Adaptive Intervention Strategies in Conduct Problems Prevention

描述（由申请人提供）：我们建议进行可行性研究，以告知未来全面SMART设计的实施（即，序贯、多重分配、随机试验），将用于构建适应性干预策略（AIS）， 问题预防。AIS通过决策规则进行个体化治疗，这些规则规定了在治疗开始前应如何根据青少年和家庭特征制定干预的类型（以青少年为中心或以父母为中心）或强度（低剂量或高剂量），和/或根据治疗期间收集的近端结局随时间推移反复调整。行为问题预防需要AIS，以解决高危青少年的异质性和对传统固定型预防干预措施的反应的可变性。在目前的SMART中，每个参与者将通过使用分步护理框架的两个干预阶段取得进展。在第一阶段，参与者将被随机分配到两个“青少年型”干预方案中的一个，要么是以青少年为重点的青少年干预简报方案（TI-B; Winters & Leitten，2007），要么是以父母为重点的育儿智慧简报方案（PW-B; Gordon，2000）。任何一个项目的响应者都将被逐步淘汰，并随着时间的推移进行维护监测。对任一方案的无应答者将逐步增加并随机分配至两个第二阶段“强化型”干预选项之一，其特征是（1）继续第一阶段选项并增加剂量（PW-扩展或TI-扩展），或（2）切换至替代扩展干预模式。这项可行性研究将招募高风险青少年（10-15岁），他们因身份或轻罪而被捕，并被转介进行庭前青少年分流计划。本可行性研究的目的是（1）开发实施SMART设计的实践基础设施，并评估从业人员对各种干预序列的依从性，（2）推出阶梯式护理干预序列，并获得SMART招募、两个阶段的流失和第一阶段干预选项的总体响应率的估计值，（3）描述入组研究的转诊青年样本的人口统计学和临床特征，（4）创建 将被用作远端结果的行为问题的潜在构造，以及（5）探索结合次级定制变量的效用（例如，儿童和家庭风险特征）的适应性干预模式。

DESCRIPTION (provided by applicant): We propose to conduct feasibility research to inform implementation of a future full-scale SMART design (i.e., sequential, multiple assignment, randomized trial) that will be used to construct adaptive intervention strategies (AIS) for conduct problems prevention. AIS individualize treatment via decision rules that specify how the type (youth-focused or parent focused) or intensity (low dosage or high dosage) of an intervention should be formulated prior to the beginning of treatment based on youth and family characteristics and/or repeatedly adjusted over time based on proximal outcomes collected during treatment. AIS are needed in conduct problems prevention to address the heterogeneity of at-risk youth and the variability in response to conventional fixed-type preventive interventions. With the present SMART each participant will progress through two stages of intervention using a stepped-care framework. In the first stage participants will be randomized to one of two 'brief-type' intervention options, either the youth-focused Teen Intervene Brief program (TI-B; Winters & Leitten, 2007) or the parent-focused Parenting Wisely-Brief program (PW-B; Gordon, 2000). Responders to either program will be stepped down and monitored over time for maintenance. Non- responders to either program will be stepped up and randomized to one of two second stage 'intensive-type' intervention options that feature either (1) continuation of the first stage option with increased dosage (PW- Expanded or TI-Expanded), or (2) switching to the alternative expanded intervention modality. This feasibility study will enroll high risk youh (10-15 years of age) who have been arrested for status or misdemeanor offenses and referred for pre-court juvenile diversion programming. The aims of this feasibility research are to (1) develop practice infrastructure for implementing a SMART design and assess practitioner adherence to the various intervention sequences, (2) roll out the stepped-care intervention sequences and obtain estimates of recruitment into SMART, attrition at both stages, and overall response rate to first-stage intervention options, (3) describe the demographic and clinical characteristics of the sample of diversion-referred youth who are enrolled in the study, (4) create a latent construct for conduct problems that will be used as the distal outcome, and (5) explore the utility of incorporating secondary tailoring variables (e.g., child and family risk characteristics) in the adaptive intervention model.