Testing Context Effects on Treatment of Drug-Using Youth

描述（由申请人提供）： 将基于研究的干预措施有效地转化为基于社区的实践是公共卫生的优先事项。为了解决有吸毒问题的青年的这一优先问题，治疗和可转移性战略必须解决四个主要挑战。(1)关注疗效试验中在对照条件下实现的治疗结局在常规护理条件下可实现的程度。(2)精神障碍，特别是行为和其他破坏性行为障碍与青少年药物滥用的共病。(3)经验支持的治疗方法的采用和实施的障碍出现在服务环境的多个层面。(4)国家药物滥用服务基础设施的问题表明，应该利用其他系统来满足有毒品问题的青年的需要。 该应用程序提出了二次分析，以利用250万美元的研究经费和1560万美元的服务费用，在41个网站，NIMH资助的研究运输经验支持的治疗1950年的青年与严重的反社会行为，其中415有共病药物使用问题。这项研究的设计、拟议的再收集一年的后续数据以及拟议的二级数据分析将使我们能够通过实现三个目标来解决上述关切。 目标1：使用基准战略，比较有反社会和药物使用问题的可运输性样本青年在治疗后2年的毒品相关犯罪和一般犯罪结果，以及在MST随机临床试验中这些青年在治疗后2年取得的结果;并且，比较行为问题，心理社会功能，在可运输性和随机对照试验样本中，通过治疗后1年，药物相关和一般犯罪结果。 目标二。在可运输性样本中，比较有和没有确定的药物使用问题的青少年治疗后2年与药物相关的和一般的犯罪结果;并比较这两组治疗后1年的行为问题，心理社会功能和物质使用问题。 目标3：测试青少年反社会行为的治疗实施和结果的多变量背景模型，有和没有物质使用问题。 3a.研究系统级变量（转介和报销来源和类型），组织结构和气候，治疗师的坚持，和其他治疗师变量（培训，经验，教育）对治疗结果的影响，青年和没有物质使用问题。 3b.研究转介和报销来源和类型，组织结构和气候，治疗师的治疗依从性变量的影响，当治疗青少年和没有物质使用问题。 3c.研究治疗师坚持MST的青少年和没有物质使用问题。总之，这些分析将测试的命题，某些治疗和运输战略，如果足够全面，可以改善以社区为基础的护理与药物滥用问题的青年专业药物滥用诊所以外。

DESCRIPTION (provided by applicant): The effective transport of research-based interventions to community-based practice is a public health priority. To address this priority for youth with substance use problems, treatment and transportability strategies must address four major challenges. (1) Concerns about the extent to which treatment outcomes achieved under controlled conditions in efficacy trials can be achieved under usual care conditions. (2) The comorbidity of psychiatric disorders, particularly conduct and other disruptive behavior disorders with youth drug abuse. (3) Barriers to the adoption and implementation of empirically supported treatments arise at multiple levels of the service context. (4) Problems with the nation's substance abuse service infrastructure suggest other systems should be enlisted to meet the needs of youth with drug problems. This application proposes secondary analyses to leverage the 2.5 million research dollars and 15.6 million service dollars expended in a 41-site, NIMH-funded study of the transportability of an empirically supported treatment to 1950 youth with serious antisocial behavior, 415 of which have comorbid drug use problems. The design of that study, proposed collection of one additional year of follow-up data, and proposed secondary data analyses will enable us to address the aforementioned concerns by accomplishing three aims. Aim 1: Using a benchmarking strategy, compare the drug-related crime and general criminal outcomes through 2 years post-treatment of Transportability sample youths with co-occurring antisocial and substance use problems and the 2-year post-treatment outcomes achieved among such youths in randomized clinical trials of MST; and, compare the behavior problem, psychosocial functioning, and drug-related and general criminal outcomes through 1 year post-treatment in the Transportability and RCT samples. Aim 2. To compare, within the Transportability sample, drug-related and general criminal outcomes 2 years post-treatment among youths with and without identified drug use problems; and, to compare 1 year post-treatment behavior problem, psychosocial functioning, and substance use problems of these two groups. Aim 3: Test a multivariate contextual model of treatment implementation and outcomes for youth with antisocial behavior with and without substance use problems. 3a. To examine the influence of system-level variables (referral and reimbursement source and type), organizational structure and climate, therapist adherence, and other therapist variables (training, experience, education) on treatment outcomes for youth with and without substance use problems. 3b. To examine the influence of referral and reimbursement source and type, organizational structure and climate, and therapist variables on therapist adherence when treating youth with and without substance use problems. 3c. To examine therapist adherence to MST for youths with and without substance use problems. Together, these analyses will test the proposition that certain treatment and transport strategies, if sufficiently comprehensive, can improve community-based care for youth with substance use problems outside of specialty substance abuse clinics.