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，该治疗旨在减少青少年严重的反社会行为，并在社区环境中实施。具体来说，这项纵向研究将检验治疗反应和无反应的交易模型，该模型侧重于儿童（生物）、家庭、环境和治疗依从性变量的相互作用，这些变量可能影响社区精神卫生保健机构的治疗结果。在社区环境中接受循证治疗（多系统治疗；MST）的185个家庭将使用多来源、多方法评估组进行5次评估（治疗前、治疗中、治疗后、随访）。指导本调查的交易模型的组成部分将通过将在基础科学（儿童情绪反应，以皮质醇水平为索引）和治疗结果研究（父母精神病理学，治疗师依从性，育儿实践，环境压力源）中确定的儿童因素作为反社会青少年治疗结果的潜在中介和调节因素进行测试。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治疗依从性和治疗结果的个人、家庭和环境因素。目的2：评估治疗师依从性在预测照顾者行为变化中的作用；并确定治疗前个体和家庭特征与治疗期间环境压力源之间的相互作用是否调节依从性与家庭实践变化之间的关联。目的3：确定治疗期间父母教养方式的改变是否介导了治疗师依从性与青少年反社会行为改变之间的关系。目标4：在循证治疗的背景下，研究与治疗相关的青少年情绪反应性变化的基础科学问题。

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.