Brief Strategic Family Therapy (BSFT)
Brief Strategic Family Therapy (BSFT) is a short-term, family-based therapeutic intervention model that targets children and adolescents aged 6 to 18 years. BSFT was designed to eliminate or reduce drug use and associated behavior problems and to restructure problematic family interactions. The approach is based on the assumption that family-based interactions strongly influence how children behave and that targeting and improving maladaptive family interactions would reduce the likelihood of behavioral problems. BSFT was originally developed at the University of Miami.
Training and technical assistance are currently provided by the Family Therapy Training Institute of Miami (FTTIM), founded and directed by BSFT’s co-developer, Olga E. Hervis, as well as by the Center for Family Studies.
The target population for BSFT is children and adolescents aged six to 18, who are experiencing family problems, involved with substances, presenting behavioral difficulties and associating with antisocial peers. The program utilizes a family systems approach and consequently involves all members of the family. It seeks to change the way family members act toward each other in order to maximize their mastery over the kind of interactions that are required to achieve competence and impede undesired behaviors.
BSFT was originally developed with Hispanic/Latino families but was subsequently tested with African American and white families as well. More recently it was selected by NIDA to be the adolescent treatment model to be tested as part of the National Clinical Trials Network. It was tested in 8 sites throughout the country with populations of all ethnic groups. The model is currently utilized in a wide variety of geographical settings and has proven to be successful with foster, as well as intact, families of varied ethnic backgrounds.
It has also been implemented in the service delivery field with several language and cultural minority groups, including Native Americans. BSFT was also successfully tested in the treatment of children ages 6 thru 12 who presented with internalizing symptomatology. That study was awarded the Outstanding Research Award by the American Association for Marriage and Family Therapy in 1989.
BSFT and its adaptations have been implemented in more than 20 states in the USA and in a variety of clinical formats, including home and center-based programs. Note: Adaptations, according to Wayne Harding, leader of the National Center’s evaluation team, should only be made in consultation with the model’s developers in order to "...retain the core components and ....preserve its effectiveness.”
BSFT is delivered in 8 to 17 weekly, one to one and a half hour sessions in which the family and BSFT counselor meet either in the family’s home or the therapist’s office. The four steps of this intervention consist of:
(1) Organizing a counselor-family work team. Developing a therapeutic alliance with each family member, and with the family as a whole, is essential for success.
(2) Diagnosing the nature of family strengths and problematic relationships. Emphasis is made on those family relationships that are supportive or problematic and on the impact they have upon the children’s behavior.
(3) Developing a treatment strategy aimed at capitalizing on strengths and correcting problematic family relations in order to increase family competence. Thus, the counselor’s approach is planned, problem-focused, direction-oriented (so s/he can move from problematic to competent interactions), and practical.
(4) Implementing change strategies and reinforcing family behaviors that sustain new levels of family competence. Important change strategies include the use of reframes to change the meaning of interactions; shifts in the nature of alliances and interpersonal boundaries; building conflict resolution skills; and providing parents with guidance and coaching.
The key approaches are (1) focus on improving parent–child interactions; (2) parent training; (3) developing conflict resolution, parenting, and communication skills; and (4) family therapy.
The BSFT approach requires the involvement of the whole family. As a consequence, it usually operates during afternoons, evenings and Saturdays.
The Family Therapy Training Institute of Miami (FTTIM) provides training and technical assistance in BSFT. Training is generally delivered on-site, at the agency location, in order to maximize adaptability and reduce costs. Agencies considering BSFT should determine whether 3 BSFT is the best fit to local needs and conditions, as well as whether there is the necessary administrative and financial support to make the model sustainable over a period of years.
“Overview of BSFT”
Programs of 1-3 days in length can be provided for states, local municipalities and agencies that are considering the model, but require more information in order to arrive at an appropriate decision.
BSFT Certification Training
To ensure program fidelity, efficacy, and sustainability, agencies must train clinicians to the level of Certification. While there is no legal requirement for licensure of providers of BSFT, Certification is almost always required by governmental entities that endorse evidence based practices, and also by the funding providers.
Following certification, BSFT certified Trainers and Supervisors provide ongoing Adherence Monitoring for a period of at least three years. After a period of consistent adherence, agencies are encouraged to identify candidates who may be able to function as BSFT Supervisors and Trainers. It has been shown that developing the internal capacity to supervise increases the likelihood of sustainability and positive outcomes.
Technical Assistance & Consultation
Technical assistance in the form of clinical case consultation, BSFT measures for assessing outcomes, and organizational considerations can be obtained on an as-needed basis.
The Family Therapy Training Institute of Miami can provide consultation to organizations for the selection of appropriate clinicians to train, as well as varied implementation and adaptation issues.
Kathleen A. Shea, Ph.D.
Administrator
Family Therapy Training Institute of Miami
1221 Brickell Avenue, 9th Floor
Miami, FL 33131
Phone: (305) 668-0850 direct
Fax: (786) 953-8404 fax
kshea@nsft-av.com
http://www.bsft-av.com
Lisa Bokalders
Associate for Instructional Resources and Planning
Family Therapy Training Institute of Miami
1221 Brickell Avenue, 9th Floor
Miami, Fl 33131
Cell: (561) 312-6850
lbokalders@bsft-av.com
http://www.bsft-av.com
Model Co-developer
Olga E. Hervis, M.S.W., L.C.S.W.
Executive Director
Family Therapy Training Institute of Miami
1221 Brickell Ave, 9th Floor
Miami, FL 33131
Phone: (888) 527-3828
E-mail: info@bsft-av.com or ohervis@bsft-av.com
Web site: www.bsft-av.com
The Family Therapy Training Institute of Miami can customize training packages that address the specific needs of an organization depending on staff experience, treatment population, and training cohort size. For a personalized proposal useful for planning purposes, please email us at info@BSFT-av.com.
This certification-level training is delivered in a series of four, three-day workshops over a period of several months. A period of weekly clinical supervision lasts from three to six months, depending on trainee advancement. BSFT certification is granted by the BSFT Competency Board. In general terms, the recommended budget for an agency implementing BSFT to certify a team of 4 to 6 clinicians is approximately between $65,000 - $80,000 for Year One, which includes travel, education material and resources, the BSFT manual, and consultation.
For more information about the program, see the Family Therapy Training Institute of Miami’s website at www.bsft-av.com.
Cost Effectiveness:
The most recent cost-effectiveness study of BSFT, which was conducted in Maryland late 2008, showed that the cost for treating one family through the full range of 24 sessions was $3,200.
That equates to $132 per session, or in a typical family of 4, $800 per person for the full cost of treatment. In summary, in the study, it cost $35 per person, per session.
In general, various studies exist in the United States that show how the successful implementation of evidence based practices reduces crime and saves billions of taxpayers’ money. “Interventions that follow all evidence-based practices can achieve recidivism reductions of 30 percent. In one widely cited 2006 review of more than 550 program evaluations, the Washington State Institute for Public Policy found that a moderate to-aggressive investment in evidence-based programs would save state taxpayers $2 billion, avert prison construction and reduce the crime rate.” Citation: Pew Center on the States, One in 31: The Long Reach of American Corrections (Washington, DC: The Pew Charitable Trusts, March 2009).
A large body of research provides evidence of BSFT's efficacy.
4 Relative to comparisons, participating children/adolescents and their families showed:
- 75% reduction in drug use
- 75% of families remained in the program for the full dosage
- 58% reduction in association with antisocial peers
- 42% improvement in conduct disorder
In addition, Families showed statistically significant:
- Increase in family participation in therapy (92% of referred/non mandated families)
- Improvements in maladaptive patterns of family interactions (family functioning)
- Improvements in family communication, conflict-resolution, and problem-solving skills
- Improvements in family cohesiveness, collaboration, and child/family bonding
Studies have also shown that BSFT is able to engage and retain a significantly larger number of cases than other forms of treatment and demonstrated that the utilization of the BSFT model is associated with improvement in self-concept, parental involvement, conduct and family functioning and with a reduction in substance abuse, emotional problems and association with antisocial peers.
Organizations implementing BSFT are encouraged to gather common outcome measures as well as any locally-relevant or required data. Three, easy-to-use measures include:
- McMaster Family Assessment Device (FAD)
- Youth Self Report (Achenbach)
- Parenting Practices Questionnaire. Lamborn, S.D., Mounts, N.S., Steinberg, L. & Dornbusch, S.M (1991). published in Child Development, 62, 1049-1065.]
There are a number of instruments which can be recommended, but they should be considered in light of an agency’s interests and reporting requirements. Here are a few for consideration:
- Structural Family Systems Rating (proprietary to FTTIM).
- Revised Behavior Problem Checklist (Quay and Peterson). There are parent, child, and teacher forms. It also has a validated Spanish form.
- DISC (Diagnostic Interview for Children) Predictive Scales. This measure is used at baseline to identify the presence or absence of 13 comorbid disorders. DISC has both youth and parent forms. This could be used Pre/Post.
- Brief Symptoms Inventory. This measure is a self-report scale developed from its parent instrument the Symptom Checklist 90 to assess psychological problems.
- National Youth Survey. This self-report delinquency scale assesses adolescent criminal behavior on 5 subscales.
- Pittsburgh Youth Survey. This measure assesses parenting practices through both parent and adolescent report.
- Family Environment Scale. This is used to measure the social-environmental characteristics of families.
- Parenting Practices Questionnaire. Lamborn, S.D., Mounts, N.S., Steinberg, L. & Dornbusch, S.M (1991). published in Child Development, 62, 1049-1065.]
- 2009 SAMHSA Science & Service Award –presented to Carroll County, Maryland for exemplary BSFT implementation
- Substance Abuse and Mental Health Services Administration: Exemplary Model Program
- Society for Prevention Research: Presidential Award
- SAMHSA’s Center for Substance Abuse Prevention: Research Award
- Strengthening America’s Families: Exemplary II Program
- Blueprints for Violence Prevention: Promising Program
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Hervis, O.E., Szapocznik, J., Mitrani, V., Rio, A. & Kurtines, W. (1998). Structural family systems ratings scale. In J. Touliatos (Ed.) Handbook of family measurement techniques (2nd edition), New York: Microfiche Publications.
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