Process and Outcome Analysis of Group Treatment for Adolescent Substance Abuse

描述（由申请人提供）：本研究是对参与认知行为团体治疗的药物滥用青少年中观察到的临床过程及其与治疗结果的关联进行二次分析。本研究的具体目的如下：1. 在一项已完成的青少年药物滥用治疗随机临床试验中，观察和编码青少年群体治疗过程中发生的每时每刻的行为。2. 对于每个青少年参与者，构建一套双向列联表，总结在小组治疗过程中发生的关键青少年同伴和青少年治疗师的行为交换或序列。2 a。为每个青少年团体治疗参与者构建四个列联表，总结青少年-治疗师和青少年-同伴行为互动的特定观察序列的过渡概率。3. 使用Kenny及其同事的适用于小团体的行动者-伙伴独立模型分析观测序列数据（Kenny et al., 2002）。3 a。使用青少年-治疗师和青少年-同伴权变表过渡概率作为小团体行为者-伴侣独立性增长曲线模型的因变量。3 b。识别青少年治疗师和青少年同伴行为序列在群体治疗过程中的变化，这些变化在显示临床改善的青少年群体与控制青少年和群体特定变异源的非改善青少年群体之间存在差异。所提出的分析结果旨在阐明临床过程的特征和区分有效和无效的青少年治疗组。重要的是，行为者-伴侣独立模型可以有效地区分青少年特异性和群体特异性（即“同伴传染”）效应。这种对青少年和群体层面的影响来源的分析可以直接解决同伴传染效应是否以及在多大程度上影响青少年群体干预的临床结果的问题。此外，提出的分析将指出特定类型的观察到的行为交换，通过同伴传染效应可能影响青少年吸毒的结果。这些方面的信息可以为促进青少年群体治疗的积极临床结果提供临床指导。

DESCRIPTION (provided by applicant): The proposed study is a secondary analysis of observed in-session clinical processes and their association with treatment outcomes among substance abusing adolescents participating in cognitive- behavioral group therapy. The specific aims of the proposed study are as follows. 1. Observe and code moment-by-moment behaviors occurring during videotaped sessions of adolescent group therapy conducted during a completed randomized clinical trial of adolescent substance abuse treatment. 2. For each adolescent participant, construct a set of two-way contingency tables summarizing critical adolescent-peer and adolescent-therapist behavioral exchanges or sequences occurring within and across group therapy sessions. 2a. Construct four contingency tables for each adolescent group therapy participant summarizing the transitional probabilities of specific observed sequences of adolescent- therapist and adolescent-peer behavioral interaction. 3. Analyze the observational sequential data using Kenny and colleagues' actor-partner independence model adapted for small groups (Kenny et al., 2002). 3a. Use the adolescent-therapist and adolescent-peer contingency table transitional probabilities as dependent variables in actor-partner independence growth curve models for small groups. 3b. Identify changes in adolescent-therapist and adolescent-peer behavioral sequences over the course of group treatment that differ between clusters of adolescents showing clinical improvement versus non-improvement controlling for adolescent- and group- specific sources of variation. The results of the proposed analysis are intended to illuminate clinical processes that characterize and distinguish between effective and ineffective adolescent treatment groups. Importantly, the actor-partner independence model can effectively tease apart adolescent-specific versus group-specific (i.e., "peer contagion") effects. This parsing of adolescent- and group-level sources of influence can directly address the questions of whether and to what extent peer contagion effects impact clinical outcomes in adolescent group interventions. Furthermore, the proposed analysis will pinpoint specific types of observed behavioral exchanges through which peer contagion effects may influence adolescent drug use outcomes. Information along these lines can inform clinical guidelines for facilitating positive clinical outcomes in adolescent group treatment.