StrengthsOriented Family Therapy SOFT: Rationale, Study Design, and Preliminary Outcomes

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Strengths-Oriented Family Therapy (SOFT)
Rationale, Study Design, and Preliminary Outcomes

• Douglas C. Smith, LMSW
• Director, Adolescent Health and Resource Center
• University of Iowa

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Goals of Presentation

• Discuss Concept of Strengths Based
  Interventions in Substance Abuse TX
• Review SOFT Intervention
• Discuss Preliminary Findings From Current
  Clinical Trial

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Brief (and Biased) HX of the Strengths-Based
Movement in SA TX

• Positive Aspects of Behavior Modification
  Overlooked by SA Counselors.
• SW Profession (and others) Raise Concerns about
  Psychiatric Labeling Effects on Clients.
• Emergence of MI and Solution-Focused Therapies
  and Popular RTC Concepts.
• Dilemma Operationalizing and Evaluating
  Effectiveness of Strengths Based Interventions.
• Just Another Common Factor? (Staudt et al.,
  2001)

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What Makes an intervention Strengths Based?

• Focuses on Client Competencies and Not
  Exclusively Concentrating on Deficits
• Is More Client-Driven Less Expert Stance
• Gives Client Recognition for Successes
• Attempts to Utilize Client Strengths in TX
• Attractive Alternatives to Past Confrontational
  Substance Abuse Treatments (Examples)
• Readiness to Change/Empathy Movement
• Seven Challenges
• Behavioral Interventions with Emphasis on
  Praise/Modeling
• Strengths Oriented Family Therapy (SOFT)

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Critiques of Strengths-Based Interventions

• Not a New Concept, but Rather a Value Stance
  Embedded in Interventions (Staudt et al., 2001).
• Multi-component Interventions with Strengths
  Focus Make it Difficult to Evaluate.
• Requires Evaluation to Occur a Process Level
• Close Monitoring of Integrity Necessary
• Time Consuming to Study
• Clients Get Uncomfortable Talking about Strengths
  if Ready to Talk about Problems.

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Why Should Strengths-Based TXs Work w/
Adolescent Substance Abusers?

• Client-Driven Goal Emphasis May be Attractive to
  Adolescents.
• Focus on Competencies May be Refreshing Enhance
  Rapport.
• (For FamilyBased Adaptations) Reframes Parents
  View of Adolescent With Problems

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Is Family Therapy Better?......

• Early Studies Suggested Family therapy gt Group or
  Individual Therapy
• Small N Studies
• Lack of Standardized Instruments
• High Attrition
• Superior Supervision/Specification in Family
  Conditions
• Mixed Findings Emerging (Azrin et al, 2001
  Dennis et al., in press)
• Current Emphasis on Finding Subtypes of Clients
  that Benefit Most

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Against this Backdrop

• Strengthening Communities for Youth (SCY) Project
  funded to
• Develop a System of Care Emphasis
• Develop an MIS
• Compare SOFT to Standard Treatment
• Provide Centralized Assessment
• Utilize Aggressive Outreach

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SOFT Ingredients

• 1 Cup Solution-Focused Techniques
• 2 Cups Family Therapy
• 1 Cup Multifamily Group Skills Training
• 1/2 Cup of Case Management
• Simmer Well and Enjoy!

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Solution Focused Therapy Assumptions (Adapted
from Walter Peller, 1992)

• Resistance Doesnt Exist
• Is not Located in Person, but in interactions
• All Clients Are willing to Work on Some Goals
• Change is Inevitable
• Pre-session Change Questions, Exceptions to
  Problems
• Focus on Concrete Tasks
• Goals Defined using Present-Tense, Action Words
• What will you be Doing
• Presence Vs. Absence
• Small BIG Changes!
• All Clients Have Strengths
• Strengths Assessment
• Clients Goals Come First

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Rationale for Treatment Approach

• Adolescents Recovery Environments Important
  (Godley et al, in press)
• Family Therapy is Effective (Liddle et al., 2004,
  Williams et al., 2000)
• CBT Skills Training Approaches Effective (Azrin
  et al., 2001)
• Strengths Focus Could Enhance Rapport.

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Goals of SOFT

• Improve Family Functioning
• Reduce/Eliminate Substance Use
• Increase Problem Solving Skills
• Develop (Nurture Existing) Future Orientation
• Address Ecology of the Problem

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Ingredients/Mechanisms of Change
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Average Dosage of SOFT vs. Standard
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Treatment Integrity Procedures

• Initial Training
• Weekly Group Supervision
• Tape Review with Feedback
• Manual exists in Draft Form (Hall et al. in
  development)
• Session Fidelity Checklist to Participants

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Dosage Integrity
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Research Design

• Initial Standardized Assessment
• Random Assignment to Condition
• Follow-Up Interviews at 3,6,9 and 12 months
• Measures Include Global Assessment of Individual
  Needs, Collateral Assessment, FACES, Issues
  Checklist, Problem Solving Discussion, Service
  Utilization Questionnaire, Working Alliance
  Inventory

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Dependent Variables

• Days of Being In Trouble with Ones Family
• Proportion of days in the past 90 days adolescent
  self-reported being in trouble with family
• Substance Frequency Scale (SFI)
• Average of of days reported of any AOD use,
  days of heavy AOD use, days of problem from AOD
  use, days of alcohol, marijuana, crack/cocaine
  and heroin use.
• Substance Problem Index (Past Month)
• Count of Dependence/Abuse criteria Common
  Problems

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Between Group Differences Mean Substance
Frequency (Range 0-1)
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Between Group Differences Proportion of Days in
Trouble with Family (P90)
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Between Group Differences Substance Problem
Scale (range 0-16)
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Between Group Differences (Baseline N82)
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Baseline to 3-Month Differences Collapsed Across
Condition (N65)
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Between Group Differences(3-Months N62)
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Results-Overview

• Significant Time Effect For Both Treatments On
  All Measures Except for Trouble with Family
• SOFT Participants Have Mean Differences for
  Substance Frequency and Problems Scales, and
  Equivalent for Family Trouble

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Limitations

• Limited Power Due to Small N
• Single Outcome Indicators Less Sensitive than
  Composites
• Study is On-Going and Results Pending

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Future Research Should Address

• Subtypes that Benefit Most from Family Therapy
• Cost-Benefit Ratios of Family Therapy vs.
  Individual Models
• Influence of Strengths Components on Client
  Outcomes.

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Acknowledgements

• Center for Substance Abuse Treatment (CSAT) Grant
  TI13354
• Special Thanks To All Families Participating in
  Our Research.