Process and Outcome Analysis of Group Treatment for Adolescent Substance Abuse

描述（由申请方提供）：拟定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会话中临床过程及其与治疗结局的相关性进行的二次分析。拟议研究的具体目标如下。1.在一项已完成的青少年药物滥用治疗的随机临床试验中，观察并编码青少年团体治疗录像期间发生的每时每刻的行为。2.对于每个青少年参与者，构建一组双向列联表，总结小组治疗会议内和小组治疗会议之间发生的关键性同伴和治疗师行为交流或序列。2a.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群体的演员-伴侣独立性模型（Kenny et al.，2002年）。3a.在小群体的行动者-伙伴独立性增长曲线模型中，使用合作治疗师和合作伙伴列联表过渡概率作为因变量。3b.确定在小组治疗过程中，治疗师和同伴行为序列的变化，这些变化在显示临床改善与未改善的青少年群体之间存在差异，控制青少年和小组特定的变异来源。拟议分析的结果旨在阐明表征和区分有效和无效青少年治疗组的临床过程。重要的是，行动者-合作伙伴独立性模型可以有效地区分特定于行动者和特定于群体的行动者（即，“同伴传染”）效应。这种对青少年和群体层面影响力来源的解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，拟议的分析将查明特定类型的观察到的行为交流，通过这种交流，同伴传染效应可能会影响青少年吸毒的结果。信息沿着这些线可以告知临床指南，促进青少年群体治疗的积极临床结果。

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.