Comparing Family Functioning in Usual Care Among Adolescents Treated for Behavior Problems

Healthy family functioning is important for successful adolescent development and serves as a protective factor against adolescent behavior problems. When adolescent behavior problems exist, family therapy can help promote warmth and cohesiveness in the family, which results in healthier family functioning. Furthermore, family therapy is the gold standard for treating adolescent behavior problems. However, most of the research on family therapy for adolescents are with manualized models that have difficulty being implemented in usual care. The purpose of this study was to compare the effectiveness of family therapy in improving family functioning as compared to individually-based treatments, all of which were offered in usual care settings. Participants were 205 adolescents and their caregivers living in a large, metropolitan area. Data were collected at four time points (baseline, 3-, 6-, and 12-month follow-up) and analyzed using latent growth curve modeling. Family functioning was assessed by separate caregiver and adolescent reports of cohesion and conflict subscales on the Family Environment Scale and caregiver-reported parent-adolescent domain of the Stress Index for Parents of Adolescents. Across treatments, caregivers reported improvement in family cohesion and decreases in family conflict and parental stress. Similarly, adolescents across treatments reported a decrease in family conflict but no concomitant increase in family cohesion. Overall, there was no between-treatment differences in overall change with both conditions showing improvement in family functioning. Results indicate that both family therapy and non-family treatment in usual care for adolescent behavior problems are effective for improving family functioning, suggesting that existing treatment services are viable options for adolescent behavioral health when offered under monitored conditions.