Transporting Clinical Research to Community Settings: Designing and Conducting a Multisite Trial of Brief Strategic Family Therapy

This paper describes the development and implementation of a trial of Brief Strategic Family Therapy (BSFT), an evidence-based drug intervention for adolescents, in eight community substance abuse treatment programs. Researchers and treatment programs collaborated closely to identify and overcome challenges, many of them related to achieving results that were both scientifically rigorous and applicable to the widest possible variety of adolescent substance abuse treatment programs. To meet these challenges, the collaborative team drew on lessons and practices from efficacy, effectiveness, and implementation research

Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

PURPOSE: Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. METHODS: This cross-sectional study includes youth aged 16-25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014-2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16-17, 18-21, 22-25 years). RESULTS: Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16-17 years old (14%) and highest among those aged 22-25 (39%). CONCLUSIONS: In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders

Baseline representativeness of patients in clinics enrolled in the PRimary care Opioid Use Disorders treatment (PROUD) trial: comparison of trial and non-trial clinics in the same health systems

BACKGROUND: Pragmatic primary care trials aim to test interventions in real world health care settings, but clinics willing and able to participate in trials may not be representative of typical clinics. This analysis compared patients in participating and non-participating clinics from the same health systems at baseline in the PRimary care Opioid Use Disorders treatment (PROUD) trial. METHODS: This observational analysis relied on secondary electronic health record and administrative claims data in 5 of 6 health systems in the PROUD trial. The sample included patients 16-90 years at an eligible primary care visit in the 3 years before randomization. Each system contributed 2 randomized PROUD trial clinics and 4 similarly sized non-trial clinics. We summarized patient characteristics in trial and non-trial clinics in the 2 years before randomization ( baseline ). Using mixed-effect regression models, we compared trial and non-trial clinics on a baseline measure of the primary trial outcome (clinic-level patient-years of opioid use disorder (OUD) treatment, scaled per 10,000 primary care patients seen) and a baseline measure of the secondary trial outcome (patient-level days of acute care utilization among patients with OUD). RESULTS: Patients were generally similar between the 10 trial clinics (n = 248,436) and 20 non-trial clinics (n = 341,130), although trial clinics\u27 patients were slightly younger, more likely to be Hispanic/Latinx, less likely to be white, more likely to have Medicaid/subsidized insurance, and lived in less wealthy neighborhoods. Baseline outcomes did not differ between trial and non-trial clinics: trial clinics had 1.0 more patient-year of OUD treatment per 10,000 patients (95% CI: - 2.9, 5.0) and a 4% higher rate of days of acute care utilization than non-trial clinics (rate ratio: 1.04; 95% CI: 0.76, 1.42). CONCLUSIONS: trial clinics and non-trial clinics were similar regarding most measured patient characteristics, and no differences were observed in baseline measures of trial primary and secondary outcomes. These findings suggest trial clinics were representative of comparably sized clinics within the same health systems. Although results do not reflect generalizability more broadly, this study illustrates an approach to assess representativeness of clinics in future pragmatic primary care trials

Brief Strategic Family Therapy™ for Adolescents with Behavior Problems

This chapter contains sections titled: Evolution of BSFT Theoretical Principles Intervention Strategies Treatment Parameters BSFT Case Example Research Findings Conclusion Notes Reference

Taking Brief Strategic Family Therapy from Bench to Trench: Evidence Generation Across Translational Phases

In this article, we review the research evidence generated over 40 years on Brief Strategic Family Therapy illustrating the NIH stages of intervention development and highlighting the translational process. Basic research (Stage 0) led to the discovery of the characteristics of the population and the nature of the problems that needed to be addressed. This step informed the selection of an intervention model that addressed the problems presented by the population, but in a fashion that was congruent with the population's culture, defined in terms of its value orientations. From this basic research, an intervention that integrated structural and strategic elements was selected and refined through testing (Stage I). The second stage of translation (Stage II) included efficacy trials of a specialized engagement module that responded to challenges to the provision of services. It also included several other efficacy trials that documented the effects of the intervention, mostly in research settings or with research therapists. Stages III/IV in the translational process led to the testing of the effectiveness of the intervention in real-world settings with community therapists and some oversight from the developer. This work revealed that an implementation/organizational intervention was required to achieve fidelity and sustainability of the intervention in real-world settings. The work is currently in Stage V in which new model development led to an implementation intervention that can ensure fidelity and sustainability. Future research will evaluate the effectiveness of the current implementation model in increasing adoption, fidelity, and long-term sustainability in real-world settings

Cultural differences in adolescent drug abuse

This chapter describes the epidemiology of drug use among adolescents from different racial and ethnic groups. Second, it addresses the cultural variables prevalent in each of these groups and their relevance in the delivery of clinical care. Third, it describes the risks and protective factors for adolescent drug use and their interface with culture and the screening tools available for the pediatrician. Finally, we present the treatment and model programs of prevention that were tested specifically with ethnic groups ranked by the National Registry of Evidence-Based Programs

Family-Based Treatments for Adolescent Substance Use

Adolescent substance use is a major risk factor for negative outcomes, including substance dependence later in life, criminal behavior, school problems, mental health disorders, injury, and death. This article provides a user-friendly, clinically focused, and pragmatic review of current and evidence-based family treatments, including multisystemic therapy, multidimensional family therapy, functional family therapy, brief strategic family therapy, ecologically based family therapy, family behavior therapy, culturally informed flexible family treatment for adolescents, and strengths-oriented family therapy. Outcomes, treatment parameters, adolescent characteristics, and implementation factors are reviewed

Brief strategic family therapy: an empirically-validated intervention for reducing adolescent behavior problems

Brief Strategic Family Therapy (BSFT) is an empirically-supported treatment for children and adolescents with behavior problems and substance use problems. For three decades, the efficacy and effectiveness of BSFT has been established through the results of rigorous clinical trials studies conducted at the University of Miami's Center for Family Studies. BSFT is based on family systems approaches, most notably the work of Salvador Minuchin and Jay Haley, but has been refined to meet the pressing needs of youth with behavior problems. BSFT theory and interventions cover four broad domains: joining with family members and the family system, assessing problematic family interactions, creating a motivational context for change, and restructuring family interactions

Integration of Public Health in LCME Accredited Medical Schools in Florida: A Survey Based Study

Introduction: The future physician will face a career challenged by a number of significant changes in healthcare, including changes in demographics and disease, an increasing focus on population health and value-based care, and changes in healthcare funding. National organizations have called for medical schools to better prepare students for these challenges, and to incorporate more public health education in medical school. While many medical schools have responded, the topics covered, the timing in the curriculum, and the importance of these topics for graduation vary widely. Florida has been a site of growth in medical education in the last 10 years. Given that new medical schools were developed during a period of increased emphasis on the need for public health education, a survey was developed to assess the state of public health education in medical schools accredited by the Liaison Committee for Medical Education (LCME) in the state of Florida. Methods: The survey included questions on school location, size of the student body, date of initial LCME accreditation, presence of department or school of public health, and presence of a pathway or track in public health. The survey asked detailed questions about public health content, curricula delivery methods, and timing of the curriculum within the four-year course of study as well as the courses providing public health content. The survey asked about the value of curricular content and the survey itself. The online survey was sent to the associate or senior associate deans for education in the seven LCME accredited schools who had full or provisional accreditation as of December 2017. Data collection occurred between March 14 and March 30, 2018. Results: Six of the seven medical schools responded. Of the eleven competencies included in the survey, schools reported between five and eleven. Three schools cover nine or more of the eleven competencies. The number of competencies covered was not statistically influenced by age of the school, percentage of underrepresented students in medicine, the presence of a school or department of public health, or a special pathway or track in public health. The most common teaching method used was a didactic lecture, and the least was the structured experience with a local health organization. The fourth year of medical school saw the least amount of public health education. Five of the six respondents felt that the competencies presented here are very important to extremely important, and one school feels that they are moderately important. Discussion: Nationally, education in public health is an important component in medical education, but the topics included, educational methods used and the importance of the content varies from school to school. The state of public health education in medical schools in Florida is robust in some schools. The individuals responsible for the curriculum support the importance of these topics. The content is delivered through a diversity of pedagogical methods. The study results demonstrate a number of opportunities for enhancement. Conclusion: Given the importance of public health content in medical schools, survey methodology using established competencies to assess public health curricula could be used in the US to provide an up-to-date assessment of the strengths and opportunities for improvement in this area