Randomized Trial of MST and ARC in a Two-Level Evidence-Based Treatment Implementation Strategy
Randomized Trial of MST and ARC in a Two-Level Evidence-Based Treatment Implementation Strategy
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DOI：
10.1037/a0019160
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发表时间：
2010-08-01
影响因子：
5.9
通讯作者：
Chapman, Jason E.
中科院分区：
文献类型：
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作者：
Glisson, Charles;Schoenwald, Sonja K.;Chapman, Jason E.
目的：一项随机试验评估两级策略对不良青少年实施循证心理健康治疗的有效性。方法：一项包含14个阿巴拉契亚农村县的2x2设计，包括2个因素：(A)每个县的犯罪青少年随机分配到多系统治疗（MST）项目或常规服务中；(b)随机分配到ARC（可获得性、响应性和连续性）组织干预中，以实施有效的社区精神卫生服务。设计创建了4种处理条件（MST + ARC、MST单独、ARC单独、对照）。对615名年龄在9-17岁的青少年（69%为男性，91%为白人）的结果测量包括儿童行为检查表和家庭外安置。结果：对6个月治疗结果的多水平、混合效应、回归分析发现，MST + ARC条件下的青少年总问题行为处于非临床水平，显著低于其他条件。在18个月的随访中，所有条件下的总问题行为都是相同的，且处于非临床水平，但MST + ARC条件下的青少年进入户外安置的比例（16%）明显低于对照组的青少年（34%）。结论：结合组织干预（如ARC）和循证治疗（如MST）的两级策略是实施有效社区精神卫生服务的有希望的方法。需要更多的研究来了解这些策略如何在各种组织环境中有效地使用，并与其他类型的循证治疗相结合。
Objective: A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Method: A 2 X 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9-17 years included the Child Behavior Checklist and out-of-home placements. Results: A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Conclusions: Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments.