Differential Response to Evidenced-Based Treatment

描述(由申请人提供)：这项研究的中心目标是确定与儿童对一种经验性验证的治疗的不同反应相关的因素，该治疗旨在减少严重的青少年反社会行为，并在社区环境中实施。具体地说，这项纵向研究将检验治疗反应和无反应的交易模型，该模型侧重于儿童(生物)、家庭、环境和治疗依从性变量之间的相互作用，这些变量可能会影响社区精神卫生保健环境中的治疗结果。将使用多源、多方法评估小组对在社区环境中接受循证治疗(多系统治疗；MST)的185个家庭进行5次评估(治疗前、治疗中两次、治疗后、随访)。通过将基础科学(儿童情绪反应性，以皮质醇水平为指标)和治疗结果研究(父母精神病理学、治疗师依从性、育儿做法、环境应激源)中被确定为反社会青年治疗结果的潜在中介和调节因素的儿童因素联系起来，对指导这项调查的交易模式的组成部分进行测试。这项单组纵向研究的总体目标是：目标1：检查可能直接和/或间接影响治疗依从性和治疗结果的个人、家庭和环境因素。目的2：评估治疗师对照顾者行为变化的预测作用；并确定治疗前、个人和家庭特征以及治疗期间环境应激源之间的交互作用是否缓和了坚持与家庭实践变化之间的联系。目的3：确定治疗期间父母教养方式的改变是否会调节治疗师的依从性和青少年反社会行为的改变之间的关系。目的4：在循证治疗的背景下，研究与治疗相关的青少年情绪反应变化的基础科学问题。

DESCRIPTION (provided by applicant): The central goal of this study is to identify factors associated with children's differential response to an empirically validated treatment designed to reduce serious youth antisocial behavior and delivered in community-based settings. Specifically, this longitudinal study will examine a transactional model of treatment response and non-response that focuses on the interaction of child (biological), family, environment and treatment adherence variables that are likely to influence treatment outcome in community mental health care settings. A total of 185 families receiving an evidence-based treatment (Multisystemic therapy; MST) in community settings will be assessed 5 times (pre treatment, twice midtreatment, post treatment, follow-up) using a multi source, multi method assessment battery. Components of the transactional model guiding this investigation will be tested by linking child factors that have been identified in basic science (child emotional responsiveness, indexed by cortisol levels) and treatment outcome research (parent psychopathology, therapist adherence, parenting practices, environmental stressors) as potential mediators and moderators of treatment outcome among antisocial youth. The general aims of this single group longitudinal study are to: Aim 1: Examine individual, family, and environmental factors that may contribute directly and/or indirectly to treatment adherence to evidence-based treatment procedures and to treatment outcome. Aim 2: Evaluate the role of therapist adherence in predicting changes in caregiver behavior; and determine whether interactions among pretreatment individual and family characteristics and environmental stressors during treatment moderate the association between adherence and changes in family practices. Aim 3: Determine whether changes in parenting practices during treatment mediate the relationship between therapist adherence and changes in youth antisocial behavior. Aim 4: Examine basic science questions regarding treatment related changes in youth emotional reactivity in the context of evidence-based treatment.