Slesnick, N., & Prestopnik, J. (2005). Ecologically Based Family Therapy outcome with substance abusing runaway adolescents. Journal of Adolescence, 28(2), 277–298. https://doi.org/10.1111/j.1752-0606.2009.00121.x

Type of Study: Randomized controlled trial
Number of Participants: 124

Population:

• Age — 12–17 years
• Race/Ethnicity — 51 Hispanic, 46 Anglo, 13 Other, 9 African American, and 5 Native American
• Gender — 73 Female and 51 Male
• Status — Participants were recruited from two local runaway shelters in Albuquerque, NM.

Location/Institution: University of New Mexico, Albuquerque

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on the impact of Ecologically Based Family Therapy (EBFT) on substance use, HIV risk, psychological and family functioning, and diagnostic status over time compared to service as usual (SAU) through the runaway shelter. Participants were randomly assigned to either the EBFT condition or the SAU condition. Measures utilized include the Form 90, the Youth Self-Report (YSR) of the Child Behavior Checklist (CBCL), the Beck Depression Inventory (BDI), and urine toxicology screens were collected for adolescents at pretreatment and the first post-treatment follow-up point. Results indicate that overall, participants who received EBFT showed a greater reduction in overall substance use compared to those assigned to SAU. Among youth who reported physical and sexual abuse, those assigned to EBFT reported fewer problem consequences and reported a reduction in the number of different drugs used over time compared to those in SAU. Limitations include, did not conduct independent ratings of treatment fidelity for EBFT, lack of generalizability of findings to runaway youth in other parts of the country that have different ethnic and racial compositions, and the reliance on youth self-report of their family environment and their own behavior.

Length of controlled postintervention follow-up: 6 and 12 months.

Slesnick, N., & Prestopnik, J. (2009). Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital & Family Therapy, 35(3), 255–277. https://doi.org/10.1111/j.1752-0606.2009.00121.x

Type of Study: Randomized controlled trial
Number of Participants: 119

Population:

• Age — 12–17 years
• Race/Ethnicity — 44% Hispanic, 29% Anglo, 11% Native American, 11% Other, and 5% African American
• Gender — 55% Female and 45% Male
• Status — Participants were primarily alcohol problem adolescents and their primary caretakers from two runaway shelters.

Location/Institution: Albuquerque, NM

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate alcohol problems in runaway adolescents and their families. Participants were assigned to either (a) home-based Ecologically Based Family Therapy (EBFT), (b) office-based Functional Family Therapy (FFT), or (c) service as usual (SAU) through the shelter. Measures utilized include the Youth Self-Report of the Child Behavior Checklist, the computerized version of the Diagnostic Interview Schedule for Children (CDISC), the Beck Depression Inventory (BDI), and the Conflict Tactics Scale (CTS). The Form 90 was used to assess alcohol and drug patterns, and urine toxicology screens were collected at pre- and posttreatment assessment to verify self-reported illicit drug use. Results indicate that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared to SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcomes. Limitations include that it is difficult to conclude whether the findings are the result of the context of treatment (home vs. office) or of treatment condition (FFT vs. EBFT), small sample size, and lack of generalizability to other youth.

Length of controlled postintervention follow-up: 6–11 months.

Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013). Intervention with substance-abusing runaway adolescents and their families: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 81(4), 600–614. https://doi.org/10.1037/a0033463

Type of Study: Randomized controlled trial
Number of Participants: 179

Population:

• Age — 12-17 years
• Race/Ethnicity — 118 African American and 46 White, non-Hispanic
• Gender — 53% Female and 48% Male
• Status — Participants were from a short-term (usually 3 days) crisis shelter and services for minor adolescents.

Location/Institution: Runaway shelter in a Midwestern city

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of 3 theoretically distinct interventions among substance abusing runaway adolescents and to explore individual differences in trajectories of change. Participants were randomly assigned to the Community Reinforcement Approach (CRA), Motivational Interviewing (MI), or Ecologically Based Family Therapy (EBFT). Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Interview, and urine screens. Results indicate that there was significant improvement in frequency of substance use among runaways in all 3 treatment groups, with a slight increase at posttreatment. Few differences among the three treatment conditions were noted. Results also indicate that CRA, EBFT, and MI are viable treatments for runaway substance-abusing adolescents. Limitations include relatively small sample size, concerns about generalizability to other locations, that participants completed less than 50% of the available sessions, and differences in the fidelity ratings between the three treatments.

Length of controlled postintervention follow-up: 21 months.

The following studies were not included in rating EBFT on the Scientific Rating Scale...

Slesnick, N., & Prestopnik, J. (2004). Office versus home-based family therapy for runaway, alcohol abusing adolescents: Examination of factors associated with treatment attendance. Alcoholism Treatment Quarterly, 22(2), 3–19. https://doi.org/10.1300/J020v22n02_02

The purpose of the study was to examine predictors of treatment attendance for runaway substance-abusing youth and their families. Participants were randomly assigned to either Ecologically Based Family Therapy (EBFT) or Functional Family Therapy (FFT). Measures utilized include the Youth Self-Report of the Child Behavior Checklist, as well as the Form 90 interview, which was the primary measure of quantity-frequency of adolescent substance use, yielding the total percent days, in the last 90, of all alcohol and drug use. Results indicate that more families assigned to home-based EBFT were both engaged and attended more sessions compared to families assigned to the office-based FFT. 76% of the EBFT families participated in four or more sessions, while only 50% of the families assigned to FFT participated in four or more sessions. Adolescents with externalizing problems receiving EBFT had better attendance than those receiving FFT. However, severity of the adolescent’s alcohol and drug use did not significantly predict treatment attendance in either EBFT or FFT. Limitations include the sole focus on shelter-residing runaway youth with primary alcohol problems, and findings based upon data collected solely from the adolescents’ perspectives. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome, just treatment attendance.

Slesnick, N., Guo, X., & Feng, X. (2013). Change in parent- and child-reported internalizing and externalizing behaviors among substance abusing runaways: The effects of family and individual treatments. Journal of Youth and Adolescence, 42(7), 980–993. https://doi.org/10.1007/s10964-012-9826-z

The study used the same sample as Slesnick et al. (2013). The purpose of the study was to compare three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically Based Family Therapy (EBFT) with substance abusing runaway adolescents and their primary caretaker. Participants were randomly assigned to MI, CRA or EBFT. Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL), and a demographic questionnaire. Results indicate that adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to show sustained improvements at the final follow-up time point. Limitations include attrition; missing data; convenience sampling; requirement to have a caregiver participate in treatment; and adolescents were substance abusing, and family relationships and predictors associated with future runaway and homeless episodes might differ among those who do not abuse alcohol and/or drugs. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Slesnick , N., Guo, X., Brackenhoff, B., & Feng, X. (2013). Two-year predictors of runaway and homeless episodes following shelter services among substance abusing adolescents. Journal of Adolescence, 36, 787–795. https://doi.org/10.1016/j.adolescence.2013.06.007 

The study used the same sample as Slesnick et al. (2013). The purpose of the study was to follow substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial comparing three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically Based Family Therapy (EBFT). Predictors of runaway and homeless episodes were examined over a two year period. Participants were randomly assigned to MI, CRA, or EBFT. Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL), and a demographic questionnaire. Results indicate that substance use and family cohesion predicted future runaway and homeless episodes, but family conflict, depressive symptoms, delinquency, or school enrollment did not predict that outcome. Limitations include attrition; missing data; use of participants from a single runaway shelter; and adolescents were substance abusing, and family relationships and predictors associated with future runaway and homeless episodes might differ among those who do not abuse alcohol and/or drugs. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Guo, X., & Slesnick, (2013). Family versus individual therapy impact on discrepancies between parents' and adolescents' perception over time. Journal of Marital and Family Therapy, 39(2), 182–194. https://doi.org/10.1111/j.1752-0606.2012.00301.x

The study used the same sample as Slesnick et al.(2013). The purpose of the study was to examine the degree of disagreement between runaway adolescents and their primary caretakers, defined as informant discrepancies, on their view of their family. How these discrepancies changed over time and whether family therapy or individual therapy could impact that change were explored by comparing three empirically supported psychotherapy interventions, Motivational Enhancement Therapy (MET), the Community Reinforcement Approach (CRA), and Ecologically Based Family Therapy (EBFT). Participants were randomly assigned to MET, CRA or EBFT. Measures utilized include the Family Environment Scale (FES), a demographic questionnaire, and administrative data on sessions completed. Results indicate that among those receiving EBFT, but not CRA or MET, informant discrepancies decreased significantly over time. Additionally, dyads with a male adolescent showed a significantly slower rate of improvement in discrepancy scores across time compared with dyads with a female adolescent. Limitations include that the direction of the discrepancy cannot be determined by the statistical methods used in the study; the somewhat low reliabilities of the FES subscales; and that results may not be generalizable to other populations, as families with a substance abusing runaway adolescent have long been recognized to represent some of the most distressed families. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Guo , X., Slesnick, N., & Feng, X. (2014). Reductions in depressive symptoms among substance-abusing runaway adolescents and their primary caretakers: A randomized clinical trial. Journal of Family Psychology, 28(1), 98–105. https://doi.org/10.1037/a0035380

The study used the same sample as Slesnick et al. (2013). The purpose of the study was to compare the effects of Ecologically Based Family Therapy (EBFT) with two individually based substance abuse interventions, the Community Reinforcement Approach (CRA) and Motivational Enhancement Therapy (MET), on runaway adolescents’ and their primary caregivers’ depressive symptoms. Participants were randomly assigned to CRA, MET or EBFT. Measures utilized include the Computerized Diagnostic Interview Schedule for Children (CDISC), the Form 90 Substance Use Interview, the Beck Depression Inventory-II, and the Youth Self-Report (YSR)/Child Behavior Checklist (CBCL). Results indicate that youth’s depressive symptoms were significantly reduced in each treatment to 2 years postbaseline. However, the trajectory of change differed across treatments, with adolescents receiving MET showing a more rapid reduction in depressive symptoms, but a quicker increase in symptoms compared with adolescents receiving EBFT. Caregivers receiving EBFT showed a statistically significant decline in depressive symptoms, but this was not observed for the CRA and MET conditions. Limitations include the small sample size within each treatment group, concerns about generalizability beyond the single runaway shelter the sample was drawn from, attrition rates, and missing data. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on substance use as an outcome.

Zhang, J., & Slesnick, N. (2017). Discrepancies in autonomy and relatedness promoting behaviors of substance using mothers and their children: The effects of a family systems intervention. Journal of Youth and Adolescence, 46(3), 668–681. https://doi.org/10.1007/s10964-016-0549-4 

The purpose of the study was to examine whether participation in Ecologically Based Family Therapy (EBFT) was associated with the joint trajectory of mother-child discrepancies, and mothers’ and children’s individual responses in autonomy and relatedness behaviors. Participants were randomly assigned to receive one of three intervention conditions: EBFT-home, EBFT-office, or Women’s Health Education (WHE, mothers only). Measures utilized include the Child Behavior Checklist (CBCL), and the Areas of Change Questionnaire (ACQ). Results indicate that subgroups varying in mother-child discrepancy patterns in their autonomy and relatedness behaviors were identified. The results also indicated that participation in EBFT was associated with decreased mother-child discrepancies, and also a synchronous increase in the mother’s and the child’s autonomy and relatedness. Additionally, increased mother-child discrepancies and mother-child dyads showing no change in autonomy and relatedness was associated with higher levels of children’s problem behaviors. The findings reveal a dynamic process of mother-child discrepancies in autonomy and relatedness behaviors related to child outcomes. Limitations include children of mothers assigned to the comparison condition did not receive any therapy while those in the EBFT conditions did, and concerns about generalizability to other populations or locations. Note: This article is not used in the rating of EBFT in the Substance Abuse Treatment (Adolescent) topic area since it did not focus on adolescent substance use as an outcome.