Efficacy of Integrative Family and Systems Treatment (I-FAST) with at-Risk African American and Caucasian American Children and Adolescents

Background and Purpose: While African American children and youth constitute a significant client population at community mental health, most outcome studies of current evidence-based family treatment models did not study the impact of race on outcomes. It is well documented that biases against mental health professionals prevent many African Americans from accessing or utilizing care effectively and that African Americans also exhibit different help-seeking behaviors.  I-FAST is a family-centered, strengths-based, meta-model organized around common factors and meta-level treatment protocols that allow for flexibility and a wide range of treatment skills to be utilized within the model to work with a wide range of client mental health problems. Because of its focus on collaboratively working with the family’s frame of problems, I-FAST aims to provide a broader and more flexible evidence-informed approach in service delivery that is culturally respectful. This study compared treatment outcomes of I-FAST on African American and Caucasian American children and youth.  This study hypothesized that there would be no significant differences between the two groups on child outcomes of Problem Severity and Functioning as based on parents, youth, and case managers’ reports.

Methods. This study used a quasi-experimental design to examine the outcomes of 54 African American and 53 Caucasian American child clients who had received I-FAST at a community mental health agency. Model fidelity was monitored by the agency as required by the recertification requirements of I-FAST. Clients ranged from 5 to 18 years old and all had DSM-IV diagnoses. There were no statistically significant differences between the two groups on age, gender, education, DSM-IV diagnoses, length of treatment, and baseline scores on the Ohio Scales outcomes of Problem Severity and Functioning. The study used paired sample t-test analysis to assess within-subjects change from pre-treatment and post-treatment.  In addition, the study calculated percentages of clients who had achieved reliable change.  Chi-squares analyses were conducted to examine between-group differences on percentages of clients who had achieved reliable change.

Results. Based on multiple reporting sources, both African American and Caucasian American child clients showed significant improvement on Problem Severity and Functioning from pre-treatment to post-treatment with effect sizes ranging from .29-.96. With the exception of Functioning based on youth’s report, approximately 40% to 70% achieved reliable change on all measured outcomes. Chi-squares analyses showed that there were no significant differences between the two groups on the percentages of child clients who had achieved reliable change on Problem Severity and Functioning based on parents’ assessment. 

 

Significance: Findings provide initial empirical evidence that supports the efficacy of I-FAST in reducing Problem Severity and improving Functioning in African and Caucasian American children and adolescents who had DSM diagnoses. Significance of the study will be discussed with reference to treatment components of I-FAST that could contribute to effectiveness of this model with African American child population. Research designs that use a mixed method and include component analysis will be helpful to further examine the mechanisms of change of I-FAST with African American child clients.