Preventing Health Disparities in Hispanic Youth

DESIGN AND METHODS. Overview. The first phase of the proposed study will include minor adaptations to the manual to enhance its "fit" with the specific characteristics of the target population, finalizing all assessment measures, finalizing the list of CTAU agencies and the referral mechanisms, conducting therapist training for the CIFTA conditions and assessor/interviewer training, and strengthening our connections with referral sources (months 1- 5). The team is experienced in all of these activities from previous treatment development and clinical trial projects. Immediately following this phase, the investigators will begin to recruit adolescents (11-14 years of age) who meet DSM-IV criteria for two of the following diagnoses (CD, DD, ADD) OR DSM-IV criteria for one diagnosis (CD, DD, ADD) and severe family conflict. Following screening, consent and assessment, the adolescents and their families will be randomly assigned to either the (1) Community Treatment as Usual Agency, or the (2) Culturally Informed Family Therapy for Adolescents. Assessments will be conducted at baseline (T1), post-treatment (T2- 4 months), follow-up 1 (T3- 12 months post baseline) and follow-up 2 (T4- 20 months post baseline). Data from service utilization and self-reports of therapeutic alliance will also be collected throughout the entire course of therapy. Longitudinal data analysis (growth curve modeling) will be used to test study hypotheses. Each of the specific components and procedures are described in detail below.

Design for Manualization of Refinements. The investigators and clinical team have experience in manualizing key treatment components. Although relatively minor, some of the specific refinements the investigators propose, based on our prior experience with CIFTA will include: 1) revising the parent training modules to be developmentally appropriate to middle school ages, 2) the establishment of healthy social activities that can shape the selection of prosocial peer groups and activities before ties to deviant peers are crystallized, 3) the creation of family session material that facilitates the parent-child discussion of country and culture of origin and helps to explore questions about the child's ethnic identity.

Manual Refinement meetings will include counselors and investigators and will be held to clarify the precise nature of the new material to be delivered, the therapeutic processes and procedures that are optimal for delivery of the material, and the interaction between these interventions and other intervention components. New manual entries/clarifications will be written together during the meeting so that the language is recommended and approved by both clinicians and investigators. The investigators have utilized this method in all of our treatment development efforts and the investigators have found that it leads to language that is user-friendly for clinicians. The team also agrees on adherence checklist items that reflect the nature of the intervention.

Therapist Selection, Training and Supervision. Two therapists (.3 FTE each) will deliver the CIFTA intervention. These therapists will be primarily selected from the Center for Family Studies, which has a cadre of therapists that have extensive experience with Hispanic youngsters and have had experience in delivering manualized treatments within a clinical research context. All therapists must also have at least a master's degree in counseling, psychology, social work or a related field. Therapists selected for this study must be bilingual (Spanish and English) to ensure that primarily Spanish-speaking family members can fully participate.

Therapist training. Training will follow the format the investigators have used over many years and also currently utilize in our Training Institute. The first phase of training will consist of a 3-day training workshop that includes the use of didactic material, the treatment manuals, and the presentation of videotaped sessions from our pilot work. The second phase will include intervention implementation with 1 pilot case. A therapist will be required to work with a pilot case for at least a one-month to be certified in that condition. The guidelines for certification the investigators will use are similar to those proposed by Carroll (1998) and will focus on the implementation of key aspects of the revised CIFTA treatment (parenting, skills modules, cultural modules, etc). Key aspects of therapy that receive poor ratings will require retraining. Interventions will be delivered over one month, a briefer period than is typical of the actual intervention in the trial, but will be sufficient to ensure comfort and competence in the key treatment components. There will be a 2 day workshop following the pilot phase to solidify any issues that remain and to incorporate any manual clarification that will assist in achieving high levels of competence and fidelity/adherence. The PI has extensive experience as a workshop trainer in family-oriented and substance abuse interventions.