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，为未来全面智能设计(即，顺序、多任务、随机试验)的实施提供信息，该设计将用于构建行为的适应性干预策略(AIS) 预防问题。人工智能机构通过决策规则使治疗个体化，这些规则规定在治疗开始之前应如何根据青年和家庭特征和/或根据治疗期间收集的近期结果反复调整干预的类型(以青年为重点或以家长为重点)或干预强度(低剂量或高剂量)。在行为问题预防方面需要人工智能，以解决高危青少年的异质性和对传统固定类型预防干预措施的反应的变异性。有了目前的SMART，每个参与者将通过使用分步护理框架的两个阶段的干预进行进展。在第一阶段，参与者将被随机分成两个“简明型”干预方案之一，要么是以青少年为重点的青少年干预简明计划(TI-B；温特斯和莱顿，2007)，要么是以父母为中心的明智-简明干预计划(PW-B；Gordon，2000)。任何一个项目的响应者都将被下台，并随着时间的推移进行维护监测。对任何一种方案都没有反应的人将被加强，并随机进入两个第二阶段“集约型”干预选项之一，这两个选项的特点是：(1)继续第一阶段选项并增加剂量(PW扩展或TI扩展)，或(2)切换到替代扩展干预模式。这项可行性研究将招募因身份或轻罪被逮捕并被转介进行庭前青少年分流计划的高危青少年(10-15岁)。这项可行性研究的目的是(1)开发实践基础设施以实施SMART设计并评估从业者对各种干预序列的遵守情况，(2)展开阶梯式护理干预序列并获得SMART招募、两个阶段的自然减员以及对第一阶段干预选项的总体响应率的估计，(3)描述参与研究的分流青少年样本的人口学和临床特征，(4)创建 行为问题的潜在结构将被用作远端结果，以及(5)探索在适应性干预模型中纳入次级定制变量(例如，儿童和家庭风险特征)的效用。

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.