americans, resilience may indeed be only “skin deep.”

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors.

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Family-centered Program Deters Substance Use, Conduct Problems, and Depressive Symptoms in Black Adolescents

Objectives: The present research addressed the following important question in pediatric medicine: Can participation in a new family-centered preventive intervention, the Strong African American Families–Teen (SAAF–T) program, deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents across 22 months? Methods: Data were collected from 502 black families in rural Georgia, assigned randomly to SAAF–T or an attention control condition. The prevention condition consisted of 5 consecutive meetings at community facilities with separate, concurrent sessions for caregivers and adolescents followed by a caregiver-adolescent session in which families practiced skills they learned in the separate sessions. Adolescents self-reported conduct problem behaviors, substance use, substance use problems, and depressive symptoms at ages 16 years (pretest) and 17 years 10 months (long-term assessment). Results: Adolescents who participated in SAAF–T evinced lower increases in conduct problem behavior, substance use, substance use problems, and depressive symptom frequencies than did adolescents in the attention control condition across the 22 months between pretest and long-term assessment. Conclusions: This is the first study to demonstrate efficacy in a prevention program designed to deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents. Because SAAF–T is a manualized, structured program, it can be easily disseminated to public health agencies, schools, churches, boys’ and girls’ clubs, and other community organizations.

Perceived Discrimination among African American Adolescents and Allostatic Load: A Longitudinal Analysis with Buffering Effects.

This study was designed to examine the prospective relations of perceived racial discrimination with allostatic load (AL), along with a possible buffer of the association. A sample of 331 African Americans in the rural South provided assessments of perceived discrimination from ages 16 to 18 years. When youth were 18 years, caregivers reported parental emotional support and youth assessed peer emotional support. AL and potential confounder variables were assessed when youth were 20. Latent growth mixture modeling identified two perceived discrimination classes: high and stable, and low and increasing. Adolescents in the high and stable class evinced heightened AL even with confounder variables controlled. The racial discrimination to AL link was not significant for young adults who received high emotional support.

The politics of making meaning: discourse analysis of a ‘postmodern’ interview

Both constructivist and constructionist models of therapy seek to produce new meanings with clients and families. Critics have pointed out that these therapies may neglect to consider the political and embedded nature of meaning making. This paper describes a discourse analysis of a construction/uctivist interview. Three interlocking conversational strategies employed by the interviewer are identified: exteriority, the disciplining of narrative and locality. These strategies are examined in the light of their effects on the unfolding narrative in the session, both in a productive and a restrictive sense. The function of therapy theory and techniques in subjugating client narratives as well as providing processes for constructing new meaning is discussed.

Long-Term Effects of the Strong African American Families Program on Youths' Conduct Problems

PURPOSE The Strong African American Families program, a universal intervention to deter alcohol use among rural African American preadolescents, was evaluated to determine whether it also prevented conduct problems across the 29 months separating the pretest and long-term follow-up assessments. The program is based on a contextual model in which intervention effects on parental behavior and youth protective factors are hypothesized to lead to behavior changes. METHODS African American 11-year-olds (N = 667) and their primary caregivers were randomly selected from public school lists of fifth-grade students and randomly assigned to an intervention (n = 369) or control (n = 298) condition. Intervention families participated in a 7-week family skills training program designed to deter alcohol use. Each meeting included separate, concurrent sessions for parents and children, followed by a joint parent-child session during which the families practiced the skills they learned in their separate sessions. Control families were mailed leaflets regarding early adolescent development, stress management, and exercise. All families completed in-home pretest, posttest, and long-term follow-up interviews during which parent-report and self-report data regarding conduct problems, low self-control, deviance-prone peer affiliations, parenting, and youth protective processes were gathered. RESULTS Intent-to-treat analyses indicated that prevention-group youth were less involved than control-group youth in conduct problems across time. As hypothesized, prevention effects were stronger for youth at greater risk of developing conduct problems. Intervention targeted parenting and youth factors partially accounted for intervention effects among high risk youth. CONCLUSIONS Although the Strong African American Families program was designed to deter underage drinking, it is also effective in preventing the development of conduct problems.

Effects of Family Risk Factors on Dosage and Efficacy of a Family-centered Preventive Intervention for Rural African Americans

This study was designed to test hypotheses about family risk factors and their links to dosage and efficacy of a family-centered preventive intervention. Participants were 172 families with an 11 year-old child randomly assigned to the intervention condition in the Strong African American Families Program (SAAF). Two family risk factors, ratio of adults to children in the household and youth unconventionality, were negatively related to dosage, defined as number of intervention sessions attended. Dosage, in turn, was associated with changes in targeted parenting behavior across the 7 months between pretest and posttest. The effect of family risk factors on the link between program dosage and changes in parenting behavior was stronger for families experiencing more risks. The results highlight the need for engagement strategies for recruiting and retaining high-risk families in preventive interventions.