Improving adolescent health by assessing in-session communication patterns

 描述(由申请人提供)：在美国，拉美裔美国人，特别是西班牙裔青年，在物质使用的负担中承担着不成比例的份额。拉美裔青年从酒精和其他药物(AOD)使用治疗中受益的可能性也低于白人青年。目前尚不清楚为什么这种差异在治疗后仍然存在。造成这种差异的两个潜在因素是治疗师的行为和AOD治疗过程中的沟通模式。先前在成人中的研究已经证明了治疗师行为、客户行为和AOD结果之间存在因果关系。如果治疗师对西班牙裔和白人青年的行为有所不同，那么主管、培训师和教育者将有具体的行为目标来衡量和改变治疗师的行为，以改善西班牙裔青年的这些不同的结果。二次分析依据生态发展理论(Szapocznik&Coatsworth，1999)对会话中的行为和过程做出具体的预测。这项研究将使用一种先进的心理治疗过程研究技术，顺序编码，来测量治疗师和客户在会话中的行为，以检验现有样本中关于西班牙裔和白人青年之间沟通模式和治疗师行为如何变化的假设，并将这些行为与AOD结果联系起来。使用来自Project Amica的现有大样本录音，这是一项评估健康差异的大型随机对照试验，包括人口统计学、心理社会评估和结果数据，将为大型、低成本和高影响的研究提供一个不同寻常的机会来检查健康差异的影响。在这项研究中评估患者和治疗师的语言提供了一个独特的机会，通过对涉及正义的青年进行动机访谈的随机对照试验来衡量沟通模式。拟议的为期4年的现有录音分析将测试成人人群中形成的因果链，使用青少年样本并比较这些对西班牙裔和高加索青年的影响，这一方法将通过证实或挑战西班牙裔青年使用AOD的现有心理治疗方法来指导临床实践。

 DESCRIPTION (provided by applicant): Hispanic Americans in general and Hispanic youth in particular, carry a disproportionate share of the burden of substance use in the United States. Hispanic youth are also less likely than are Caucasian youth to benefit from treatment for alcohol and other drug (AOD) use. It remains unknown why this disparity persists after treatment. Two potential factors in this disparity are therapist behaviors and communication patterns during treatment sessions for AOD use. Previous research in adults has demonstrated a causal chain between therapist behavior, client behavior, and AOD outcomes. If therapists behave differently with Hispanic and Caucasian youth, then supervisors, trainers, and educators would have concrete behavioral targets to measure and change therapist behavior to improve these disparate outcomes for Hispanic youth. The proposed secondary analysis relies upon Eco developmental theory (Szapocznik & Coatsworth, 1999) to make specific predictions about within-session behaviors and processes. This study will use an advanced psychotherapy process research technique, sequential coding, to measure within-session behaviors of therapists and clients to test these hypotheses about how communication patterns and therapist behaviors may vary between Hispanic and Caucasian youth in an existing sample of 506 recorded psychotherapy sessions with adjudicated youth, and to link these behaviors to AOD outcomes. Using this large, existing sample of audio recordings from Project AMICA, a large randomized controlled trial to assess health disparities, complete with demographics, psychosocial assessments, and outcome data, will provide an unusual opportunity for a large, low-cost and high-impact study to examine health disparities effects. Evaluating client and therapist language in this study presents a unique opportunity to measure communication patterns from a randomized controlled trial of motivational interviewing with justice- involved youth. The proposed 4-year analysis of existing recordings will test a causal chain developed in adult populations, using an adolescent sample and comparing those effects for Hispanic and Caucasian youth, an approach that will guide clinical practice by either corroborating or challenging current approaches to psychotherapy for AOD use with Hispanic youth.