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Practice Profile

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

Evidence Ratings for Outcomes:

Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
Promising - One Meta-Analysis Education - Academic achievement/school performance

Practice Description

Practice Goals
In general family-based interventions are designed to decrease adolescent problem and antisocial behaviors by making positive changes in their familial and social environments (Dopp et al. 2017). Specifically, these interventions focus on establishing better communication and reducing conflict between parents and adolescents, improving parenting skills, and helping adolescents better engage with their families and in their school environment (Baldwin et al. 2012). Various therapies inform the specific treatment techniques used, including but not limited to behavioral, and cognitive–behavioral therapies.

Target Population
Family-based treatment programs may target a variety of youth, including juvenile offenders with a history of serious antisocial behavior, youth involved in the justice system, and at-risk youth exhibiting behaviors such as conduct problems, substance use, or delinquency.

Practice Activities
Family-based treatments include several types of manualized therapy models. These include Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), Multidimensional Family Therapy (MFT), Multisystemic Therapy (MST), and Treatment Foster Care Oregon (TFCO; formerly known as Multidimensional Treatment Foster Care). Other types of family-based treatment include short-term family intervention, parent skills training, adolescent diversion programs that include a family condition, and intensive home-based services.

These interventions share common components in theoretical framework and service delivery. Generally, family-based interventions are designed to address the specific characteristics of youth and their social systems (i.e., family, peers, school, and neighborhood) that are associated with antisocial and offending behavior. Therefore, family-based treatment conditions always involve the participation of multiple family members in appropriate contexts such as home, school, and community (Dopp et al. 2017).

In addition, while family-based treatment can be delivered on its own, some other program examples included targeted case management as part of the family-based treatment condition or participation in juvenile drug court in addition to treatment (Dopp et al. 2017). Furthermore, setting for services, number of sessions, and length of treatment may vary by therapy type and individual case.

Meta-Analysis Outcomes

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Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Across five studies, Woolfenden, Williams, and Peat (2002) found a statistically significant decrease in the rate of rearrest 1 to 3 years later (SMD = -0.56) indicating that youth who participated in family-based treatment programs were less likely to be rearrested, compared with youth who did not participate in a family-based treatment program. Conversely, Baldwin and colleagues (2012) found that, across four studies of family-based treatment, there was a nonsignificant effect on adolescent delinquency for treatment participants, compared with the participants in a no-treatment control group.
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Dopp and colleagues (2017) examined 89 effect sizes from 28 studies and found that family-based treatment had statistically significant positive effects on antisocial behavior for treatment participants (d = 0.25), compared with the control groups. This finding indicates that youth who were exposed to family-based treatment interventions exhibited less antisocial behavior, compared with control group youth.
Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
Dopp and colleagues (2017) examined 24 effect sizes from 10 studies and found that family-based treatment had statistically significant positive effects on substance use or abuse for treatment participants (d = 0.41), compared with control groups. This finding indicates that youth who were exposed to family-based treatment interventions reported less substance use or abuse, compared with control group youth.
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
Dopp and colleagues (2017) examined 59 effect sizes from 16 studies and found that family-based treatment had a statistically significant positive effect on psychological functioning in treatment participants (d = 0.30), compared with control participants. This finding indicates that youth who were exposed to family-based treatment interventions demonstrated improved psychological functioning, compared with control group youth.
Promising - One Meta-Analysis Education - Academic achievement/school performance
Dopp and colleagues (2017) examined 10 effect sizes from 6 studies and found that family-based treatment interventions had statistically significant positive effects on the school performance of treatment participants (d = 0.29), compared with control participants. This finding indicates that youth who were exposed to family-based treatment interventions demonstrated improved school performance, compared with control group youth.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11973 - 20064210
Meta-Analysis 21973 - 19978749
Meta-Analysis 31990 - 2013285564

Meta-Analysis 1
Baldwin and colleagues (2012) conducted a meta-analysis to examine the effectiveness of family-based treatment intervention programs on substance abuse, delinquency, and conduct problems in adolescents (ages 11–19). Specifically, the authors looked at randomized trials of Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), Multidimensional Family Therapy (MFT), or Multisystemic Therapy (MST). Studies were identified using an electronic search of PsycINFO, Medline, and Dissertation Abstracts International, through February 2009, including published and unpublished work. The treatment had to be delivered on its own (i.e., not in combination with other interventions), and prevention studies were excluded.

A total of 24 randomized controlled designed studies were included. The authors did not report an overall aggregated effect size because varying comparison types made interpreting results difficult. Instead they segregated the sample by types of comparison groups: 1) treatment as usual (i.e., referral to juvenile delinquency treatment center), 2) alternative therapy (i.e., any therapy besides family therapy), and 3) no-treatment control. The comparisons used in this CrimeSolutions.gov review comprised studies of BSFT (n = 3) and FFT (n = 1) compared with no-treatment control groups. The researchers did not provide any descriptive information regarding the study characteristics or sample demographics.

A weighted random effects model was used in the analysis. A mean effect size was calculated, using a standardized mean difference statistic (d). Additional moderator, influence, and publication bias analyses were conducted to account for the heterogeneity across the small number of studies included.

Meta-Analysis 2
Woolfenden, Williams, and Peat (2002) conducted a meta-analysis to examine the effectiveness of family-based treatment intervention programs on delinquency and and other problem behaviors in adolescents (ages 10–17). Studies were eligible for review if they were randomized controlled trials of family and/or parenting interventions for children and adolescents aged 10–17 with conduct disorder and/or delinquency. Conduct disorder was defined by a standardized psychological assessment (such as the Child Behavior Checklist) or a psychiatric diagnosis, and delinquency was defined by a referral from a juvenile justice or other legal system for a child/adolescent who committed a serious crime or offended on at least two occasions. Studies that only included sex or drug offenses were excluded. Literature was electronically searched (including Cochrane Controlled Trial Register, Medline, EMBASE, CINAHL, PsycINFO, SocioFile, ERIC, and HealthStar) through July 1999; published and unpublished work was included.

Eight randomized controlled designed studies were included in the review. The studies together included 749 youth participants. The studies were conducted in the United States, with the exception of one study from Australia. The study samples were predominantly male, with one study sample including a slightly greater number of girls than boys. Seven of the studies included youth referred to treatment by the juvenile justice system; the other focused on youth referred to treatment by schools, parents, or other youth agencies. The included studies used a number of different family and parenting interventions, including short-term family therapy, parent training, MST, multidimensional intervention foster care (MTFC), and an adolescent diversion project that included a family condition and a multi-focus condition. Researchers used a weighted mean difference to calculate the time in institutions, a relative risk ratio to measure adolescents’ risk of rearrests, and a standardized mean difference to calculate their rate of rearrest at 1 to 3 years later.

Meta-Analysis 3
Dopp and colleagues (2017) conducted a meta-analysis on family-based treatments for serious and violent juvenile offenders (up to age 18). Studies were eligible if they 1) focused on one or more family-based treatments; 2) included a sample of serious juvenile offenders; 3) used a prospective research design, including at least one comparison condition); 4) included at least one outcome measure of antisocial behavior of targeted youth; and 5) included a published or unpublished English-language report of the study by January 1, 2014. Electronic databases searched included PsycINFO and Medline (via PubMed) to identity eligible studies. Reference lists from published reviews of youth psychosocial treatments was also conducted to identify relevant studies. In addition, websites of certain organizations were consulted and a hand search of the tables of contents of several journals that regularly published studies of psychosocial treatments was also conducted. Specific searches were also conducted to identify unpublished studies.

A total of 28 studies (which included 324 effect sizes) were included in the meta-analysis. The studies together included 5,565 youth participants. Of these studies, 19 were randomized controlled trials, and 9 were non-randomized. The majority of studies (n = 21) were conducted in the United States, and the others were conducted in Europe (n = 6) or Canada (n = 1). The average age for participants at the start of treatment was 15.0 years. The majority of the sample was male (72.0 percent) and identified as white (58.3 percent). The sample also included a significant number of black (30.6 percent), Hispanic (9.5 percent); and Asian, American Indian, or multiracial (8.0 percent) youth. Of the total sample, an average of 4.34 had committed pretreatment offenses, and others had committed one or more felony (72.5 percent), violent offense (50.0 percent), or sexual offense (10.7 percent).

Of the 28 studies, 19 examined the effectiveness of MST, 4 examined Treatment Foster Care Oregon (formerly MTFC), 3 examined FFT, 1 examined BSFT, and 1 looked at intensive home-based services. Across the studies, these programs lasted for an average of 25.9 weeks and involved 50.8 hours of contact with the youth and/or family members.

Effect sizes were calculated using Cohen’s d, so that a positive number represented a beneficial effect for the family-based treatment group relative to the comparison group. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model.
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Cost

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There is no cost information available for this practice.
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Other Information

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Dopp and colleagues (2017) reported on moderator analyses of family-based treatments for serious and violent juvenile offenders (up to age 18). The results showed significant moderating effects across several domains, including the study sample characteristics and treatment providers. When looking at sample characteristics, results indicated that family-based treatments had greater positive effects in studies with a larger percentage of Hispanic youth and in studies in which participants had a higher average number of pretreatment total offenses. When considering the treatment provider, results indicated that family-based treatments had greater positive effects in studies in which the treatment was delivered by providers with mental health training versus those delivered by nonmental health professionals.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Baldwin, Scott A., Sarah Christian, Arjan Berkeljon, William R. Shadish, and Roy Bean. 2012. “The Effects of Family Therapies for Adolescent Delinquency and Substance Abuse: A Meta-analysis.” Journal of Marital and Family Therapy 38(1):281–304.

Meta-Analysis 2
Woolfenden, S.R., K. Williams, and J.K. Peat. 2002. “Family and Parenting Interventions for Conduct Disorder and Delinquency: A Meta-Analysis of Randomized Controlled Trials.” Archives of Disease in Childhood 86(4):251–56.
https://adc.bmj.com/content/86/4/251.long

Meta-Analysis 3
Dopp, Alex R., Charles M. Borduin, Mark H. White, and Sofie Kuppens. 2017. “Family-based Treatments for Serious Juvenile Offenders: A Multilevel Meta-Analysis.” Journal of Consulting and Clinical Psychology 85(4):335–54.
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Additional References

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These sources were used in the development of the practice profile:

Latimer, J. 2001. “A Meta-Analytic Examination of Youth Delinquency, Family Treatment, and Recidivism.” Canadian Journal of Criminology:237–53. (This meta-analysis was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall outcome rating.)
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST–PSB) Promising - One study
This program is an adaptation of Multisystemic Therapy, specifically designed for adolescents who have committed sexual offenses and demonstrated other problem behaviors. The program is rated Promising. Program participants had lower rates of self-reported person and property offenses as well as lower rates of arrests for sexual crimes and other crimes, compared with control group participants. These findings were statistically significant.

Functional Family Therapy (FFT) Effective - More than one study
This is a family-based prevention and intervention program for dysfunctional youth, ages 11 to 18, who are justice-involved or at risk for delinquency, violence, substance use, or other behavioral problems. The program is rated Effective. Program participants showed a statistically significant reduction in general recidivism and risky behavior, compared with control group participants. However, there were no differences between groups on felony recidivism or caregiver strengths and needs.

Multidimensional Treatment Foster Care–Adolescents Effective - More than one study
A behavioral treatment alternative to residential placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. This program is rated Effective. It was associated with a significant drop in official criminal referral rates, involvement in criminal activities, and days spent in lock up among MTFC-A boys. Similarly, the program was associated with a significant reduction in delinquency and days spent in lock up among MTFC-A girls.

Multisystemic Therapy–Substance Abuse Effective - More than one study
This version of multisystemic therapy is for adolescents with substance abuse and dependency issues. This program is rated Effective. Treatment youth showed statistically significant reductions in marijuana use and in aggressive behavior and convictions for aggressive behavior, compared with control group youth. However, no significant differences between groups were found for symptoms of mental health, criminal behavior, or alcohol or cocaine use.

Multisystemic Therapy (MST) Effective - More than one study
A family and community-based treatment program for adolescent offenders who have exhibited serious antisocial, problem, and delinquent behaviors. The program is rated Effective. The treatment group had fewer rearrests and spent fewer days incarcerated than a comparison group that received usual services The program had a positive impact on family cohesion and social skills for the intervention group; but over time did not show better substance use outcomes than the comparison.

Brief Strategic Family Therapy Promising - More than one study
This is a family-based intervention designed to prevent and treat youth behavior problems. The program is rated Promising. Intervention families showed a statistically significant greater likelihood of being engaged and retained in treatment, and intervention youth showed statistically significant greater improvement in conduct disorder and socialized aggression. There were no statistically significant differences in adolescent alcohol use or improved family functioning.

Multidimensional Family Therapy Effective - More than one study
A manualized family-based treatment and substance abuse prevention program developed for adolescents with drug and behavior problems. The program is typically delivered in an outpatient setting, but it can also be used in inpatient settings. The program is rated Effective. The program resulted in the greatest and most consistent improvements in adolescent substance abuse and associated behavior problems.

Adolescent Diversion Project (Michigan State University) Effective - More than one study
A strengths-based, advocacy oriented program that diverts arrested youth from formal processing in the juvenile justice system and provides them community-based services. This program is rated Effective. The program was associated with a significant reduction in the rates of official delinquency of participating juveniles as compared to juveniles formally processed in the system. However, the program did not significantly affect youths’ self-reported delinquency.

Functional Family Therapy-Child Welfare (FFT-CW®) Promising - One study
This adapted version of Functional Family Therapy is designed to improve functioning for child welfare-involved families. This program is rated Promising. Treatment families showed a statistically significant greater likelihood of achieving all treatment goals and a lower likelihood of being referred to another program at case closing, compared with control families. However, there were no statistically significant differences between groups in out-of-home placements.

Family Therapy for Adolescent Behavior Problems No Effects - One study
This program assessed the impact of a nonmanualized family-based treatment approach for adolescent behavior problems. The program is rated No Effects. Results indicated that the treatment group experienced statistically significant reductions in adolescent-reported externalizing and internalizing behaviors. However, there were no statistically significant differences between groups in caregiver-reported externalizing and internalizing behaviors or in adolescent-reported alcohol or drug use.
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Practice Snapshot

Age: 10 - 19

Gender: Both

Race/Ethnicity: American Indians/Alaska Native, Asian/Pacific Islander, Black, Hispanic, Other, White

Targeted Population: Alcohol and Other Drug (AOD) Offenders, Families, High Risk Offenders, Serious/Violent Offender, Young Offenders

Settings: Home, Other Community Setting, School

Practice Type: Academic Skills Enhancement, Alcohol and Drug Prevention, Alcohol and Drug Therapy/Treatment, Conflict Resolution/Interpersonal Skills, Diversion, Family Therapy, Parent Training, Violence Prevention, Wraparound/Case Management

Unit of Analysis: Persons