How to Coach Yourself and Others Coaching Families | Page 82

outpatient agencies serving drug-abusing adolescents. All families who were successfully engaged received
BSFT. In the experimental therapy, families were engaged and retained using BSFT engagement
techniques. Successful engagement was defined as the conjoint family (minimally the identified patient and
his or her parents and siblings living in the same household) attending the first BSFT session, which was
usually to assess the drug-using adolescent and his or her family. Treatment integrity analyses revealed that
interventions in both engagement therapies adhered to prescribed guidelines using six levels of engagement
effort that were operationally defined and that the therapies were clearly distinguishable by level of
engagement effort applied.
The six levels of engagement effort
The six levels of engagement effort, as enumerated in Szapocznik et al. (1988, p. 554), are:
Level 0 - expressing polite concern, scheduling an intake appointment, establishing that cases met criteria
for inclusion in the study, and making clear who must attend the intake assessment;
Level 1 - attempting minimal joining, encouraging the caller to involve the family, asking about the depth
and breadth of adolescent problems, and asking about family members;
Level 2 - attempting more thorough joining; asking about family interactions; seeking information about
the problems, values, and interests of family members; supporting and establishing an alliance with the
caller; beginning to establish leadership; and asking whether all family members would be willing to attend
the intake appointment;
Level 3 - restructuring for engagement through the caller, advising the caller about negotiating and
reframing, and following up with family members (either over the phone or personally with the caller at the
therapist's office) to be sure that intake appointments would be kept;
Level 4 - conducting lower level ecological engagement interventions, joining family members or
conducting intrapersonal restructuring (with family members other than the original caller) over the phone
or in the therapist's office, and contacting significant others (by phone) to gather more information; and
Level 5 - conducting higher level ecological interventions, making out-of-office visits to family members
or significant others, and using significant others to help conduct restructuring.
Level 0-1 behaviors were permitted for both the BSFT engagement and engagement-as-usual conditions.
Level 2-5 behaviors were permitted only for the BSFT engagement condition. Efficacy was measured in
rates of both family treatment entry as well as retention to treatment completion.
Efficacy of methods of engagement
The efficacy of the two methods of engagement was measured by the percentage of families who entered
treatment and the percentage of families who completed the treatment. The results revealed that 42 percent
of the families in the engagement-as-usual therapy and 93 percent of the families in the BSFT engagement
therapy were successfully engaged. In addition, 25 percent of engaged cases in the engagement-as-usual
treatment and 77 percent of engaged cases in the BSFT engagement treatment successfully completed
treatment. These differences in engagement and retention between the two methods of engagement were
both statistically significant. Improvements in adolescent symptoms occurred but were not significantly
different between the two methods of engagement. Thus, the critical distinction between the treatments was
in their different rates of engagement and retention. Therefore, BSFT engagement had a positive impact on
more families than did engagement as usual.
In addition to replicating the previous engagement study, the second study (Santisteban et al. 1996) also
explored factors that might moderate the efficacy of the engagement interventions. In contrast to the
previous engagement study, Santisteban et al. (1996) more stringently defined the success of engagement as
a minimum of two office visits: the intake session and the first therapy session. The researchers randomly
assigned 193 Hispanic families to one experimental and two control treatments. The experimental therapy
was BSFT plus BSFT engagement. The first control therapy was BSFT plus engagement as usual, and the
second was group counseling plus engagement as usual. In both control treatments, engagement as usual
involved no specialized engagement strategies.

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