Development of Outpatient MST for Dually Diagnosed Youth

描述（由申请人提供）： 青少年药物滥用会给青少年、他们的家庭、社区和社会带来重大的负面后果和巨大的代价。此外，药物滥用青年的精神病合并症的发病率很高，双重诊断的青年治疗费用更高。然而，迄今为止，还没有专门用于治疗药物滥用障碍和精神健康诊断并存的青年的门诊治疗方法。目前的项目旨在调整和评估多系统治疗（MST），一个行之有效的治疗慢性行为问题或严重的情绪障碍的青少年，治疗双重诊断的青年使用门诊模式的服务提供。在本研究项目的第一阶段，标准的MST治疗手册，监督手册，质量保证协议和治疗师培训协议将适用于门诊设置，以治疗双重诊断的青年。在第二阶段，修订后的方案将被纳入一项试点试验，其中40名双重诊断的青年被随机分配到治疗条件下，20名接受门诊MST，20名接受常规门诊服务。将在治疗前、入组后6个月和入组后12个月进行全面的多方法、多系统评估，以评价治疗疗效。具体目标是：具体目标1：本研究的主要目的是调整和测试MST在门诊环境中的使用，以治疗被诊断患有药物使用障碍和共病内化障碍的青少年。我们假设接受门诊MST的青少年将表现出明显更少的药物使用（例如，青少年自我报告和尿液筛查）在6个月和12个月随访时比接受常规服务的对照青少年，接受门诊MST的青少年将表现出心理健康指数的显著改善（例如，在6个月和12个月的随访中，与对照青少年相比，将青少年和护理人员关于诊断访谈的合并报告以及青少年、护理人员和教师关于内化症状的报告）具体目标2：除了改善青少年发育学之外，目前的研究旨在测试门诊MST在改善青少年在与成功的青少年发展相关的其他领域的功能方面的有效性。我们假设接受门诊MST的青少年将证明行为改善（例如，青少年，照顾者和教师报告的外部化），学校（例如，学校出勤率）和家庭功能（例如，在6个月和12个月的随访中，与接受常规服务的对照青年相比，青年和照顾者报告了家庭适应性和凝聚力。具体目标3：建议研究的最终目的，是提供较一般社会服务更能为消费者接受的服务。我们假设，接受门诊MST的青年和家庭将经历显着更大的消费者满意度比控制青年和家庭谁接受常规服务。

DESCRIPTION (provided by applicant): Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth are high and youths with a dual diagnosis are more costly to treat. To date, however, no outpatient treatments have been tested specifically for treating youth with co-occurring substance use disorders and mental health diagnoses. The current project aims to adapt and evaluate Multisystemic Therapy (MST), a well validated treatment for chronic behavioral problems or serious emotional disturbance in adolescents, to treat dually diagnosed youth using an outpatient model of service delivery. In Phase I of this research project, the standard MST treatment manual, supervision manual, quality assurance protocol, and therapist training protocol will be adapted for use in outpatient settings to treat dually diagnosed youth. In Phase II, the revised protocols will be included in a pilot trial with 40 dually diagnosed youth randomly assigned to treatment conditions, with 20 receiving Outpatient MST and 20 receiving usual outpatient services. Comprehensive multimethod, multisource assessments will be conducted pretreatment, 6 months post entry, and 12 months post entry to evaluate treatment efficacy. Specific aims are: Specific Aim 1: The primary aim of the present research is to adapt and test MST for use in outpatient settings to treat youth diagnosed with a substance use disorder and comorbid internalizing disorder. We hypothesize that youth receiving Outpatient MST will exhibit significantly less drug use (e.g., youth self-reports and urine screens) at 6- and 12-month follow-up than control youth who receive usual services, and that youth receiving Outpatient MST will exhibit significant improvement on indices of mental health (e.g., combined youth and caregiver reports on diagnostic interviews and youth, caregiver, and teacher reports of internalizing symptoms) at 6- and 12-month follow-up compared to control youth Specific Aim 2: In addition to improved symptomatology, the current research aims to test the effectiveness of Outpatient MST to improve youth functioning in other domains pertinent to successful adolescent development. We hypothesize that youth receiving Outpatient MST will evidence improved behavioral (e.g., youth, caregiver, and teacher reports of externalizing), school (e.g., school attendance), and family functioning (e.g., youth and caregiver reports of family adaptability and cohesion) at 6- and 12-month follow-up compared to control youth who receive usual services. Specific Aim 3: The final aim of the proposed research is to provide services that are more acceptable to consumers than are usual services provided in the community. We hypothesize that youth and families receiving Outpatient MST will experience significantly greater consumer satisfaction than control youth and families who receive usual services.