Differential Response to Evidenced-Based Treatment

描述（由申请人提供）：本研究的中心目标是确定与儿童对经验验证的治疗的差异反应相关的因素，该治疗旨在减少严重的青少年反社会行为，并在社区环境中提供。具体而言，这项纵向研究将检查治疗反应和无反应的交易模型，重点是儿童（生物），家庭，环境和治疗依从性变量的相互作用，可能会影响社区精神卫生保健环境中的治疗结果。将使用多来源、多方法评估组合对在社区环境中接受循证治疗（多系统治疗; MST）的共计185个家庭进行5次评估（治疗前、治疗中两次、治疗后、随访）。指导这项调查的交易模型的组成部分将被测试，已确定在基础科学（儿童情绪反应，皮质醇水平指数）和治疗结果的研究（父母的精神病理学，治疗师的依从性，育儿的做法，环境压力）作为潜在的调解人和调解人的治疗结果之间的反社会青年。这项单组纵向研究的总体目标是：目标1：检查可能直接和/或间接影响循证治疗程序依从性和治疗结局的个人、家庭和环境因素。目标二：评估治疗依从性在预测看护者行为变化中的作用;并确定治疗前个人和家庭特征以及治疗期间环境压力因素之间的相互作用是否会缓和依从性与家庭实践变化之间的关联。目标3：确定在治疗过程中父母的做法是否改变调解治疗师的依从性和青年反社会行为的变化之间的关系。目的4：在循证治疗的背景下，研究与治疗相关的青年情绪反应变化的基本科学问题。

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.