Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes,Treatment Fidelity,and Transportability

The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examination of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.     

The Development and Transportability of Multisystemic Therapy-Substance Abuse: A Treatment for Adolescents with Substance Use Disorders

Multisystemic Therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009) is an evidence-based treatment that has been shown to be effective with adolescents with conduct-related problems. This article describes the development and transportability process related to an adaptation of MST titled Multisystemic Therapy-Substance Abuse (MST-SA). MST-SA is designed to treat adolescents with substance use disorders and is based on the work of Budney and Higgins (1998) and Azrin and colleagues (2001). Budney and Higgins have developed an effective treatment for adult cocaine abusers titled Community Reinforcement Approach (CRA). CRA is a form of contingency management (an evidence-based treatment for substance use disorder), which consists of frequent drug testing, an extensive reward system, functional analyses of triggers for drug use, plans to address triggers for drug use, and drug refusal skill training. Azrin and colleagues (2001) have developed an effective treatment for adolescents with substance use disorders, which includes an extensive list of rewards adolescents can earn for having negative drug screens. This article discusses results from an adaptation pilot, a randomized clinical efficacy trial, an effectiveness trial, and transportability pilots of MST-SA. Overall, results have been favorable for MST-SA, and efforts to transport MST-SA are underway with more than 30 transportability pilots of MST-SA in the United States, England, and Denmark.     

Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access.

Great strides have been made in developing psychosocial interventions for the treatment of depression and bipolar disorder over the last three decades, but more remains to be done. The National Institute of Mental Health Psychosocial Intervention Development Workgroup recommends three priorities for future innovation: 1) development of new and more effective interventions that address both symptom change and functional capacity, 2) development of interventions that prevent onset and recurrence of clinical episodes in at-risk populations, and 3) development of user-friendly interventions and nontraditional delivery methods to increase access to evidence-based interventions. In each of these areas, the Workgroup recommends systematic study of the mediating mechanisms that drive the process of change and the moderators that influence their effects. This information will highlight the elements of psychosocial interventions that most contribute to the prevention and treatment of mood disorders across diagnostic groups, populations served, and community settings. The process of developing innovative interventions should have as its goal a mental health service delivery system that prevents the onset and recurrence of the mood disorders, furnishes increasingly effective treatment for those who seek it, and provides access to evidence-based psychosocial interventions via all feasible means.     

灰色综合评价方法在野战卫生装备部署性评价上的应用

目的：针对野战卫生装备使用的战时及紧急事件特殊野外环境与普通医院的医疗设备差异，对其进行部署性评价。方法：根据影响野战卫生装备部署性的诸多因素环节，构建了野战卫生装备部署性综合评价指标体系，应用灰色系统理论建立了综合评价模型。通过模型参数求解，确定多个野战卫生装备部署性的综合评价排序。结果：评价实例表明，该方法简单方便，受评价指标间关联性影响小，评价结果与卖际情况相符。结论：野战卫生装备部署性评价结果，对选择部署性好的野战卫生装备，满足战时及紧急事件条件下使用具有重要意义。同时。该理论方法也为其他军事装备部署性评价奠定了基础。     

Extending inferences from a randomized trial to a new target population

When treatment effect modifiers influence the decision to participate in a randomized trial, the average treatment effect in the population represented by the randomized individuals will differ from the effect in other populations. In this tutorial, we consider methods for extending causal inferences about time-fixed treatments from a trial to a new target population of nonparticipants, using data from a completed randomized trial and baseline covariate data from a sample from the target population. We examine methods based on modeling the expectation of the outcome, the probability of participation, or both (doubly robust). We compare the methods in a simulation study and show how they can be implemented in software. We apply the methods to a randomized trial nested within a cohort of trial-eligible patients to compare coronary artery surgery plus medical therapy versus medical therapy alone for patients with chronic coronary artery disease. We conclude by discussing issues that arise when using the methods in applied analyses.     

Children and Adolescents in Cognitive–Behavioral Therapy: Some Past Efforts and Current Advances, and the Challenges in Our Future

The last two decades have been witness to advances in cognitive-behavioral therapy for children and adolescents, and certain treatments have been labeled empirically supported. However, not all cases show irrefutable gains and much treatment development and research remains. Following a brief precis of the past and present, we identify and examine several important directions for future research in child and adolescent therapy. Specifically, we consider (a) the nature and magnitude of improvement, including the need to assess the clinical significance of improvement, (b) general issues in assessment, such as parent-child agreement, method variance, and measurement equivalence, (c) the optimal role of parents in child and adolescent treatment, (d) potential moderators and mediators of positive outcomes, (e) the place of medications, and the potential role of parental expectations and/or preferences surrounding treatment selection, (f) therapist factors that may contribute to outcome, and (g) the effects of treatment on the sequelae of the target disorder. Last, the need to consider developmental issues and the transportability of CBT across settings are discussed.     

Successfully Integrating an HIV Risk Reduction Intervention into a Community-Based Substance Abuse Treatment Program

A number of evidence-based HIV risk reduction interventions are now widely available to clinicians. However, difficulties with intervention transportability have historically impeded the integration of evidence-based interventions into clinical settings. In this article, we discuss one successful approach to transportability through appropriate intervention selection, adaptation, placement, and evaluation. Our intervention adaptation process required substantially reducing the content and duration of an evidence-based intervention. Findings from 226 assessed participants suggested significant drug- and sex-related risk reduction outcomes, particularly among participants at greatest risk. Results point to a need to examine the relative costs/benefits of comprehensive, evidence-based interventions vs. shortened, adapted versions thereof.     

Moving Evidence-Based Drug Abuse Prevention Programs From Basic Science to Practice: “Bridging the Efficacy-Effectiveness Interface”

This article examines the challenges faced by developers of youth drug abuse prevention programs in transporting scientifically proven or evidence-based programs into natural community practice systems. Models for research on the transfer of prevention technology are described with specific emphasis given to the relationship between efficacy and effectiveness studies. Barriers that impede the successful integration of efficacy methods within effectiveness studies (e.g., client factors, practitioner factors, intervention structure characteristics, and environmental and organizational factors) are discussed. We present a modified model for program development and evaluation that includes a new type of research design, the hybrid efficacy-effectiveness study that addresses program transportability. The utility of the hybrid study is illustrated in the evaluation of the Early Risers “Skills for Success” prevention program.