Family Therapy Via Video Teleconference for Substance-Abusing Rural Adolescents

It has been well documented that only about 10% of adolescents with clinically diagnosable
substance use problems receive treatment in any given year. One of the major contributing
factors to chronic levels of unmet need for treatment among this population is the
unavailability and inaccessibility of treatment services. Service accessibility is
particularly limited in rural areas. To address problems of service availability and
accessibility in rural areas, the use of video teleconferencing technology to provide direct
services has emerged within the fields of medicine and psychiatry in particular. The use of
such technology to enhance the delivery of behavioral psychotherapy is beginning to emerge
as well. A handful of primarily small-scale pilot and feasibility studies indicate that
psychotherapy interventions administered using video teleconferencing technology may be as
effective as traditional face-to-face interventions. Few randomized clinical trials of
telepsychotherapy have been conducted to date, however, and virtually none have examined
video teleconferencing interventions for any type of child or adolescent behavioral problem
including substance abuse. The proposed study is intended to address the need for research
evaluating the application of video teleconferencing technology as a means of service
delivery for substance abusing adolescents and their families living in rural areas.
Specifically, this study will examine the efficacy of Functional Family Therapy administered
by video teleconference (FFT-V) in the homes of substance abusing adolescents. FFT-V will be
compared with FFT administered face-to-face in the family home as well as to
services-as-usual (SAU) coordinated through the Juvenile Services Division (JSD) of the
State of New Mexico Children, Youth, and Families Department (CYFD). FFT, based on more than
30 years of research, is an established EBT for adolescent substance abuse and related
problem behaviors such as HIV risk and delinquency. Moreover, FFT is one of few
evidence-based therapies shown to be effective for rural families. The study will be
conducted in the homes of participating adolescents and parents living in rural communities
located between 30 and 50 miles from the Center for Family and Adolescent Research (CFAR) in
Albuquerque, NM. One hundred and twenty youth will be referred to the study by Children
Youth and Family Department juvenile probation officers within two rural counties in New
Mexico, Sandoval and Valencia, which are adjacent to the town of Albuquerque which is
located in Bernalillo County. Adolescent participants meeting diagnostic criteria for
substance abuse or dependence, along with the participating parent, will be randomly
assigned to the FFT, FFT-V, or SAU conditions. Four assessments of all participants in all
three conditions will occur at: pre-treatment, 4-, 8-, and 12 months after treatment
initiation. Outcome analyses will examine adolescent substance abuse, HIV risk behavior,
delinquency, and recidivism, family functioning, and adolescent association with substance
abusing peers. The study will also examine clinical process variables known to impact
treatment efficacy (e.g., therapeutic alliance formation, treatment motivation, and
retention). The overarching objective of the study is to examine the degree to which an
empirically based model of substance abuse treatment such as FFT can be effectively
administered via video teleconferencing to adolescents and families living in rural and
remote areas and thus have less access to treatment.

Inclusion Criteria:

- 13-18 years of age

- Meet DSM-IV diagnostic criteria for substance abuse or dependence

- Reside with at least one parent or parental figure who is willing to participate in
the study

- Reside in a rural community approximately 30-50 miles from the CFAR office

- Have sufficient residential stability to permit contact with CFAR throughout the
study (e.g., not homeless or runaway at time of intake).

Exclusion Criteria:

- Incarcerated or in a restrictive placement outside the home (e.g., residential
treatment, in-patient care)

- Evidence of a psychotic or organic state of sufficient severity to interfere with the
ability to understand the research and clinical procedures

- A sibling is already participating in the study

- Evidence of posing a danger to self or others based on routine safety screening
protocols (see Intake below)

- Evidence that more intensive services other than outpatient treatment are required
(e.g., in-patient care, detoxification).