Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA)
A family therapy program for Hispanic parents and adolescents that aims to improve parenting and reduce adolescent substance use.
Program Outcomes
- Antisocial-aggressive Behavior
- Conduct Problems
- Externalizing
Program Type
- Alcohol Prevention and Treatment
- Counseling and Social Work
- Diversion
- Drug Prevention/Treatment
- Family Therapy
- Foster Care and Family Prevention
- Parent Training
- Skills Training
Program Setting
- Online
- Mental Health/Treatment Center
Continuum of Intervention
- Selective Prevention
Age
- Late Adolescence (15-18) - High School
- Early Adolescence (12-14) - Middle School
Gender
- Both
Race/Ethnicity
- African American
- Hispanic or Latino
Endorsements
Blueprints: Promising
Program Information Contact
Daniel Santisteban, Ph.D.
Director of Research and EBT Training
TIA International
(800) 674-7842
DanielSantisteban@TIAInternational.org
https://TIAInternational.org
Program Developer/Owner
Daniel A. Santisteban, Ph.D. and Maite Mena, Psy.D.
TIA International
Brief Description of the Program
The multicomponent adolescent and family therapy program designed originally for Latino youth and families has three components (family, individual, and psychoeducation) and is adaptive with flexible decision rules to guide the tailoring process. It has infused cultural-related themes into the treatment that cover discrimination, acculturation, and immigration-related stressors. The families are offered up to 24 sessions (6 sessions per month) consisting of a combination of family therapy sessions, individual adolescent therapy sessions and psychoeducational sessions with youth and/or caregivers. Clients/families receive interventions at a community-based training clinic or a family treatment center, and therapists are bilingual.
The multicomponent adolescent and family therapy program designed originally for Latino youth and families has three components (family, individual, and psychoeducation) and is adaptive with flexible decision rules to guide the tailoring process. Only those psychoeducational modules that address unique youth and family needs are selected. It has infused cultural-related themes into the treatment that cover discrimination, acculturation, and immigration-related stressors. The families are offered up to 24 sessions (6 sessions per month) consisting of a combination of family therapy sessions, individual adolescent therapy sessions and psychoeducational sessions with youth and/or caregivers. Clients/families receive interventions at a community-based training clinic or a family treatment center, and therapists are bilingual.
The goal is to address core underlying family (e.g., conflict, support, ruptured relationships, parenting practices) and adolescent (e.g., low motivation to change and adolescent skills) processes that impact a variety of adolescent symptoms. Therapists can adapt the intervention to the unique needs of an identified adolescent and family and the unique cultural variations seen in youth and families. The modular psycho-educational content can focus on different presenting issues such as depression, self-harm, LGBT-related marginalization, conduct problems, and substance use.
Outcomes
Primary Evidence Base for Certification
Study 2
Santisteban et al. (2017) found that the intervention group relative to the control group had significantly
- lower parent-reported child conduct disorder,
- lower parent-reported child aggression,
- lower youth-reported externalizing,
- higher parent-reported family cohesion (protective factor),
- higher youth-reported family cohesion (protective factor).
Brief Evaluation Methodology
Primary Evidence Base for Certification
Of the three studies Blueprints has reviewed, one (Study 2) meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 2
Santisteban et al. (2017) conducted a randomized controlled trial that examined 80 Hispanic and Black youths with behavioral or mental health problems. After assigning the youths and their families to an intervention group or a waitlist control group, the study measured conduct and mental health problems at posttest.
Risk Factors
Individual: Early initiation of antisocial behavior, Early initiation of drug use, Rebelliousness, Stress, Substance use, Victim of bullying
Peer: Interaction with antisocial peers
Family: Family conflict/violence, Neglectful parenting, Parent stress, Poor family management, Psychological aggression/discipline
Protective Factors
Individual: Coping Skills, Perceived risk of drug use, Problem solving skills, Skills for social interaction
Family: Attachment to parents, Opportunities for prosocial involvement with parents
*
Risk/Protective Factor was significantly impacted by the program
See also: Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) Logic Model (PDF)
Race/Ethnicity Specific Findings
- Hispanic or Latino
Subgroup Analysis Details
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 2 Santisteban et al. (2017) found subgroup effects by examining a sample with 75% or more of Hispanic youths.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
The Study 2 sample was 80% Hispanic, 20% Black, and 56% male.
The CIFFTA training model focuses on five core competencies (systemic conceptualization, engagement, eliciting motivation, modifying interactions, tailoring treatment) and three sets of skills (conceptual, perceptual, executive).
New trainees are given access to the Family Therapy Training and Implementation Platform. Approximately 15 hours are typically required to complete the training and practice exercises (that lead to specific and focused expert feedback).
The TIA team also begins to consult with the agency leadership team to dialogue about organizational readiness and processes that facilitate adoption and sustainment.
Upon completion of the online training, therapists begin bi-weekly coaching/consultation sessions. A therapist strengths profile informs coaching needs.
Training Certification Process
When a team is working toward certification and agency licensing to practice CIFFTA, recorded sessions are sent to the TIA CIFFTA team via secure mechanisms and therapists and CIFFTA experts meet to discuss feedback. Therapist competencies are considered for all key CIFFTA components.
A CIFFTA team member site visitor may visit the agency as part of the organizational readiness work, to connect with therapists and supervisors, and plan and prepare an onsite CIFFTA supervisor into year 02.
A key part of licensing an agency is to ensure that there is a qualified and certified CIFFTA on-site supervisor. When new staff join the organization, they can learn the basic concepts on the online CIFFTA platform and the on-site supervisor can begin to lead the coaching phase.
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
Start-Up Costs
Initial Training and Technical Assistance
The year one training package cost is $20,000 for agencies with up to 6 counselors delivering the program. This includes access to a training platform (approx. 15 hours of training), quizzes and practice exercises, expert feedback on practice exercises, all treatment manuals and psychoeducational module materials, a set of organizational readiness consultations that can include an in-person site visit, and 20 hours of team coaching and support on CIFFTA implementation with families. The cost will increase at a discounted rate for larger teams.
If the goal is certification and licensing (a 2-year process), the team members and supervisor will begin in year one to provide recorded therapy sessions that the Training and Implementation Associates (TIA) CIFFTA team can use in supervision to provide detailed feedback, and rate for competency. Year one for teams that are seeking certification and licensing has a package cost of $25,000 (or more, if team > 6). See full licensing costs below.
Curriculum and Materials
The training package (cost listed above) includes a comprehensive treatment manual, animations showing good and poor treatment delivery, and a full set of psychoeducational modules (20 to date) in Spanish and English.
Licensing
Full therapist certification and agency/site licensing requires an additional year (year 02) of review of recorded sessions, coaching, support, fidelity monitoring activities, and organizational consultations. Although the time and effort to reach certification and licensing can vary substantially depending on the therapist, on the number of families they treat, and their participation in the consultations, one can expect that a second year is needed at the cost of $25,000 (or more, if team > 6). TIA seeks to ensure that the entire agency is licensed so that the structures and processes are in place to ensure the optimal delivery and effectiveness of CIFFTA services.
Continuation of the license after the second year has additional requirements needed to maintain fidelity and to avoid drift. Internal agency staff play a key role.
Other Start-Up Costs
When a team is training and participating in coaching/consultation, the team can expect that a reduced caseload is needed (12-14 cases depending on the amount of activity related to certification). This is a cost consideration.
The program requires rooms large enough for family therapy and child waiting area as well as late afternoon and evening hours to offer to youth after school and working parents.
Many find it useful to start a systemically oriented program with less experienced therapists who are not fully committed to an individually oriented approach. They may adopt the model more readily, which can sometimes lead to lower costs.
Intervention Implementation Costs
Ongoing Curriculum and Materials
There are no additional material costs - just ongoing platform access for updated material if desired and for refresher courses.
Staffing
Masters level counselors/therapists and clinical supervisors deliver the program. They may be less experienced therapists and it is helpful if they are trained in systems thinking.
Other Implementation Costs
Substantial clinical supervision by someone trained in CIFFTA is necessary.
Implementation Support and Fidelity Monitoring Costs
Ongoing Training and Technical Assistance
Coaching on an ongoing basis during the first 2 years is included in the certification cost. Refresher courses are available at additional cost.
Fidelity Monitoring and Evaluation
Recording and rater costs are built into the certification cost.
Ongoing License Fees
An annual license fee of $7,500 for a team of 6 therapists covers review of therapist and supervisor sessions to ensure quality and fidelity, and to reduce drift.
Other Implementation Support and Fidelity Monitoring Costs
No information is available
Other Cost Considerations
No information is available
Year One Cost Example
In this example, an agency with a six-person team (therapists and supervisor) seeking full certification and site licensing deliver the CIFFTA program to 200 youth/families by providing 1.5 hours of treatment per week per family in Year 1. It is assumed that the agency has sufficient space for family therapy and child waiting area. Salaries will vary by locale, and are not included here.
| Training package for team of 6 (includes training, materials and supervision by TIA personnel) | $25,000.00 |
| Total One Year Cost | $25,000.00 |
With the cost of the CIFFTA package at $25,000 in Year 1, delivery of the program to 200 families would yield a rate of $125 per family.
Year 2 would require a similar expense to obtain certification and site licensing. Thereafter, ongoing licensing expenses would be significantly reduced.
No information is available
Program Developer/Owner
Daniel A. Santisteban, Ph.D. and Maite Mena, Psy.D. TIA International800.674.7842 Ext. 702danielsantisteban@tiainternational.org https://tiainternational.org
Program Outcomes
- Antisocial-aggressive Behavior
- Conduct Problems
- Externalizing
Program Specifics
Program Type
- Alcohol Prevention and Treatment
- Counseling and Social Work
- Diversion
- Drug Prevention/Treatment
- Family Therapy
- Foster Care and Family Prevention
- Parent Training
- Skills Training
Program Setting
- Online
- Mental Health/Treatment Center
Continuum of Intervention
- Selective Prevention
Program Goals
A family therapy program for Hispanic parents and adolescents that aims to improve parenting and reduce adolescent substance use.
Population Demographics
The program targets Hispanic adolescents with symptoms of serious behavioral or mental health problems.
Target Population
Age
- Late Adolescence (15-18) - High School
- Early Adolescence (12-14) - Middle School
Gender
- Both
Race/Ethnicity
- African American
- Hispanic or Latino
Race/Ethnicity Specific Findings
- Hispanic or Latino
Subgroup Analysis Details
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 2 Santisteban et al. (2017) found subgroup effects by examining a sample with 75% or more of Hispanic youths.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
The Study 2 sample was 80% Hispanic, 20% Black, and 56% male.
Risk/Protective Factor Domain
- Individual
- Peer
- Family
Risk/Protective Factors
Risk Factors
Individual: Early initiation of antisocial behavior, Early initiation of drug use, Rebelliousness, Stress, Substance use, Victim of bullying
Peer: Interaction with antisocial peers
Family: Family conflict/violence, Neglectful parenting, Parent stress, Poor family management, Psychological aggression/discipline
Protective Factors
Individual: Coping Skills, Perceived risk of drug use, Problem solving skills, Skills for social interaction
Family: Attachment to parents, Opportunities for prosocial involvement with parents
*Risk/Protective Factor was significantly impacted by the program
See also: Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) Logic Model (PDF)
Brief Description of the Program
The multicomponent adolescent and family therapy program designed originally for Latino youth and families has three components (family, individual, and psychoeducation) and is adaptive with flexible decision rules to guide the tailoring process. It has infused cultural-related themes into the treatment that cover discrimination, acculturation, and immigration-related stressors. The families are offered up to 24 sessions (6 sessions per month) consisting of a combination of family therapy sessions, individual adolescent therapy sessions and psychoeducational sessions with youth and/or caregivers. Clients/families receive interventions at a community-based training clinic or a family treatment center, and therapists are bilingual.
Description of the Program
The multicomponent adolescent and family therapy program designed originally for Latino youth and families has three components (family, individual, and psychoeducation) and is adaptive with flexible decision rules to guide the tailoring process. Only those psychoeducational modules that address unique youth and family needs are selected. It has infused cultural-related themes into the treatment that cover discrimination, acculturation, and immigration-related stressors. The families are offered up to 24 sessions (6 sessions per month) consisting of a combination of family therapy sessions, individual adolescent therapy sessions and psychoeducational sessions with youth and/or caregivers. Clients/families receive interventions at a community-based training clinic or a family treatment center, and therapists are bilingual.
The goal is to address core underlying family (e.g., conflict, support, ruptured relationships, parenting practices) and adolescent (e.g., low motivation to change and adolescent skills) processes that impact a variety of adolescent symptoms. Therapists can adapt the intervention to the unique needs of an identified adolescent and family and the unique cultural variations seen in youth and families. The modular psycho-educational content can focus on different presenting issues such as depression, self-harm, LGBT-related marginalization, conduct problems, and substance use.
Theoretical Rationale
CIFFTA's family therapy work has its foundations in Structural Family Therapy and Ecological Systems Theory. CIFFTA's individual therapy has its foundations in Motivational Interviewing and adolescent skills training.
Brief Evaluation Methodology
Primary Evidence Base for Certification
Of the three studies Blueprints has reviewed, one (Study 2) meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 2
Santisteban et al. (2017) conducted a randomized controlled trial that examined 80 Hispanic and Black youths with behavioral or mental health problems. After assigning the youths and their families to an intervention group or a waitlist control group, the study measured conduct and mental health problems at posttest.
Outcomes (Brief, over all studies)
Primary Evidence Base for Certification
Study 2
Santisteban et al. (2017) found that the intervention group relative to the control group had significantly lower parent-reported child conduct disorder, lower parent-reported child aggression, lower youth-reported externalizing, higher parent-reported family cohesion (risk and protective factor), and higher youth-reported family cohesion (protective factor).
Outcomes
Primary Evidence Base for Certification
Study 2
Santisteban et al. (2017) found that the intervention group relative to the control group had significantly
- lower parent-reported child conduct disorder,
- lower parent-reported child aggression,
- lower youth-reported externalizing,
- higher parent-reported family cohesion (protective factor),
- higher youth-reported family cohesion (protective factor).
Effect Size
The effect sizes reported in Study 2 by Santisteban et al. (2017) ranged from .45 to .59.
Generalizability
One study meets Blueprints standards for high quality in methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 2 (Santisteban et al. (2017)
Study 2 (Santisteban et al., 2017) recruited youths with behavioral or mental health problems and compared the program to those receiving the program to a no-treatment control group. The location was not directly specified in the article but is presumably Miami, FL, the location of the authors' clinic where treatment occurred.
Potential Limitations
Study 1 (Santisteban et al., 2011)
- Very small sample
- One youth measure came from a non-independent parent rating
- Evidence of baseline differences between conditions
- Incomplete tests for differential attrition
- Some evidence of differential attrition
Santisteban, D. A., Mena, M. P., & McCabe, B. E. (2011). Preliminary results for an adaptive family treatment for drug abuse in Hispanic youth. Journal of Family Psychology, 25(4), 610-614. doi:10.1037/a0024016
Study 3 (Santisteban et al., 2022)
- Some youth measures came from non-independent parent ratings
- No main effects on youth behavioral outcomes
Santisteban, D. A., Mena, M. P., McCabe, B. E., Abalo, C., & Puccinelli, M. (2022). Comparing individually based and family-based treatments for internalizing, externalizing, and family symptoms in Latino youth. Family Process, 1-18. doi:10.1111/famp.12776
Endorsements
Blueprints: Promising
Program Information Contact
Daniel Santisteban, Ph.D.
Director of Research and EBT Training
TIA International
(800) 674-7842
DanielSantisteban@TIAInternational.org
https://TIAInternational.org