Additional Efficacy Findings for Strengths Oriented Family Therapy (SOFT): A Quasiexperimental Study

Background and Purpose.  A key consideration for determining the efficacy of a treatment is whether or not outcomes are robust across replication studies.  In a single randomized trial, Strengths Oriented Family Therapy (SOFT) participants had equivalent outcomes when compared to those receiving The Seven Challenges, an active comparison group treatment.  It would be beneficial to know whether SOFT is superior to a treatment as usual condition, which would enable us to know if it outperforms treatments that are typically available in the community.  Thus, the purpose of this study was to compare the outcomes of adolescents receiving SOFT, to a matched sample of adolescents that received other treatments meant to approximate a Treatment as Usual (TAU) condition.

            Method.  Cases were selected for analysis if they had received SOFT in the original clinical trial and completed baseline and 3, 6 and 12 month follow up assessments (n=43; 77% of sample).  SOFT participants were matched to adolescents in the GAIN dataset that were treated in outpatient settings, for whom the treatment was coded as non-empirically supported, and who completed the baseline and follow up measures (n=884). Propensity score weights were developed using 34 variables known to correlate with outcomes.   Weighted regressions were used to estimate the average treatment effect on the treated (ATT), by comparing the SOFT (n=43) participants to TAU adolescents (n=43) on indices of substance use frequency, substance use problems, days spent in controlled environments, and emotional problems.    

            Results.  After matching, the SOFT and TAU groups were equivalent on all baseline indices.  SOFT participants had significantly fewer emotional problems at 6 and 12 months. Effect sizes were moderate.  No significant differences were detected for other outcomes, with both groups improving over time.  Contrary to what we’d expect when contrasting with a TAU condition, outcomes for SOFT participants were equivalent on three out of the four outcomes.  However, subsequent analyses of which youth were selected as TAU participants called into question whether the comparison group was in fact a TAU condition, and it is likely that this study inadvertently used an active comparison group.

            Conclusion and Implications. In this replication study, SOFT participants fared as well or better than those receiving comparison treatments.  Combined with the prior randomized trial, these data support the efficacy of SOFT in reducing substance use problems, substance use frequency and emotional problems.  These are important findings as SOFT contains unique components (i.e., strengths assessment, multiple family skills training groups) not present in other empirically supported treatments.  We recommend further study on the mechanisms of change operating within SOFT and the ease with which it can be implemented in typical practice sites.