| Research has consistently demonstrated that caregiver participation in adolescent substance abuse treatment is essential to achieving positive outcomes. Family-based approaches have shown superiority in engaging and retaining families in treatment, and have produced more favorable outcomes than other methods of adolescent substance abuse treatment that do not target the parent or primary caregiver as part of the treatment intervention. Despite evidence demonstrating that caregiver level of involvement in treatment, commitment to changing parenting behaviors, and agreement with the goals and relevance of therapy are better indicators of caregiver engagement in treatment than simply the number of therapy sessions attended, family-based treatments of adolescent substance abuse have not assessed these behavioral indicators of engagement.; The purpose of the present study was to assess caregiver engagement during mid-treatment in Multisystemic Therapy (MST), a family- and evidence- based treatment for adolescent delinquency and substance abuse or dependence. Specifically, this research used a multi-source, multi-method approach (i.e., observations of in-session caregiver verbalizations, global observer ratings, and therapist and caregiver report) to examine pretreatment family and parental adversity predictors of caregiver engagement in MST treatment of adolescent substance abuse, and to explore the nature of the relationship between caregiver race and caregiver engagement in MST.; Participants included 89 primary caregivers who received MST treatment for their substance abusing juvenile offenders; 60 were African American, 28 were European American, and 1 was Asian American, 59 caregivers were single and 60 experienced financial hardship. One audiotaped therapy session for each family was randomly selected at mid-treatment. Global observer ratings, and caregiver positive and resistant in-session behaviors were used to assess caregiver engagement. Two observers rated each therapy session. In addition, therapist and self-report questionnaire items were used to assess the convergent validity of the observational measure. Findings supported the reliability and construct validity of the observational measure of caregiver engagement in MST, particularly for African American caregivers. In addition, factor analyses suggested that caregiver engagement in treatment had both qualitative and quantitative aspects of caregiver participation in treatment. Caregiver adversity, as measured by caregiver substance abuse, mental illness, past history with problems with the law, financial hardship, and single caregiver status, did not predict caregiver engagement during the mid-point of MST. However, caregiver and youth age, the presence of the youth in the therapy session, and caregiver race were significantly related to at least one measure of caregiver engagement in MST with substance abusing juvenile offenders. |
