Program Goals/Target Population
Ecologically Based Family Therapy (EBFT) is a home-based, family preservation model that focuses on families who are in crisis because a youth has run away from home. EBFT was developed based on the HOMEBUILDERS family preservation model in which services are initiated when there is a family crisis, such as a child’s removal or departure from the home. EBFT targets 12- to 17-year-olds who are staying in a runaway shelter and are also dealing with substance abuse issues (such as alcohol dependence). The goal of EBFT is to improve family functioning and reduce youths’ substance use.
Program Theory
EBFT incorporates concepts from the crisis intervention theory, which argues that families are more amenable to counseling and open to change during a crisis (Slesnick and Prestopnik 2009). EBFT also incorporates components of Bronfenbrenner’s (1979) theory of social ecology, which views individuals as being in a complex, interconnected system that includes individual, family, and extrafamilial factors (such as peers, school, and neighborhood). Behavior is viewed as the product of the interplay between the child and these systems, and also as the product of how the systems relate to one another.
Program Components
To derive greater benefit from family members’ motivation to meet and work through the runaway crisis, therapy sessions occur frequently early on in the process. EBFT is delivered to families in their homes across 16 sessions, lasting 50 minutes each. EBFT is home based to reduce barriers to treatment, such as child care or transportation. Treatment begins by preparing the adolescent and the family members, in individual sessions, to come together and talk about the issues that led to the runaway episode. After the individual sessions, the family and youth are brought together to address the issues associated with the dysfunctional interactions between family members and the continuation of problem behaviors. There is no assumption in the EBFT model that positive changes in the parent–adolescent relationship will necessarily lead to changes in substance-using behavior. Therefore, in both the individual and family sessions a framework is created to deal with the substance use in overt ways.
The therapists guide families from an intrapersonal to interpersonal interpretation of problems by using interpretations, questions and reframes that have relational bases. Cognitive–behavioral techniques are also used to change problem behavior patterns. New skills are taught and designed to be practiced and applied outside the therapy context. Therapists develop a rapport with the family while assessing the treatment needs of family members. The sessions are designed to be nonconfrontational; thus, therapists set tones that are not hostile or judgmental.
EBFT is guided by a manual that is divided into four sections. The first section describes the engagement procedure used with the youths and their families. The second section provides common themes to therapy involving runaway youths and their families, such as youth transitioning back into the home or parental refusal to allow the youth to live in the home. The final section outlines the sequence of clinical tasks for each therapy session. For example, in sessions 1 and 2, tasks include engagement, information gathering, and immediate needs assessment. The third session provides four individual sessions on HIV prevention. The final section, session 4, outlines the sequence of clinical tasks for the therapy sessions. These tasks continue throughout treatment.
Key Personnel
Families are seen by a single therapist. The therapist also serves as a therapeutic case manager, who coordinates meetings or services for the youth and the family based on a needs assessment.
