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A broad organizational perspective. As we suggested earlier, consistent with the systemic approach on which the BSFT intervention is based, challenges in implementing the BSFT model and working with clinicians are also viewed from a broader, organizational perspective. Examples of such obstacles include cases where BSFT therapists are located in administrative units that are not dedicated to delivering the BSFT model. In such situations, therapists may be given a caseload of 30- 60 patients. Such caseloads can be managed through individual and group interventions, but are not possible to manage when whole families need to be engaged in treatment, when sessions often must be conducted in families' homes during evening and weekend hours, and when retaining family members requires frequent out-of-session contacts. The usual caseload for BSFT therapy is 10 families. For another example, if a community agency is not fully involved in the delivery of the BSFT model, therapists will often fail to submit videotapes required for supervision. Without these videotapes, we are unable to provide adequate monitoring, coaching, and feedback on BSFT adherence. Hence, supervisors cannot be successful unless the agency leadership is actively involved in ensuring that therapists have a caseload that allows them to deliver the BSFT intervention properly, are provided with adequate time to review their own videotapes, and are required to submit videotapes for supervision.
Rather than faulting therapists or other agency members for implementation challenges, such as clinicians' reluctance to quickly adopt the BSFT model, BSFT Implementation focuses on exploring the interactional patterns that support and maintain these obstacles. Using this systemic thinking, the BSFT Implementation team focuses on transforming interactional patterns that represent obstacles to change toward BSFT adoption and fidelity. BSFT Implementation applies BSFT intervention techniques such as joining, tracking and eliciting, diagnosing, reframing, and restructuring to transform organizational interactional patterns that are obstacles to implementation. Because the BSFT intervention is a problem focused model, BSFT Implementation focuses only on those interactional patterns within the agency that must be reconfigured for the BSFT model to be delivered successfully. This principle is parallel to the focus of the BSFT clinical intervention- only those family interactions that are directly associated with the adolescent's symptoms are targeted in therapy. Other organizational issues are unlikely to be addressed if they are peripheral to BSFT Implementation.