Process and Outcome Analysis of Group Treatment for Adolescent Substance Abuse

描述(由申请人提供)：这项拟议的研究是对参与认知行为团体治疗的滥用药物青少年中观察到的中期临床过程及其与治疗结果的相关性的二次分析。拟议研究的具体目标如下。1.观察并编码在青少年药物滥用治疗的完全随机临床试验期间进行的青少年团体治疗的录像过程中发生的每一时刻的行为。2.对于每个青少年参与者，构建一组双向联想表，总结在团体治疗过程中和跨团体治疗过程中发生的关键的青少年-同伴和青少年治疗师行为交流或序列。2A。为每个青少年团体治疗参与者构建四个列联表，总结青少年-治疗师和青少年-同伴行为互动的特定观察序列的过渡概率。3.使用Kenny和他的同事们适用于小团体的行动者-伙伴独立性模型来分析观察到的序列数据(Kenny等人，2002年)。3A.将青少年-治疗师和青少年-同伴转换概率表作为因变量用于小群体的演员-伴侣独立性成长曲线模型。3B.确定在集体治疗过程中青少年治疗师和青少年同伴行为序列的变化，这些变化在表现出临床改善与未改善的青少年群体之间存在差异，控制了青少年和特定群体的变异来源。拟议的分析结果旨在阐明有效和无效的青少年治疗组的特征和区分的临床过程。重要的是，行为者-伴侣独立性模型可以有效地梳理出青少年特有的影响与群体特有的影响(即“同伴传染”)。这种对青少年和群体层面影响来源的分析可以直接解决同伴传染效应是否以及在多大程度上影响青少年群体干预的临床结果的问题。此外，拟议的分析将准确地指出观察到的特定类型的行为交换，通过这些交换，同伴传染效应可能会影响青少年的药物使用结果。沿着这些路线的信息可以为促进青少年群体治疗的积极临床结果的临床指南提供信息。

DESCRIPTION (provided by applicant): The proposed study is a secondary analysis of observed in-session clinical processes and their association with treatment outcomes among substance abusing adolescents participating in cognitive- behavioral group therapy. The specific aims of the proposed study are as follows. 1. Observe and code moment-by-moment behaviors occurring during videotaped sessions of adolescent group therapy conducted during a completed randomized clinical trial of adolescent substance abuse treatment. 2. For each adolescent participant, construct a set of two-way contingency tables summarizing critical adolescent-peer and adolescent-therapist behavioral exchanges or sequences occurring within and across group therapy sessions. 2a. Construct four contingency tables for each adolescent group therapy participant summarizing the transitional probabilities of specific observed sequences of adolescent- therapist and adolescent-peer behavioral interaction. 3. Analyze the observational sequential data using Kenny and colleagues' actor-partner independence model adapted for small groups (Kenny et al., 2002). 3a. Use the adolescent-therapist and adolescent-peer contingency table transitional probabilities as dependent variables in actor-partner independence growth curve models for small groups. 3b. Identify changes in adolescent-therapist and adolescent-peer behavioral sequences over the course of group treatment that differ between clusters of adolescents showing clinical improvement versus non-improvement controlling for adolescent- and group- specific sources of variation. The results of the proposed analysis are intended to illuminate clinical processes that characterize and distinguish between effective and ineffective adolescent treatment groups. Importantly, the actor-partner independence model can effectively tease apart adolescent-specific versus group-specific (i.e., "peer contagion") effects. This parsing of adolescent- and group-level sources of influence can directly address the questions of whether and to what extent peer contagion effects impact clinical outcomes in adolescent group interventions. Furthermore, the proposed analysis will pinpoint specific types of observed behavioral exchanges through which peer contagion effects may influence adolescent drug use outcomes. Information along these lines can inform clinical guidelines for facilitating positive clinical outcomes in adolescent group treatment.