Effectiveness Trial: MST with Juvenile Offenders

描述（由申请人提供）：青少年性犯罪者提出了严重的临床问题，导致昂贵的（和未经测试的）心理健康和少年司法当局的干预措施。基于现存的文献，我们认为，占主导地位的（即，对青少年性犯罪者的干预措施（限制性的）与这些青年的发展需要不太匹配;因此，这些干预措施不太可能比基于社区的替代措施更有效。此外，我们认为，有效的服务将（a）有能力应对多种风险因素;（B）个性化;（c）克服获得服务的障碍;（d）包括强有力的质量保证机制;（e）注重建设环境系统的能力，特别是围绕青年的家庭;（f）促进社区安全。为了验证这些论点，本申请提出了一项有效性研究，比较青少年性犯罪者与多系统治疗（MST; Henggeler，Schoenwald，Borduin，Rowland，& Cunningham，1998）与接受常规少年司法和精神卫生服务的青少年相比，在一项随机设计中，160名青少年性犯罪者将被分配到MST（N = 80）与社区服务。（US; N = 80）治疗条件。将使用多方法、多应答者评估组合检查与临床相关的关键结局（例如，犯罪行为，精神病学）和服务（例如，服务利用率、成本效益）结果。将每6个月进行一次评估，直至转诊后随访2年，每月跟踪服务利用率和治疗依从性。研究的具体目标是：目标1。评估治疗对青少年犯罪活动、心理健康功能、酗酒和吸毒的影响”，以及对家庭关系、同伴关系和入学率的影响。跟踪青少年少年司法参与，心理健康和药物滥用服务的利用，以及在整个治疗条件下的家庭外安置及其相关费用，为期24个月。假设有利的MST治疗效果，检查可能的调节剂（例如，种族，性犯罪者亚型）和中介者（例如，改善家庭关系）。

DESCRIPTION (provided by applicant): Adolescent sexual offenders present serious clinical problems that have led to expensive (and untested) interventions from mental health and juvenile justice authoritics. Based on the extant literature, we argue that the predominant (i.e., restrictive) interventions for adolescent sexual offenders are not well matched with the developmental needs of these youths; and, consequently, these interventions are not likely to be more effective than community-based alternatives. Moreover, we suggest that effective services will (a) have the capacity to address multiple risk factors; (b) be individualized; (c) overcome barriers to service access; (d) include strong quality assurance mechanisms; (e) focus on building the capacities of the environmental systems, especially the family, surrounding the youth; and (f) promote community safety. To test these contentions, this application proposes an effectiveness study comparing adolescent sex offenders treated with multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) versus adolescents treated with usual juvenile justice and mental health services, In a randomized design, 160 juvenile sex offenders will be assigned to MST (N = 80) vs. Usual Services (US; N = 80) treatment conditions. A multimethod, multirespondent assessment battery will be used to examine key outcomes pertaining to clinical (e.g., criminal behavior, symptomatology ) and service (e.g., service utilization, cost effectiveness) outcomes. Assessments will be conducted at 6-month intervals through a 2-year post referral follow-up, with monthly tracking of service utilization and treatment adherence. The specific aims of the study are:Aim 1. To evaluate treatment effects on youth criminal activity, mental health functioning, and alcohol and drug use," as well as on family relations, peer relations, and school attendance.Aim 2. To track adolescent juvenile justice involvement, mental health and substance abuse service utilization, and out-of-home placements and their associated costs across the treatment conditions for 24 months post recruitment.Aim 3. Assuming favorable MST treatment effects, to examine the possible moderators (e.g., race, sexual offender subtype) and mediators (e.g., improved family relations) of such effects.