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、社区和社会带来严重的负面后果和高昂的代价。此外，滥用药物的青少年中精神疾病共病的比率很高，患有双重诊断的青少年的治疗费用更高。然而，到目前为止，还没有专门针对患有共生物质使用障碍和精神健康诊断的青少年进行门诊治疗的测试。目前的项目旨在调整和评估多系统疗法(MST)，这是一种经过良好验证的治疗青少年慢性行为问题或严重情绪障碍的方法，以使用门诊服务提供模式治疗双重诊断的青年。在这项研究项目的第一阶段，标准的MST治疗手册、监督手册、质量保证方案和治疗师培训方案将被改编用于门诊环境，以治疗双重诊断的青年。在第二阶段，修订的方案将包括在一项试点试验中，40名被诊断为双重诊断的青年随机分配到治疗条件下，其中20人接受MST门诊治疗，20人接受普通门诊服务。治疗前、入院后6个月、入院后12个月进行综合多方法、多源评估，评价治疗效果。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，用于门诊治疗被诊断为物质使用障碍和共病内化障碍的青少年。我们假设，与接受常规服务的对照青年相比，接受MST门诊治疗的青年在6个月和12个月的随访中表现出明显较少的药物使用(例如，青年自我报告和尿检)，并且在6个月和12个月的随访中，接受门诊MST的青年在心理健康指数(例如，关于诊断访谈的青年和照顾者的综合报告以及青年、照顾者和教师关于内化症状的报告)方面将显示出显著的改善。具体目标2：除了改善症状，目前的研究旨在测试门诊MST在改善与青少年成功发展相关的其他领域的青少年功能方面的有效性。我们假设，与接受常规服务的对照青年相比，接受门诊MST的青年在6个月和12个月的随访中将证明，与接受常规服务的对照青年相比，接受门诊MST的青年在行为(例如，青年、照顾者和教师关于外化的报告)、学校(例如，学校出勤率)和家庭功能(例如，青年和照顾者关于家庭适应性和凝聚力的报告)方面将有改善。具体目标3：拟议研究的最终目标是提供比社区通常提供的服务更容易为消费者接受的服务。我们假设，接受MST门诊治疗的青少年和家庭将比接受常规服务的对照青少年和家庭体验到更高的消费者满意度。

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.