An Exploratory Study Comparing Common to Specific Factors Approaches to Home-Based Treatment of At-Risk Children and Adolescents: Integrative Family and Systems Treatment (I-FAST) and Multi-Systemic Therapy (MST)
The need for program flexibility in EBPs in order to fit within the constraints of community mental health practice is increasingly being called for in the literature. A key question is how to best provide flexible treatment services that will fit within real world constraints while at the same time is still coherent and effective. Given that the most established evidenced-based approaches for family treatment (e.g., MST, FFT, MDFT, BSFT) are based on similar theoretical foundations and have been found to be effective with the same types of at-risk youth and families, one viable path is to develop and use an approach based on the common factors approach. The purpose of this article is to present and discuss findings of a study that compared treatment outcomes of I-FAST, a moderated common factors approach, with MST, which is a specific factor approach, for treating at-risk children and adolescents and their families. This study hypothesized that there will be no significant differences between I-FAST and MST in the child outcomes of problem severity and functioning, as well as hopefulness and treatment satisfaction.
Methods. This is a program evaluation that used a non-randomized quasi-experimental design to explore the outcomes of 79 I-FAST clients (a moderated common factors approach) and 47 MST clients (a specific factors approach). Clients in both I-FAST and MST groups ranged from 12 to 18 years old and all had DSM-IV diagnoses. There were no statistically significant differences between the two treatment conditions on age, gender, race, education, DSM-IV diagnoses and length of treatment. Linear Mixed-model repeated-measures analyses were used to compare treatment outcomes between I-FAST and MST on the four Ohio Scales outcomes of Problem Severity, Functioning, Hopefulness and Treatment Satisfaction from pre-treatment to termination as reported by the youth, parents, and case managers. The study also calculated percentages of clients who had achieved clinically significant and reliable change. Model developers and the agency carefully monitored model fidelity of both I-FAST and MST.
Results. Findings of this study provided initial support to the study hypothesis that there were no significant differences between I-FAST and MST in their trajectory of change in Problem Severity, Functioning, Hopefulness, and Satisfaction based on parents and case managers’ assessments. Findings based on youth’s assessment, however, indicated that there were significant differences between the trajectory of improvement of I-FAST and MST from pre-treatment to termination on Problem Severity and Functioning. There were also significantly higher percentages of clients in the I-FAST group attaining clinically significant and reliable change than clients in the MST group in Functioning based on youth and parents’ assessments.
Conclusions and implications: Findings of this study present initial empirical evidence that I-FAST, a moderated common factors approach, could be as effective as an established specific factors approach in treating at-risk children and adolescents and their families. Study findings could have useful implications for training of professionals in providing effective and accountable family treatments as well as the implementation and sustainability of evidence-based family treatments at the agency level.