A culturally responsive, family-enhanced intervention model.

The Multicultural Interventions for Adolescent Substance Use, referred to as The Shadow Project, was a 3-year, NIAAA-funded pilot study involving 60 American Indian families who had a youth entering alcohol and drug inpatient treatment. Participation was voluntary and involved comparison of two different treatment modalities: treatment as usual and a brief family-enhanced intervention. In adapting this family-based intervention specifically for American Indian families, a cultural approach to assessment and intervention was integrated into the process, with the intervention focusing on building support around the youth to attain abstinence and assuring the youth that their family, community, and substance abuse counselor were motivating influences. Five areas were assessed in the family observation tasks: relationship building, positive reinforcement, limit setting, monitoring, problem solving, and communication. Cultural adaptation was made for two of the five tasks. Two legends were used to assess the families' skill level in relationship building, problem solving, and communication as a family unit. By incorporating Indian stories, families were encouraged to respond in a culturally appropriate manner. Preliminary findings show that these stories were linked to child prosocial behavior and the percentage of days abstinent from individual drug use. This pilot project also adapted culturally responsive instruments, tasks, and validity to this population. The first year required adaptation of recruitment methods, tribal and treatment center agreements, referral contacts, and implementation of intervention and follow-up with adolescents and their families. The second year was composed of intervention implementation and follow-up assessments. To determine the intervention program's long-term effect on reducing adolescent alcohol and other drug use, all families were followed up and assessed 11 months after they left treatment. The third and final year of the study included follow-up, data entry, and data analysis.