Implementing BSFT

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A team of trainees will participate in the Brief Strategic Family Therapy® workshops and supervision process, working toward an achievement of competency.

Brief Strategic Family Therapy® Program Summary


1. The BSFT model was developed in over 35 years of research with African American and Hispanic families in Miami. This innovative family intervention:

  • Targets drug using, delinquent youth
  • Prevents them from entering the child welfare or juvenile justice system

2. The philosophy of the BSFT model is:

  • The family provides the most influential context for youth
  • The family should be the focus of intervention
  • Families of delinquent, drug using youth tend to interact in unhealthy ways that allow these problems to persist
  • By working with families, the BSFT model not only decreases youth problems, but also creates a healthier functioning family

3. The BSFT model has been evaluated in a number of randomized clinical trials testing:

  • Engagement of entire families
  • Treatment Retention
  • Family Functioning
  • Drug use
  • Delinquent Behavior

4. The BSFT model is:

  • A problem focused intervention
  • Conducted in 16 weekly sessions, depending on the severity of the presenting problem.
    • A team of four therapists is the standard unit for the BSFT program
    • Multiple BSFT teams can exist within one agency
    • The intervention is delivered in clinic offices or at clients’ homes

5. BSFT Specialized Engagement

  • Addresses the challenge of getting entire families to attend sessions
  • Specialized engagement techniques are used by BSFT therapists to:
    • Diagnose the family system
    • Determine family patterns creating barriers to treatment
  • Works around those barriers to invite all family members to the first session
  • If all family members do not attend the first session, the work of the first session is to get all family members to attend the second session

6. Where in the world is the BSFT program?

  • Over 15,000 families have received the BSFT intervention in the United States and Europe
  • Creating transformation for youth and families in child prevention programs
  • Creating transformation for youth and families in Juvenile Justice diversion programs

Cost Analysis
BSFT Outpatient Treatment
16 weeks $4,668.00

The BSFT Model Research Summary

The BSFT model has been evaluated in a number of randomized clinical trials for engagement, treatment retention, family functioning and adolescent outcomes, only some of which are reviewed here.

BSFT Efficacy

Engagement: The efficacy of BSFT Engagement was tested in three separate studies with Hispanic families and adolescents with behavior and drug problems. In the first study, Hispanic families with drug abusing adolescents were randomly assigned to BSFT + Engagement as Usual (i.e., the control condition) and BSFT + BSFT Engagement (i.e., the experimental condition). Ninety three percent BSFT Engagement condition families engaged into treatment compared with only 42% of the families in the Engagement as Usual condition. Moreover, 75% of families in the BSFT Engagement condition completed treatment compared with only 25% of families in the Treatment as Usual condition (Szapocznik et al, 1988). A second study (Santisteban et al., 1996) found that 81% of BSFT Engagement condition families were successfully engaged, whereas in the control conditions, 60% of the families were successfully engaged. A third study (Coatsworth et al, 2001) using a community control condition found 81% engagement in BSFT and 61% for the community control condition. Of those engaged 71% of BSFT cases remained to treatment completion, but only 42% of the community control families completed.

Outcomes: The efficacy of the BSFT model in reducing behavior problems and drug abuse has been tested in two randomized, controlled clinical trials. In the first trial, José Szapocznik and colleagues randomized behavior-problem and emotional-problem 6-11 year old boys to BSFT, individual psychodynamic child therapy, or a recreational placebo control condition. Outcome analyses BSFT Outpatient Treatment 16 weeks $4,668.00 indicated that BSFT treatment was equally effective as individual psychodynamic child therapy, and more efficacious than recreational control, in reducing children’s behavioral and emotional problems, and in maintaining these reductions at 1-year post-termination. However, at 1-year follow-up, the BSFT condition was associated with a significant improvement in observer-rated family functioning, whereas individual psychodynamic child therapy was associated with a significant deterioration in observer-rated family functioning. José Szapocznik and Guillermo Prado have used this finding, and other similar results, to caution against the use of individually focused treatments that may impair family functioning.

A randomized trial (Santisteban et al., 2003) comparing the efficacy of the BSFT intervention to group counseling (modeled after an intervention widely used in the community) among problem behavior adolescents found that the BSFT condition was significantly more efficacious in reducing conduct problems, associations with antisocial peers, and marijuana use, and in improving observer-rated family functioning. Moreover, group counseling was associated with worsened conduct problems, associations with antisocial peers, and marijuana use.

BSFT Effectiveness

This study used a large sample of 480 African American, Hispanic and White American families in eight community agencies throughout the US and Puerto Rico to compare the BSFT model to whatever treatment as usual was used in the agencies’ adolescent outpatient program (Robbins et al, 2010). Seventy two percent of the adolescents were referred by the juvenile justice system.

Engagement and Retention. Families in the treatment as usual condition were 2.33 times as likely to fail to be engaged into treatment compared to families in BSFT, and 1.41 times as likely to fail to be retained in treatment for at least 8 sessions compared to families in BSFT. Families assigned to the BSFT condition attended a mean of 9.5 sessions, compared to a mean of 6 sessions for the treatment as usual condition. These findings were equally applicable to all three ethnic groups in the study.

Delinquent Behavior and Drug Use Outcomes. The study found that the BSFT model was significantly more effective in improving family functioning than treatment as usual. However, drug use differences only emerged at the 12-month follow up time point. In the BSFT condition, reductions in drug use were associated with therapist adherence to the model. In an unselected sample condition, with therapists who had multiple responsibilities and large caseloads, adherence suffered. Consequently, to maintain high levels of adherence and ensure faster treatment outcomes, our current implementation model selects therapists and works with therapists who are fully dedicated to the BSFT model. In a 5-year follow-up study, the BSFT condition showed significant reduction in delinquent behavior and the number of re-arrests. (Horigian, et al. 2015).

References

Horigian, V.E., M.S., Feaster, D.J., Robbins, M.S., Brincks, A.M., Ucha, J., Cuccinelli, M.J., Szapocznik, J., & Rohrbaugh, M.J., (2015). A Cross-sectional Asse3ssment of the Long Term Effects of Brief Strategic Family Therapy for Adolescent Substance Use. The American Journal on Addictions, 24: 637-645.

Robbins, M.S., Feaster, D.J., Horigian, V.E., Cuccinelli, M.J., Szapocznik, J., & Henderson, C. (2011). Therapist adherence in Brief Strategic Family Therapy for Adolescent drug abusers. American Psychological Association, 79, 43-53.

Robbins, M.S., Szapocznik, J., Horigian, V.E., Feaster, D.J., Puccinelli, M., Jacobs, P., Burlew, K., Westlein, R., Bachrach, K., & Brigham, G. (2009). Brief strategic family therapy™ for adolescent drug abusers: A multi-site effectiveness study. Contemporary Clinical Trials, 30, 269- 278.

Briones, E., Robbins, M.S., & Szapocznik, J. (2008). Brief Strategic Family Therapy: Engagement and treatment. Alcoholism Treatment Quarterly, 26, 81-103.

Nickel, M. et al. (2006). Influence of family therapy on bullying behaviour, cortisol secretion, anger, and quality of life in bullying male adolescents: A randomized, prospective, controlled study. Canadian Journal of Psychiatry, 51, 355-362.

Nickel, M., et al. (2006). Bullying girls – Changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy and Psychosomatics, 75, 47-55.

Horigian, V., Robbins, M.S., & Szapocznik, J. (2004). Brief Strategic Family Therapy. Brief Strategic and Systemic Therapy: European Review [inaugural issue] 1, 251-271. Santisteban, D.A., Coatsworth, J.D., Perez Vidal, A., Kurtines, W.M., Schwartz, S.J., LaPerriere, A., & Szapocznik, J. (2003). The efficacy of Brief Strategic Family Therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17 (1), 121-133.

Szapocznik, J., Hervis, O.E., & Schwartz, S. (2003). Brief Strategic Family Therapy for adolescent drug abuse. [NIH publication no. 03-4751; NIDA Therapy Manuals for Drug Addiction Series]. Rockville, Maryland: National Institute on Drug Abuse.

Robbins, M.S., Mitrani, V.B., Zarate, M., Perez, G., Coatsworth, J.D. & Szapocznik, J. (2002). Change processes in family therapy with Hispanic adolescents. Hispanic Journal of Behavioral Sciences 24, 505-519.

Robbins, M.S., Bachrach, K., & Szapocznik, J. (2002). Bridging the research-practice gap in adolescent substance abuse treatment: The case of Brief Strategic Family Therapy. Journal of Substance Abuse Treatment, 23, 123-132.

Coatsworth, J.D., Santisteban, D.A., McBride, C., Szapocznik, J. (2001). Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40, 313-332. Robbins, M.S., & Szapocznik, J. (2000). Brief Structural Family Therapy with behavior problem youth. Office of Juvenile Justice and Delinquency Prevention Bulletin, Office of Justice Programs, U.S. Department of Justice, Washington, D.C.

Szapocznik, J., & Williams, R.A. (2000). Brief strategic family therapy: Twenty-five years of interplay among theory, research, and practice. Clinical Child & Family Psychology Review, 3, 11, 7-134.

Santisteban, D.A., Szapocznik, J., Perez-Vidal, A., Kurtines, W.M., Murray, E.J., & Lapierre, (1996). Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology, 10, 35-44.

Szapocznik, J., Rio, A., Murray, E., Cohen, R., Scopetta, M., Rivas-Vazquez, A., Hervis, O., Posada, V., & Kurtines, W. (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Journal of Consulting and Clinical Psychology, 57, (5) 571-578.

Szapocznik, J., Perez-Vidal, A., Brickman, A., Foote, F.H., Santisteban, D., Hervis, O.E., & Kurtines, W.M. (1988). Engaging adolescent drug abusers and their families into treatment: A Strategic Structural Systems approach. Journal Counseling & Clinical Psychology, 56, 552-557.

A person shakes hands with family

The BSFT® Program workshops are only part of the ongoing training commitment that Brief Strategic Family Therapy® Institute makes to the agencies, clinics and therapists that it trains.

In training therapists to competency, workshops then ongoing supervision and review and fidelity ratings are required to gain BSFT® Program site licensing. Prior to launching the workshops, a site readiness process is implemented to evaluate and prepare the site for integrating the BSFT® Program into their organization and current working methods.

If conditions are met, the training program begins with three three-day workshops including interactive lectures, videotape demonstrations and clinical case consultations, plus weekly supervision of the BSFT® therapists.

Workshops consist of:

  • Interactive Lectures
  • Case Presentations (videos)
  • Live family sessions

BSFT® Program training curriculum is comprehensively manualized. The proprietary manual is available to organizations who agree and commit to training, supervision and licensure.

Reductions in behavior problems are related to the agency’s fidelity to the BSFT® Program. A strong training commitment leads to great outcomes.

– Joan Muir, Ph.D., Brief Strategic Family Therapy® Institute Executive Director

 

The Brief Strategic Family Therapy® Institute has trained and consulted at agencies in over 30 states as well as in Europe and South America.

World map with pin marks on North America, South America, Europe and Australia

Where in the World is the BSFT Model:
Examples of BSFT® Implementation

  • Framtid Stockholm, Stockholm, Sweden

The BSFT model has been implemented in multiple states across the USA, and in several countries abroad. The oldest BSFT program in the world is Framtid Stockholm, founded by the City of Stockholm, Sweden. In 2007, the City of Stockholm had completed a research study on juvenile addiction. The study revealed that despite the very generous array of social services including family therapy, a category of youth was identified that did not do well. They were difficult to engage in addiction treatment. Research on the BSFT model revealed that the intervention was unique. It had a clinical component known as Specialized Engagement that had been developed and tested in research, separate from the BSFT intervention itself. Acknowledging that there is intrinsic resistance to intervention by all family systems, Specialized Engagement was developed to bring whole families into treatment. The decision was made in 2007 to implement a BSFT program at Maria Ungdom with a team of six therapists. Maria Ungdom was a premier drug addiction facility in Stockholm, well respected across Europe, as the model for treating juvenile addiction providing outreach, outpatient and inpatient treatment. The BSFT program at Maria Ungdom was successful not only in treatment outcomes, but it also produced three stellar BSFT On-Site Supervisors, who were subsequently recruited by the BSFT Institute as BSFT Model Managers.

In 2015, the director of Maria Undgom, Göran Hägglund created a new organization, and retired Maria Ungdom after 49 years of service, with the full support of the City of Stockholm. The new organization Framtid Stockholm, contains eight units, one of which was Maria Ungdom, renamed Mini Maria. In 2017, the City of Stockholm initiated a new BSFT program in the district of Jarva, outside of central Stockholm. The goal was to offer the BSFT model to a diverse group of refugees and immigrants. This second program has also thrived despite initial challenges for recruiting families while having two separate social districts working in tandem. Remarkably, in 2021, the Swedish National Board of Health listed the BSFT model among a group of EBMs for which funding to all municipalities is now available.

  • New York City Administration for Children’s Services, City of New York

Currently, the largest funder of BSFT programs is New York City Administration for Children’s Services (ACS). There are presently thirteen BSFT teams (52 BSFT therapists) seeing families across all five boroughs of New York City. In 2009, New York Foundling, New York’s City’s oldest social welfare agency, approached the BSFT Institute to start a mental health clinic for youth with addiction. This clinic was successful as a fee for service program until 2012, when New York Foundling was awarded funding for BSFT implementation by ACS for child abuse prevention services. ACS was the first municipality in the nation to implement nine evidence based models (EBMs). This pioneering initiative directly addressed the need to prevent the recurrence of child abuse and neglect.

ACS Division of Preventive Services awarded New York Foundling, Jewish Child Care Association, Jewish Board for Children and Family Services and Graham Windham, a total of nine BSFT teams for the funding period 2013-2020. Recurrence of maltreatment data collected by ACS, showed that BSFT programs had the lowest rate in the last three years of the program. Again, in 2020, ACS Division of Preventive Services awarded Jewish Board for Children and Family Services, Graham Windham and New York Foundling to implement nine BSFT teams. In addition, in 2021, ACS Division of Youth and Family Justice awarded New York Foundling and Community Mediation Services funding to implement four BSFT teams.