How to Coach Yourself and Others Coaching Families

Results showed that 81 percent of families were successfully engaged in the BSFT plus BSFT engagement experimental treatment. In contrast, 60 percent of the families in the two control therapies were successfully engaged. These differences in engagement were statistically significant. However, the efficacy of the experimental therapy procedures was moderated by the cultural/ethnic identity of the Hispanic families in the study. Among families assigned to BSFT engagement, 93 percent of the non-Cuban Hispanics (composed primarily of Nicaraguan, Colombian, Puerto Rican, Peruvian, and Mexican families) and 64 percent of the Cuban Hispanics were engaged. These findings have led to further study of the mechanism by which culture/ethnicity and other contextual factors may influence clinical processes related to engagement (Santisteban et al. 1996; Santisteban et al. in press). The results of the Szapocznik et al. (1988) and Santisteban et al. (1996) studies strongly support the efficacy of BSFT engagement. Further, the second study with its focus on cultural/ethnic identity supports the widely held belief that therapeutic interactions must be responsive to contextual changes in the treatment population (Sue et al. 1994; Szapocznik and Kurtines 1993). A third study (Coatsworth et al. 2001) compared BSFT to a community control intervention in terms of its ability to engage and retain adolescents and their families in treatment. An important aspect of this study was that an outside treatment agency administered the control intervention. Because of that, the control intervention (e.g., usual engagement strategies) was less subject to the influence of the investigators. Findings in this study, as in previous studies, showed that BSFT was significantly more successful, at 81 percent, in engaging adolescents and their families in treatment than was the community control treatment, at 61 percent. Likewise, among those engaged in treatment, a higher percentage of adolescents and their families in BSFT, at 71 percent, were retained in treatment compared to those in the community control intervention, at 42 percent. In BSFT, 58 percent of adolescents and their families completed treatment compared to 25 percent of those in the community control intervention. Families in BSFT were 2.3 times more likely both to be engaged and retained in treatment than were families randomized to the community control treatment. An additional finding of the Coatsworth et al. (2001) study warrants special mention. In BSFT, families of adolescents with more severe conduct problem symptoms were more likely to remain in treatment than were families of adolescents whose conduct problem symptoms were less severe. The opposite pattern was evident in the community control intervention, with families that were retained in treatment showing lower intake levels of conduct problems than did families who dropped out. These findings are particularly important because they suggest that adolescents who are most in need of services are more likely to stay in BSFT than in traditional community treatments. 83

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