Family Therapy Via Video Teleconference for Substance-Abusing Rural Adolescents
Condition: Substance-Related Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The current proposal is a randomized clinical trial testing the efficacy of Functional Family
      Therapy (FFT) administered by video teleconference (FFT-V) in the homes of substance abusing
      adolescents. In the proposed investigation, FFT-V will be compared with FFT administered
      face-to-face in the family home as well as to a services-as-usual (SAU) condition. The
      overarching objective of the study is to examine the degree to which an empirically based
      model of substance abuse treatment such as FFT can be effectively administered via video
      teleconferencing to adolescents and families living in rural and remote areas who would be
      otherwise unlikely to access treatment. The specific aims of the proposed study are to (1)
      evaluate the efficacy of FFT-V compared to FFT and SAU in reducing adolescent drug use, HIV
      risk behavior, delinquency, and recidivism, (2) evaluate the efficacy of FFT-V compared to
      FFT in establishing functional levels of therapeutic alliance formation, treatment
      attendance, retention, and satisfaction with treatment, (3) evaluate the efficacy of FFT-V
      compared to FFT and SAU in impacting core mechanisms of change in adolescent behavior
      including improved levels of family functioning and adolescent association with substance
      using peers, and (4) conduct a preliminary cost-effectiveness analysis to derive initial
      estimates of the relative costs of each treatment modality per outcome unit.
    

Detailed description: 
      It has been well documented that only about 10% of adolescents with clinically diagnosable
      substance use problems receive treatment in any given year. One of the major contributing
      factors to chronic levels of unmet need for treatment among this population is the
      unavailability and inaccessibility of treatment services. Service accessibility is
      particularly limited in rural areas. To address problems of service availability and
      accessibility in rural areas, the use of video teleconferencing technology to provide direct
      services has emerged within the fields of medicine and psychiatry in particular. The use of
      such technology to enhance the delivery of behavioral psychotherapy is beginning to emerge as
      well. A handful of primarily small-scale pilot and feasibility studies indicate that
      psychotherapy interventions administered using video teleconferencing technology may be as
      effective as traditional face-to-face interventions. Few randomized clinical trials of
      telepsychotherapy have been conducted to date, however, and virtually none have examined
      video teleconferencing interventions for any type of child or adolescent behavioral problem
      including substance abuse. The proposed study is intended to address the need for research
      evaluating the application of video teleconferencing technology as a means of service
      delivery for substance abusing adolescents and their families living in rural areas.
      Specifically, this study will examine the efficacy of Functional Family Therapy administered
      by video teleconference (FFT-V) in the homes of substance abusing adolescents. FFT-V will be
      compared with FFT administered face-to-face in the family home as well as to
      services-as-usual (SAU) coordinated through the Juvenile Services Division (JSD) of the State
      of New Mexico Children, Youth, and Families Department (CYFD). FFT, based on more than 30
      years of research, is an established EBT for adolescent substance abuse and related problem
      behaviors such as HIV risk and delinquency. Moreover, FFT is one of few evidence-based
      therapies shown to be effective for rural families. The study will be conducted in the homes
      of participating adolescents and parents living in rural communities located between 30 and
      50 miles from the Center for Family and Adolescent Research (CFAR) in Albuquerque, NM. One
      hundred and twenty youth will be referred to the study by Children Youth and Family
      Department juvenile probation officers within two rural counties in New Mexico, Sandoval and
      Valencia, which are adjacent to the town of Albuquerque which is located in Bernalillo
      County. Adolescent participants meeting diagnostic criteria for substance abuse or
      dependence, along with the participating parent, will be randomly assigned to the FFT, FFT-V,
      or SAU conditions. Four assessments of all participants in all three conditions will occur
      at: pre-treatment, 4-, 8-, and 12 months after treatment initiation. Outcome analyses will
      examine adolescent substance abuse, HIV risk behavior, delinquency, and recidivism, family
      functioning, and adolescent association with substance abusing peers. The study will also
      examine clinical process variables known to impact treatment efficacy (e.g., therapeutic
      alliance formation, treatment motivation, and retention). The overarching objective of the
      study is to examine the degree to which an empirically based model of substance abuse
      treatment such as FFT can be effectively administered via video teleconferencing to
      adolescents and families living in rural and remote areas and thus have less access to
      treatment.
    

Intervention name(s): Functional Family Tx; Services as Usual
Intervention type(s): Behavioral; Behavioral
Other intervention name(s): FFT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Substance Abuse; Adolescents; Families; Functional Family Therapy; Video; Teleconferencing; Telemedicine