Program Profile: Ecologically Based Family Therapy (EBFT) for Substance-Abusing Runaway Adolescents

This is a home-based, family preservation model for families in crisis because a youth has run away from home. The model targets 12- to 17-year-olds who are staying in a runaway shelter and dealing with substance abuse issues. The program is rated Promising. Treatment group adolescents reported a statistically significant reduction in the percentage of days they used alcohol or drugs, compared with control group adolescents who received services as usual, at the 15-month follow up.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Target Population

Ecologically Based Family Therapy (EBFT) is a home-based, family preservation model that focuses on families who are in crisis because a youth has run away from home. EBFT was developed based on the HOMEBUILDERS family preservation model in which services are initiated when there is a family crisis, such as a child’s removal or departure from the home. EBFT targets 12- to 17-year-olds who are staying in a runaway shelter and are also dealing with substance abuse issues (such as alcohol dependence). The goal of EBFT is to improve family functioning and reduce youths’ substance use.

Program Theory

EBFT incorporates concepts from the crisis intervention theory, which argues that families are more amenable to counseling and open to change during a crisis (Slesnick and Prestopnik 2009). EBFT also incorporates components of Bronfenbrenner’s (1979) theory of social ecology, which views individuals as being in a complex, interconnected system that includes individual, family, and extrafamilial factors (such as peers, school, and neighborhood). Behavior is viewed as the product of the interplay between the child and these systems, and also as the product of how the systems relate to one another.

Program Components

To derive greater benefit from family members’ motivation to meet and work through the runaway crisis, therapy sessions occur frequently early on in the process. EBFT is delivered to families in their homes across 16 sessions, lasting 50 minutes each. EBFT is home based to reduce barriers to treatment, such as child care or transportation. Treatment begins by preparing the adolescent and the family members, in individual sessions, to come together and talk about the issues that led to the runaway episode. After the individual sessions, the family and youth are brought together to address the issues associated with the dysfunctional interactions between family members and the continuation of problem behaviors. There is no assumption in the EBFT model that positive changes in the parent–adolescent relationship will necessarily lead to changes in substance-using behavior. Therefore, in both the individual and family sessions a framework is created to deal with the substance use in overt ways.

The therapists guide families from an intrapersonal to interpersonal interpretation of problems by using interpretations, questions and reframes that have relational bases. Cognitive–behavioral techniques are also used to change problem behavior patterns. New skills are taught and designed to be practiced and applied outside the therapy context. Therapists develop a rapport with the family while assessing the treatment needs of family members. The sessions are designed to be nonconfrontational; thus, therapists set tones that are not hostile or judgmental.

EBFT is guided by a manual that is divided into four sections. The first section describes the engagement procedure used with the youths and their families. The second section provides common themes to therapy involving runaway youths and their families, such as youth transitioning back into the home or parental refusal to allow the youth to live in the home. The final section outlines the sequence of clinical tasks for each therapy session. For example, in sessions 1 and 2, tasks include engagement, information gathering, and immediate needs assessment. The third session provides four individual sessions on HIV prevention. The final section, session 4, outlines the sequence of clinical tasks for the therapy sessions. These tasks continue throughout treatment.

Key Personnel

Families are seen by a single therapist. The therapist also serves as a therapeutic case manager, who coordinates meetings or services for the youth and the family based on a needs assessment.

Study

Slesnick and Prestopnik (2009) studied the impact of home-based Ecologically Based Family Therapy (EBFT) on a convenience sample of runaway adolescents with alcohol problems and their families. All study participants were sampled from two runaway shelters in Albuquerque, N.M. To be eligible, youths had to be 12 to 17 years old and have a primary alcohol problem (for example, alcohol dependence and marijuana abuse, but not vice versa). In addition, youths’ families had to reside within 60 miles of the research site, and the parents had to agree to the possibility of family therapy.

Eligible youths were randomly assigned to one of three conditions using a computerized urn randomization program (which retains random allocation and balances groups on a priori categorical variables). The participants were assigned to receive home-based EBFT (n = 37), office-based Functional Family Therapy (FFT; n = 40), or services as usual (SAU; n = 42). The CrimeSolutions review of this study focused on the comparison between the EFBT group and the SAU group.

The average age of the entire study sample was 15.1 years. Fewer than half of the sample (45 percent) were male, and the ethnicity breakdown was 44 percent Hispanic, 29 percent white, 11 percent Native American, 5 percent African American, and 11 percent other ethnicities. The entire study sample was primary alcohol users, and 89 percent met the DSM–IV criteria for alcohol abuse or dependence. Thirty-seven percent had a diagnosis of marijuana dependence, 29 percent had a diagnosis of marijuana abuse, 5 percent had a diagnosis of other substance abuse, and 17 percent had a diagnosis of other substance dependence. There were no significant differences between the groups on demographic characteristics and substance use. The SAU comparison group did have higher measures of delinquency compared with the EBFT and FFT treatment groups.

Youths randomized to the EBFT treatment group received services from a therapist in their homes. Youths randomized to the FFT treatment group received office-based services. The goal of FFT is to alter dysfunctional family patterns that may contribute to alcohol abuse, running away, and other related problem behaviors of youths. In addition to assessing the effect of EBFT on runaway adolescents, the study authors wanted to examine the impact of home-based versus office-based treatment, which is why some youths received FFT. Both office-based FFT and home-based EBFT were offered for 16 sessions, 50 minutes each. Youths randomized to the SAU comparison group received case management services and individual therapy meetings, usually provided by the runaway shelter staff.

The data was examined using a series of 3 (treatment modality) x 4 (time) repeated measures of Analysis of Variance (ANOVA). Intent-to-treat analysis was conducted with all study participants on the main variables. The primary outcome of interest was substance use, which was measured with several instruments. The Form 90 uses a timeline follow-back method and grid averaging to assess alcohol and drug use patterns of adolescent substance users. Urine toxicology screens were also collected from youths at pretreatment and posttreatment assessments to verify self-reported illicit drug use. The Adolescent Drinking Index was used to measure problems specifically associated with drinking. The POSIT (Problem Oriented Screening Instrument for Teenagers) was used to measure problem consequences associated with drug use. The study also looked at measures of psychological functioning and family functioning; however, the results are not discussed here. No subgroup analysis was conducted.

The study by Slesnick and Prestopnik (2009) evaluating the effects of Ecologically Based Family Therapy (EBFT) on adolescents living in runaway shelters in Albuquerque, N.M., involved experienced and trained family systems–based therapists. The therapists were given a 2-day didactic training in both EBFT and Functional Family therapy. There was also ongoing supervision provided within a university-based setting. Most of the therapy sessions were conducted by two female therapists who were master’s-level licensed professional counselors and had from 2 to 5 years’ field experience. Treatment was guided by the EBFT manual (Slesnick 2000).

Comparative Research

Slesnick and Prestopnik (2009) examined the effects of Ecologically Based Family Therapy (EBFT) on runaway adolescents with alcohol problems. In addition to comparing outcomes between EBFT treatment group adolescents and control group adolescents who received services as usual (SAU), the study authors examined differences between EBFT adolescents and adolescents who participated in Functional Family Therapy (FFT). However, they did not find any statistically significant differences on measures of substance use between the home-based EBFT treatment group and office-based FFT treatment group, at the 15-month follow up. Overall, adolescents who participated in both family therapies combined reported a 72 percent reduction in alcohol or drug use.

CrimeSolutions doe not consider comparative research learn more about how CrimeSolutions treats comparative effectiveness research.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Bronfenbrenner, Urie. 1979. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Mass.: Harvard University Press.

Slesnick, Natasha, and Jillian J. Prestopnik. 2004. “Office versus Home-Based Family Therapy for Runaway, Alcohol Abusing Adolescents: Examination of Factors Associated with Treatment Attendance.” Alcohol Treatment Quarterly 22(2):3–19.

Slesnick, Natasha, and Jillian J. Prestopnik. 2005a. “Ecologically Based Family Therapy Outcome With Substance-Abusing Runaway Adolescents.” Journal of Adolescence 28(2):277–98. (This study was reviewed but did not meet CrimeSolutions' criteria for inclusion in the overall program rating.)

Slesnick, Natasha, and Jillian J. Prestopnik. 2005b. “Dual and Multiple Diagnosis Among Substance Using Runaway Youth.” American Journal of Drug and Alcohol Abuse 31(1):179–201.

Slesnick, Natasha, Gizem Erdem, Suzanne Bartle–Haring, and Gregory S. Brigham. 2013. “Intervention With Substance-Abusing Runaway Adolescents and Their Families: Results From a Randomized Clinical Trial.” Journal of Consulting and Clinical Psychology 81(4):600–614. (This study was reviewed but did not meet CrimeSolutions’ criteria for inclusion in the overall program rating.)

Slesnick, Natasha. 2000. “Treatment Manual: Ecologically Based Family Therapy for Substance-Abusing Runaway Youth.” Unpublished manuscript.

Following are CrimeSolutions-rated programs that are related to this practice:

Interventions Targeting Street-Connected Youth

Interventions that aim to improve the situation of street-connected children and young people. The practice is rated Effective for family functioning, but Ineffective for alcohol use, depression levels, delinquent behaviors, and internalizing behaviors.

Evidence Ratings for Outcomes

	Family Functioning - Family functioning
	Drugs & Substance Abuse - Alcohol
	Mental Health & Behavioral Health - Internalizing behavior
	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Psychological functioning

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?