Adherence and Competence in Adolescent Drug Use Therapy

描述：(申请人提供) 拟议研究的最终目标是提高有效性。 通过调查青少年滥用药物的两种手动治疗方法 治疗依从性和治疗师能力与治疗结果的关系。 这项研究将检验随机临床试验的现有数据，比较 多维家庭治疗与个体认知行为 治疗(CBT)，它代表了两个被广泛实践、经验支持的 青少年药物使用的治疗方法。治疗依从性和 治疗师的能力已被确定为手册的关键要素 治疗的实施和作为治疗收益的关键预测因素 青少年和成人人口。阐明两者之间联系的研究 在坚持不懈中，能力和结果对于发展更多 有效、有针对性和可移植的治疗模式，可在 不同的临床环境。主题将包括143个市中心，主要是 非裔美国人，少年司法涉及青少年及其照顾者。 青少年和照顾者完成药物治疗前后的措施 使用和吸毒，外化和内化症状，亲社会 行为和家庭功能。治疗过程的存档录像带将 接受审查以评估治疗的忠诚度、治疗师技能和治疗效果 联盟。研究假设将测试直接和间接影响 对青少年吸毒和共病症状的坚持和能力。 结构方程建模将检验：(1)对于MDFT， 坚持和能力通过改进产生更好的结果 育儿技能和家庭关系；(2)对于CBT，更高的忠诚度和 能力通过增加青少年的能力来产生更好的结果 自我效能感与亲社会参与；(3)两种治疗方式的效果 治疗依从性受到治疗师能力和治疗效果的影响 联盟。这项研究将是最早探索两者之间关系的研究之一 治疗依从性和结果，也是第一个学习治疗师的人 能力，与青少年吸毒样本。

DESCRIPTION: (provided by applicant) The ultimate objective of the proposed study is to increase the effectiveness of two manualized treatments for adolescent drug abuse by investigating the relation of treatment adherence and therapist competence to treatment outcomes. The study will examine existing data from a randomized clinical trial comparing multidimensional family therapy (MDFT) and individual cognitive-behavioral therapy (CBT), which represent two widely practiced, empirically supported treatment approaches for adolescent substance use. Treatment adherence and therapist competence have been identified as critical elements of manualized treatment implementation and as key predictors of therapeutic gains in both adolescent and adult populations. Studies that illuminate the associations among adherence, competence, and outcome are vital for developing more effective, targeted, and transportable therapy models for dissemination in diverse clinical settings. Subjects will include 143 inner-city, primarily African American, juvenile-justice involved adolescents and their caregivers. Adolescents and caregivers completed pre- and post-treatment measures of drug use and drug involvement, externalizing and internalizing symptoms, prosocial behavior, and family functioning. Archived videotapes of therapy sessions will be reviewed to assess treatment fidelity, therapist skill, and therapeutic alliance. Study hypotheses will test both the direct and indirect effects of adherence and competence on adolescent drug use and comorbid symptomatology. Structural equation modeling will examine whether: (1) for MDFT, greater adherence and competence produce better outcomes by means of improving parenting skills and family relationships; (2) for CBT, greater adherence and competence produce better outcomes by means of increasing adolescent self-efficacy and prosocial involvement; (3) for both treatments, the effects of treatment adherence are moderated by therapist competence and therapeutic alliance. This study will be among the first to explore the relation between treatment adherence and outcome, and the very first to study therapist competence, with an adolescent drug-using sample.