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Littell JH. The Logic of Generalization From Systematic Reviews and Meta-Analyses of Impact Evaluations. EVALUATION REVIEW 2024; 48:427-460. [PMID: 38261473 DOI: 10.1177/0193841x241227481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Systematic reviews and meta-analyses are viewed as potent tools for generalized causal inference. These reviews are routinely used to inform decision makers about expected effects of interventions. However, the logic of generalization from research reviews to diverse policy and practice contexts is not well developed. Building on sampling theory, concerns about epistemic uncertainty, and principles of generalized causal inference, this article presents a pragmatic approach to generalizability assessment for use with systematic reviews and meta-analyses. This approach is applied to two systematic reviews and meta-analyses of effects of "evidence-based" psychosocial interventions for youth and families. Evaluations included in systematic reviews are not necessarily representative of populations and treatments of interest. Generalizability of results is limited by high risks of bias, uncertain estimates, and insufficient descriptive data from impact evaluations. Systematic reviews and meta-analyses can be used to test generalizability claims, explore heterogeneity, and identify potential moderators of effects. These reviews can also produce pooled estimates that are not representative of any larger sets of studies, programs, or people. Further work is needed to improve the conduct and reporting of impact evaluations and systematic reviews, and to develop practical approaches to generalizability assessment and guide applications of interventions in diverse policy and practice contexts.
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Affiliation(s)
- Julia H Littell
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA
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2
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Green F, Axford N, Eastmond N, Berry V, Mannes J, Allen K, Callaghan L, Hobbs T. Transporting an Evidence-based Youth Development Program to a New Country: A Narrative Description and Analysis of Pre-implementation Adaptation. JOURNAL OF PREVENTION (2022) 2023; 44:729-747. [PMID: 37768424 PMCID: PMC10638196 DOI: 10.1007/s10935-023-00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/29/2023]
Abstract
There is a pressing need to prevent and address youth crime and violence owing to its prevalence, harms and cost to society. Interventions with proven effectiveness in doing this exist. Adopting and adapting them in new contexts is potentially cost-effective. However, more research is needed into how to make adaptations that enhance intervention implementation, effectiveness and maintenance in new settings. This article reports the pre-implementation adaptation work involved in transporting Becoming a Man (BAM) from the US to the UK. BAM is a selective school-based youth development program for 12-18 year-old boys that aims to improve school engagement and reduce interactions with the criminal justice system. We describe the nature of and rationale for adaptations and identify learning for future adaptation efforts. An adaptation team comprising the intervention developers, new providers and the evaluators met weekly for 10 weeks, applying a structured, pragmatic and evidence-informed approach to adapt the BAM curriculum and implementation process. Changes were informed by documentary analysis, group-based discussions and site visits. The group agreed 27 changes to the content of 17/30 lessons, at both surface (e.g., cultural references) and deep (key mechanisms or concepts) levels. Of 28 contextual factors considered, 15 discrepancies between the US and UK were identified and resolved (e.g., differences in staffing arrangements). Strengths of the process were the blend of expertise on the adaptation team in the program and local context, and constant reference to and ongoing refinement of the program theory of change. Limitations included the lack of involvement of school staff or students. Further research is needed into potential conflicts between stakeholder perspectives during adaptation and whose views to prioritise and when.
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Affiliation(s)
- Finlay Green
- Dartington Service Design Lab, Buckfastleigh, UK
| | | | | | | | - Julia Mannes
- Dartington Service Design Lab, Buckfastleigh, UK
| | | | | | - Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, UK
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3
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Hayden NK, Flynn S, Blumenfeld F, Hastings RP, Gray KM, Cullen S, Cullen MA, Langdon PE. Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation. Pilot Feasibility Stud 2023; 9:193. [PMID: 38012747 PMCID: PMC10680250 DOI: 10.1186/s40814-023-01409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Child criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation. METHODS This pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services. RESULTS Accrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023. CONCLUSIONS The results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation. TRIAL REGISTRATION Trial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021- https://doi.org/10.1186/ISRCTN16164816 .
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Affiliation(s)
- N K Hayden
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - S Flynn
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - F Blumenfeld
- School of Health and Social Care, University of Essex, Colchester, UK
| | - R P Hastings
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - K M Gray
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - S Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - M A Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - P E Langdon
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK.
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK.
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4
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McCart MR, Sheidow AJ, Jaramillo J. Evidence Base Update of Psychosocial Treatments for Adolescents with Disruptive Behavior. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022:1-28. [DOI: 10.1080/15374416.2022.2145566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Simmons C, Mitchell-Adams H, Baskin-Sommers A. Environmental Predictors of Within-Person Changes in Callous-Unemotional Traits among Justice-Involved Male Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-18. [PMID: 35900060 DOI: 10.1080/15374416.2022.2093207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Youth who display elevated callous-unemotional (CU) traits are at risk for negative developmental outcomes. Previous studies demonstrate that environmental conditions contribute to elevated levels of CU traits, but the majority of this work focuses on a single source of environmental influence. To better understand how environmental conditions contribute to changes in CU traits during adolescence, the current study examined the time-varying relation between CU traits, parent, peer, and community conditions. METHOD Using data from the longitudinal Pathways to Desistance study (N = 1,026 males, Mage = 15.98, SD = 1.16; 40.94% Black, 34.11% Latino, 20.66% White, 4.29% Other), full-factorial fixed effect regression models were implemented to examine how parental hostility, antisocial peers, community violence, and neighborhood disorder are individually and interactively associated with within-person changes in CU traits during adolescence (15-21 years). RESULTS Results indicated that proximal conditions (i.e., negative parenting, antisocial peers) had more consistent associations with CU traits than distal conditions (i.e., neighborhood disorder, community violence). Affiliation with antisocial peers was not significantly related to CU traits when youth were simultaneously exposed to high community violence and low neighborhood disorder. Further, the association between CU traits and impact of living in high disordered, high violence neighborhoods was stronger for younger youth. CONCLUSION Results indicate that the association among parents, peers, and CU trait development is more nuanced than previously suggested, such that the risk that each environmental condition poses is moderated by a youth's age and their exposure to distal conditions.
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Stabler L, Evans R, Scourfield J, Morgan F, Weightman A, Willis S, Searchfield L, Meindl M, Wood S, Nurmatov U, Kemp A, Forrester D, Brand SL. A scoping review of system-level mechanisms to prevent children being in out-of-home care. BRITISH JOURNAL OF SOCIAL WORK 2022; 52:2515-2536. [PMID: 36685801 PMCID: PMC9847665 DOI: 10.1093/bjsw/bcab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 06/17/2023]
Abstract
Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.
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Affiliation(s)
- Lorna Stabler
- Correspondence to Lorna Stabler, Children’s Social Care Research and Development Centre (CASCADE), Cardiff University, 1-3 Museum Place, Cathays, CF10 3BD, UK. E-mail:
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cathays, CF10 3BD, UK
| | - Jonathan Scourfield
- Children’s Social Care Research and Development Centre (CASCADE), Cardiff University, Cathays, CF10 3BD, UK
| | - Fiona Morgan
- Public Health Wales, No. 2. Capital Quarter, Cardiff, CF10 4BZ, UK
| | - Alison Weightman
- Specialist Unit for Review Evidence, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Simone Willis
- Specialist Unit for Review Evidence, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence, Cardiff University, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Mel Meindl
- Children’s Social Care Research and Development Centre (CASCADE), Cardiff University, Cathays, CF10 3BD, UK
| | - Sophie Wood
- Children’s Social Care Research and Development Centre (CASCADE), Cardiff University, Cathays, CF10 3BD, UK
| | - Ulugbek Nurmatov
- School of Medicine, University Hospital Wales, Cardiff, CF14 4XN, UK
| | - Alison Kemp
- School of Medicine, University Hospital Wales, Cardiff, CF14 4XN, UK
| | - Donald Forrester
- Children’s Social Care Research and Development Centre (CASCADE), Cardiff University, Cathays, CF10 3BD, UK
| | - Sarah L Brand
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, Exeter, Devon, EX1 2LU, UK
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Bo S, Sharp C, Kongerslev MT, Luyten P, Fonagy P. Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach. Borderline Personal Disord Emot Dysregul 2022; 9:16. [PMID: 35701834 PMCID: PMC9199171 DOI: 10.1186/s40479-022-00187-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years of psychotherapy research in general and (b) recent advances in mentalization-based understanding of why treatment works, which together point to the importance of following a socioecological approach in the treatment of personality problems in adolescence - a developmental period that insists on a treatment approach that goes beyond the therapist-client dyad. CASE PRESENTATION Here, we describe such an approach, and offer a clinical case example with a young 16-year old girl diagnosed with borderline personality disorder, to illustrate what a shift toward a more socioecological approach would entail. CONCLUSIONS The clinical impact of the socioecological approach and the potential benefits as illustrated in the current case illustration, offers a framework that justifies and allows for the expansion of service delivery for youth with borderline personality disorder beyond dyadic therapist-client work.
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Affiliation(s)
- Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark. .,Child and Adolescent Mental Health Services, Ny Oestergade 12, 4000, Roskilde, Region Zealand, Denmark.
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, USA
| | - Mickey T Kongerslev
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Louvain, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud Centre, London, UK
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Antisocial cognition as a mediator of the peer influence effect and peer selection effect in antisocial adolescents. Eur Child Adolesc Psychiatry 2022; 31:177-187. [PMID: 33330952 PMCID: PMC8816781 DOI: 10.1007/s00787-020-01695-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/22/2020] [Indexed: 10/25/2022]
Abstract
The peer influence and peer selection effects are two widely replicated findings in the criminological literature that refer to the predictive relationship between antisocial behaviour and delinquent peer association as well as between delinquent peer association and antisocial behaviour, respectively. Research suggests that antisocial cognition might constitute a causal mechanism underlying part of these effects. This study investigated the extent that the peer influence and peer selection effects are mediated by one key aspect of antisocial cognition-beliefs and attitudes supporting peer conflict. This study examined whether beliefs and attitudes supporting peer conflict mediated the relationship between delinquent peer association and volume of self-reported antisocial behaviour and vice-versa, across a 1-year follow-up period, in 683 (433 male, 250 female) British adolescents (mean age: 13.8 years) with a history of serious antisocial behaviour. Participants completed measures at baseline and 6, 12 and 18 months thereafter. Findings indicated that beliefs and attitudes supporting peer conflict partially mediated the peer influence and peer selection effects, explaining a substantial proportion of the total effect in the peer influence (i.e., 26%) and peer selection (i.e., 17%) models. These results suggest that beliefs and attitudes supporting peer conflict could explain part of the mechanism underlying the peer influence and peer selection effects in adolescents with a history of serious antisocial behaviour.
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Sheidow AJ, McCart MR, Drazdowski TK. Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:56-82. [PMID: 34723395 PMCID: PMC8761163 DOI: 10.1111/jmft.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 05/27/2023]
Abstract
Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.
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10
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Ganesan K, Shakoor S, Wertz J, Agnew-Blais J, Bowes L, Jaffee SR, Matthews T, Arseneault L. Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2041-2052. [PMID: 33856493 PMCID: PMC8521530 DOI: 10.1007/s00127-021-02062-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Bullying behaviours and other conduct problems often co-occur. However, we do not yet know whether bullying behaviours are associated with early factors and later poor outcomes independently of conduct problems. While there are differing, specific interventions for bullying behaviours and for conduct problems, it is unclear if such specificity is justified given parallels between both behaviours. METHODS We used prospective data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2232 children. Mothers and teachers reported on children's bullying behaviours and conduct problems at ages 7 and 10. We collected measures of risk factors, including temperament and family factors, when children were age 5. We assessed behavioural, emotional, educational and social problems when participants reached the ages of 12 and 18. RESULTS Bullying behaviours and conduct problems co-occurred in childhood. Our findings indicated that bullying behaviours and other conduct problems were independently associated with the same risk factors. Furthermore, they were associated with the same poor outcomes at both ages 12 and 18. Despite this, bullying behaviours were uniquely associated with behavioural, emotional, educational and social problems at age 18. CONCLUSIONS Our findings suggest that anti-bullying programmes and interventions aimed at reducing conduct problems could benefit from greater integration. Furthermore, our study highlights the mental health problems children who bully may face in later years and the need to consider those in intervention plans.
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Affiliation(s)
- Keertana Ganesan
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Sania Shakoor
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Queen Mary, University of London, London, UK
| | - Jasmin Wertz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Jessica Agnew-Blais
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Matthews
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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Cherlin S, Wason JMS. Developing a predictive signature for two trial endpoints using the cross-validated risk scores method. Biostatistics 2021; 24:327-344. [PMID: 34165151 PMCID: PMC10102911 DOI: 10.1093/biostatistics/kxaa055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
The existing cross-validated risk scores (CVRS) design has been proposed for developing and testing the efficacy of a treatment in a high-efficacy patient group (the sensitive group) using high-dimensional data (such as genetic data). The design is based on computing a risk score for each patient and dividing them into clusters using a nonparametric clustering procedure. In some settings, it is desirable to consider the tradeoff between two outcomes, such as efficacy and toxicity, or cost and effectiveness. With this motivation, we extend the CVRS design (CVRS2) to consider two outcomes. The design employs bivariate risk scores that are divided into clusters. We assess the properties of the CVRS2 using simulated data and illustrate its application on a randomized psychiatry trial. We show that CVRS2 is able to reliably identify the sensitive group (the group for which the new treatment provides benefit on both outcomes) in the simulated data. We apply the CVRS2 design to a psychology clinical trial that had offender status and substance use status as two outcomes and collected a large number of baseline covariates. The CVRS2 design yields a significant treatment effect for both outcomes, while the CVRS approach identified a significant effect for the offender status only after prefiltering the covariates.
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Affiliation(s)
- Svetlana Cherlin
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - James M S Wason
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK and MRC Biostatistics Unit, University of Cambridge, East Forvie Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
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Juul S, Gluud C, Simonsen S, Frandsen FW, Kirsch I, Jakobsen JC. Blinding in randomised clinical trials of psychological interventions: a retrospective study of published trial reports. BMJ Evid Based Med 2021; 26:109. [PMID: 32998993 DOI: 10.1136/bmjebm-2020-111407] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To study the extent of blinding in randomised clinical trials of psychological interventions and the interpretative considerations if randomised clinical trials are not blinded. DESIGN Retrospective study of trial reports published in six high impact factor journals within the field of psychiatry in 2017 and 2018. SETTING Trial reports published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics. MAIN OUTCOME MEASURES Blinding status of participants, treatment providers, outcome assessors, data managers, the data safety and monitoring committee, statisticians and conclusion makers, if trialists rejected the null hypothesis on the primary outcome measure, and if trialists discussed the potential bias risk from lack of blinding in the published trial report. RESULTS 63 randomised clinical trials of psychological interventions were identified. None (0%; 95% CI 0% to 5.75%) of the trials reported blinding of all possible key persons. 37 (58.7%; 95% CI 46.42% to 70.04%) trials reported blinding of outcome assessors. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of participants. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of data managers. Three (4.8%; 95% CI 1.63% to 13.09%) trials reported blinding of statisticians. None of the trials reported blinding of treatment providers, the data safety and monitoring committee, and conclusion makers. 45 (71.4%; 95% CI 59.30% to 81.10%) trials rejected the null hypothesis on the primary outcome(s). 13 (20.7%; 95% CI 12.48% to 32.17%) trials discussed the potential bias risk from lack of blinding in the published trial report. CONCLUSIONS Blinding of key persons involved in randomised clinical trials of psychological interventions is rarely sufficiently documented. The possible interpretative limitations are only rarely considered. There is a need of randomised clinical trials of psychological interventions with documented blinding attempts of all possible key persons.
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Affiliation(s)
- Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Frederik Weischer Frandsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, Boston, Massachusetts, USA
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Thøgersen DM, Bjørnebekk G, Scavenius C, Elmose M. Callous-Unemotional Traits Do Not Predict Functional Family Therapy Outcomes for Adolescents With Behavior Problems. Front Psychol 2021; 11:537706. [PMID: 33536955 PMCID: PMC7848225 DOI: 10.3389/fpsyg.2020.537706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/21/2020] [Indexed: 12/04/2022] Open
Abstract
Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional (CU) traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy (FFT). This study used a single-group pre-post evaluation design with a sample of 407 adolescents (49.1% female, mean age = 14.4 years, SD = 1.9) receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population.
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Affiliation(s)
- Dagfinn Mørkrid Thøgersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Gunnar Bjørnebekk
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | | | - Mette Elmose
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Shenderovich Y, Ward CL, Lachman JM, Wessels I, Sacolo-Gwebu H, Okop K, Oliver D, Ngcobo LL, Tomlinson M, Fang Z, Janowski R, Hutchings J, Gardner F, Cluver L. Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: study protocol. Implement Sci Commun 2020; 1:109. [PMID: 38624613 PMCID: PMC7719848 DOI: 10.1186/s43058-020-00086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation.Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification. Discussion This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.
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Affiliation(s)
- Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Catherine L. Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Inge Wessels
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Kufre Okop
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Zuyi Fang
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Roselinde Janowski
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Promoting Learning from Null or Negative Results in Prevention Science Trials. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 23:751-763. [PMID: 32748164 PMCID: PMC7398716 DOI: 10.1007/s11121-020-01140-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There can be a tendency for investigators to disregard or explain away null or negative results in prevention science trials. Examples include not publicizing findings, conducting spurious subgroup analyses, or attributing the outcome post hoc to real or perceived weaknesses in trial design or intervention implementation. This is unhelpful for several reasons, not least that it skews the evidence base, contributes to research “waste”, undermines respect for science, and stifles creativity in intervention development. In this paper, we identify possible policy and practice responses when interventions have null (ineffective) or negative (harmful) results, and argue that these are influenced by: the intervention itself (e.g., stage of gestation, perceived importance); trial design, conduct, and results (e.g., pattern of null/negative effects, internal and external validity); context (e.g., wider evidence base, state of policy); and individual perspectives and interests (e.g., stake in the intervention). We advance several strategies to promote more informative null or negative effect trials and enable learning from such results, focusing on changes to culture, process, intervention design, trial design, and environment.
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16
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Cherlin S, Wason JMS. Developing and testing high‐efficacy patient subgroups within a clinical trial using risk scores. Stat Med 2020; 39:3285-3298. [PMID: 32662542 PMCID: PMC7611900 DOI: 10.1002/sim.8665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/18/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022]
Abstract
There is the potential for high-dimensional information about patients collected in clinical trials (such as genomic, imaging, and data from wearable technologies) to be informative for the efficacy of a new treatment in situations where only a subset of patients benefits from the treatment. The adaptive signature design (ASD) method has been proposed for developing and testing the efficacy of a treatment in a high-efficacy patient group (the sensitive group) using genetic data. The method requires selection of three tuning parameters which may be highly computationally expensive. We propose a variation to the ASD method, the cross-validated risk scores (CVRS) design method, that does not require selection of any tuning parameters. The method is based on computing a risk score for each patient and dividing them into clusters using a nonparametric clustering procedure.We assess the properties of CVRS against the originally proposed cross-validated ASD using simulation data and a real psychiatry trial. CVRS, as assessed for various sample sizes and response rates, has a substantial reduction in the computational time required. In many simulation scenarios, there is a substantial improvement in the ability to correctly identify the sensitive group and the power of the design to detect a treatment effect in the sensitive group.We illustrate the application of the CVRS method on the psychiatry trial.
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Affiliation(s)
- Svetlana Cherlin
- Newcastle Clinical Trials Unit Newcastle University Newcastle upon Tyne UK
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
| | - James M. S. Wason
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
- MRC Biostatistics Unit Cambridge Institute of Public Health Cambridge UK
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17
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Fonagy P, Butler S, Cottrell D, Scott S, Pilling S, Eisler I, Fuggle P, Kraam A, Byford S, Wason J, Smith JA, Anokhina A, Ellison R, Simes E, Ganguli P, Allison E, Goodyer IM. Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background
The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months).
Objectives
The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants.
Design
Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation.
Setting
Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home.
Participants
A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female.
Interventions
MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial.
Main outcome measures
Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending.
Results
No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men.
Limitations
Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality.
Future research
Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators.
Conclusions
The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully.
Trial registration
Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Peter Fuggle
- Anna Freud National Centre for Children and Families, London, UK
| | - Abdullah Kraam
- Univesity of Leeds and South West Yorkshire Partnership NHS Foundation Trust, Leeds, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, School of Science, Birkbeck, University of London, London, UK
| | - Alisa Anokhina
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Rachel Ellison
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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18
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Fonagy P, Butler S, Cottrell D, Scott S, Pilling S, Eisler I, Fuggle P, Kraam A, Byford S, Wason J, Smith JA, Anokhina A, Ellison R, Simes E, Ganguli P, Allison E, Goodyer IM. Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): 5-year follow-up of a pragmatic, randomised, controlled, superiority trial. Lancet Psychiatry 2020; 7:420-430. [PMID: 32353277 DOI: 10.1016/s2215-0366(20)30131-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multisystemic therapy is a manualised treatment programme for young people aged 11-17 years who exhibit antisocial behaviour. To our knowledge, the Systemic Therapy for At Risk Teens (START) trial is the first large-scale randomised controlled trial of multisystemic therapy in the UK. Previous findings reported to 18 months after baseline (START-I study) did not indicate superiority of multisystemic therapy compared with management as usual. Here, we report outcomes of the trial to 60 months (START-II study). METHODS In this pragmatic, randomised, controlled, superiority trial, young people (aged 11-17 years) with moderate-to-severe antisocial behaviour were recruited from social services, youth offending teams, schools, child and adolescent mental health services, and voluntary services across England, UK. Participants were eligible if they had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. Eligible families were randomly assigned (1:1), using stochastic minimisation and stratifying for treatment centre, sex, age at enrolment, and age at onset of antisocial behaviour, to management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. For this extension study, the primary outcome was the proportion of participants with offences with convictions in each group at 60 months after randomisation. This study is registered with ISRCTN, ISRCTN77132214, and is closed to accrual. FINDINGS Between Feb 4, 2010, and Sept 1, 2012, 1076 young people and families were assessed for eligibility and 684 were randomly assigned to management as usual (n=342) or multisystemic therapy (n=342). By 60 months' of follow-up, 188 (55%) of 342 people in the multisystemic therapy group had at least one offence with a criminal conviction, compared with 180 (53%) of 341 in the management-as-usual group (odds ratio 1·13, 95% CI 0·82-1·56; p=0·44). INTERPRETATION The results of the 5-year follow-up show no evidence of longer-term superiority for multisystemic therapy compared with management as usual. FUNDING National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter Fuggle
- Anna Freud National Centre for Children and Families, London, UK
| | - Abdullah Kraam
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, Birkbeck College, University of London, London, UK
| | - Alisa Anokhina
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rachel Ellison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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19
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Rogers JC, Broome MR. Effectiveness of multisystemic therapy for adolescent antisocial behaviour: follow-up findings from the START trial. Lancet Psychiatry 2020; 7:375-376. [PMID: 32353262 DOI: 10.1016/s2215-0366(20)30167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jack C Rogers
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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20
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Constantinou MP, Goodyer IM, Eisler I, Butler S, Kraam A, Scott S, Pilling S, Simes E, Ellison R, Allison E, Fonagy P. Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention. J Am Acad Child Adolesc Psychiatry 2019; 58:776-786. [PMID: 30768397 DOI: 10.1016/j.jaac.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/16/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be summarized by a single latent dimension known as the p factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a psychosocial intervention. METHOD A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11-18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. RESULTS A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, the p factor accounted for most of the variance in total scores. The p factor, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p factor and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. CONCLUSION The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores. CLINICAL TRIAL REGISTRATION INFORMATION START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context; http://www.isrctn.com; ISRCTN77132214.
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Affiliation(s)
| | | | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, University College London, UK
| | - Stephen Butler
- University of Prince Edward Island, Charlottetown, Canada
| | - Abdullah Kraam
- University of Leeds and Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, UK
| | - Elizabeth Simes
- Division of Psychology and Language Sciences, University College London, UK
| | - Rachel Ellison
- Division of Psychology and Language Sciences, University College London, UK
| | - Elizabeth Allison
- Division of Psychology and Language Sciences, University College London, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, UK
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21
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Duggan C. Looking from the outside: No substitute for rigorous evaluation. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:189-195. [PMID: 31483552 DOI: 10.1002/cbm.2129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Looking in from the outside, what would the ordinary person expect of forensic mental health services? I suggest that there are three questions he or she would ask: (a) Are there public health measures that can be introduced to prevent those with mental disorder going on to commit crimes? (b) Can we identify in advance the individual who is likely to go on and commit a violent act because of his or her mental health difficulties, and prevent that or limit damage? (c) If a seriously harmful act has already been committed, what interventions might prevent a repetition? All of these questions are about prevention of an untoward event in the future and anticipate knowledge. How secure can we be that current forensic mental health practitioners can make adequately evidenced responses? I fear that examination of current literature would indicate that they and their academic colleagues would fall short of these expectations. Reasons for this are undoubtedly numerous. The issues are complex, with the interplay of many variables from the vagaries of human nature through varying presentations of disorders, still often classified rather than diagnosed, to widely differing environments which, further, may suddenly change in a critical way. The impact of a serious offence can be so catastrophic that officialdom often decides that "something must be done." Yet, without a good evidence base, such decision-making is often ineffective and wasteful of resources. The limited evidence base has not been helped by the virtual extinction of an academic forensic psychiatry infrastructure and funding within British universities and the National Health Service. This does not bode well for the future.
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Affiliation(s)
- Conor Duggan
- Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
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22
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Hales H, Holt C, Delmage E, Lengua C. What next for adolescent forensic mental health research? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:196-206. [PMID: 31478288 DOI: 10.1002/cbm.2124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public. AIM The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective. METHODS Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England. FINDINGS As in most countries, service development seems first driven by unusual, newsworthy cases. Overall, however, current English provision follows sound primary, secondary, and tertiary prevention principles with parallel tiers of service, including public health initiatives. Primary prevention and more specific treatments are likely to be informed by research findings, but service structure tends to emerge from a wider review base, including criminal justice, social and educational practitioner reviews, and also politics. Thus, services and populations of service users may change in advance of research evidence. Substantial reduction in numbers of young offenders in prison in England, for example, is clearly good in principle, but the intensity of need in the residual group is posing new challenges to which there are, yet, few answers. CONCLUSIONS Although the last 15 years of coordinated service development in England has been broadly theoretically based, it has not been systematically assessed to establish what works best for whom. New problems emerging, such as new drugs of misuse, and new opportunities, such as technology for supporting and monitoring, require model studies. More research focusing on correlates of success is essential.
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Affiliation(s)
- Heidi Hales
- West London NHS Trust, Three Bridges Secure Unit, St Bernard's Hospital, Southall, UK
| | - Clare Holt
- STC Rainsbrook, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Enys Delmage
- Nga Taiohi and Hikitia Secure Adolescent Units, Kenepuru Hospital, Porirua, New Zealand
| | - César Lengua
- North East Commissioning Support Unit, Durham, UK
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23
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Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Franke B, Freitag CM, De Brito SA. Conduct disorder. Nat Rev Dis Primers 2019; 5:43. [PMID: 31249310 DOI: 10.1038/s41572-019-0095-y] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.
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Affiliation(s)
| | - David J Hawes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA and Institute for Learning Science and Teacher Education, Australian Catholic University, Brisbane, Queensland, Australia
| | | | - Candice L Odgers
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stephane A De Brito
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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Blankestein A, van der Rijken R, Eeren HV, Lange A, Scholte R, Moonen X, De Vuyst K, Leunissen J, Didden R. Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:575-590. [PMID: 30620111 PMCID: PMC6850470 DOI: 10.1111/jar.12551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 09/14/2018] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND An adaptation of multisystemic therapy (MST) was piloted to find out whether it would yield better outcomes than standard MST in families where the adolescent not only shows antisocial or delinquent behaviour, but also has an intellectual disability. METHOD To establish the comparative effectiveness of MST-ID (n = 55) versus standard MST (n = 73), treatment outcomes were compared at the end of treatment and at 6-month follow-up. Pre-treatment differences were controlled for using the propensity score method. RESULTS Multisystemic therapy-ID resulted in reduced police contact and reduced rule breaking behaviour that lasted up to 6 months post-treatment. Compared to standard MST, MST-ID more frequently resulted in improvements in parenting skills, family relations, social support, involvement with pro-social peers and sustained positive behavioural changes. At follow-up, more adolescents who had received MST-ID were still living at home. CONCLUSIONS These results support further development of and research into the MST-ID adaptation.
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Affiliation(s)
- Annemarieke Blankestein
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
- Viersprong Institute for Studies on Personality DisordersHalsterenThe Netherlands
| | - Rachel van der Rijken
- Viersprong Institute for Studies on Personality DisordersHalsterenThe Netherlands
- PraktikonNijmegenThe Netherlands
| | - Hester V. Eeren
- Viersprong Institute for Studies on Personality DisordersHalsterenThe Netherlands
- Department of Psychiatry, Section Medical Psychology and PsychotherapyErasmus Medical CenterRotterdamThe Netherlands
| | - Aurelie Lange
- Viersprong Institute for Studies on Personality DisordersHalsterenThe Netherlands
- Department of Psychiatry, Section Medical Psychology and PsychotherapyErasmus Medical CenterRotterdamThe Netherlands
| | - Ron Scholte
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
- Viersprong Institute for Studies on Personality DisordersHalsterenThe Netherlands
- Tilburg UniversityTilburgThe Netherlands
| | | | | | | | - Robert Didden
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
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Ford T, Hayes R, Byford S, Edwards V, Fletcher M, Logan S, Norwich B, Pritchard W, Allen K, Allwood M, Ganguli P, Grimes K, Hansford L, Longdon B, Norman S, Price A, Russell AE, Ukoumunne OC. Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPoor mental health in childhood is common, persistent and associated with a range of adverse outcomes that include persistent psychopathology, as well as risk-taking behaviour, criminality and educational failure, all of which may also compromise health. There is a growing policy focus on children’s mental health and the role of schools in particular in addressing this.ObjectivesTo evaluate whether or not the Incredible Years®(IY) Teacher Classroom Management (TCM) training improved children’s mental health, behaviour, educational attainment and enjoyment of school, improved teachers’ mental health and relationship with work, and was cost-effective in relation to potential improvements.DesignA two-arm, pragmatic, parallel-group, superiority, cluster randomised controlled trial.SettingA total of 80 UK schools (clusters) were recruited in three distinct cohorts between 2012 and 2014 and randomised to TCM (intervention) or teaching as usual [(TAU) control] with follow-ups at 9, 18 and 30 months. Schools and teachers were not masked to allocation.ParticipantsEighty schools (n = 2075 children) were randomised: 40 (n = 1037 children) to TCM and 40 (n = 1038 children) to TAU.InterventionsTCM was delivered to teachers in six whole-day sessions, spread over 6 months. The explicit goals of TCM are to enhance classroom management skills and improve teacher–student relationships.Main outcome measuresThe primary planned outcome was the teacher-reported Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score. Random-effects linear regression and marginal logistic regression models using generalized estimating equations were used to analyse outcomes.ResultsThe intervention reduced the SDQ-TD score at 9 months [adjusted mean difference (AMD) –1.0, 95% confidence interval (CI) –1.9 to –0.1;p = 0.03] but there was little evidence of effects at 18 months (AMD –0.1, 95% CI –1.5 to 1.2;p = 0.85) and 30 months (AMD –0.7, 95% CI –1.9 to 0.4;p = 0.23). Planned subgroup analyses suggested that TCM is more effective than TAU for children with poor mental health. Cost-effectiveness analysis using the SDQ-TD suggested that the probability of TCM being cost-effective compared with TAU was associated with some uncertainty (range of 40% to 80% depending on the willingness to pay for a unit improvement in SDQ-TD score). In terms of quality-adjusted life-years (QALYs), there was evidence to suggest that TCM was cost-effective compared with TAU at the National Institute for Health and Care Excellence thresholds of £20,000–30,000 per QALY at 9- and 18-month follow-up, but not at 30-month follow-up. There was evidence of reduced disruptive behaviour (p = 0.04) and reductions in inattention and overactivity (p = 0.02) at the 30-month follow-up. Despite no main effect on educational attainment, subgroup analysis indicated that the intervention’s effect differed between those who did and those who did not have poor mental health for both literacy (interactionp = 0.04) and numeracy (interactionp = 0.03). Independent blind observations and qualitative feedback from teachers suggested that teachers’ behaviour in the classroom changed as a result of attending TCM training.LimitationsTeachers were not masked to allocation and attrition was marked for parent-reported data.ConclusionsOur findings provide tentative evidence that TCM may be an effective universal child mental health intervention in the short term, particularly for primary school children who are identified as struggling, and it may be a cost-effective intervention in the short term.Future workFurther research should explore TCM as a whole-school approach by training all school staff and should evaluate the impact of TCM on academic progress in a more thorough and systematic manner.Trial registrationCurrent Controlled Trials ISRCTN84130388.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. Funding was also provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).
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Affiliation(s)
- Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | | | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | | | - Brahm Norwich
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Will Pritchard
- Education and Early Years, Cornwall County Council, Truro, UK
| | - Kate Allen
- University of Exeter Medical School, Exeter, UK
| | | | - Poushali Ganguli
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Katie Grimes
- Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Anna Price
- University of Exeter Medical School, Exeter, UK
| | | | - Obioha C Ukoumunne
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
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Lim S, Lambie I, van Toledo A. Characteristics of Female Youth Offenders in New Zealand. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:198-217. [PMID: 30198362 DOI: 10.1177/0306624x18799002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Female youth offending is poorly understood, despite increased rates of such offending. Research indicates there are a range of factors that have a causal impact on the development of offending in young people. This study investigated risk factors using a retrospective file audit of 184 female youth offenders in New Zealand. The findings were classified using Bronfenbrenner's ecological model, which highlights the different contextual levels that influence behavior, including individual, family, peer, school, community, and cultural factors. The results indicate that there are significant risk factors for female youth offenders. There were high rates of mental health difficulties, drug use, histories of maltreatment, family stressors, peer issues, and school behavior problems in the cohort. There was very little difference between violent and nonviolent offenders. All the young women had risk factors affecting them at many levels. Targeted, multisystemic intervention and prevention programs are therefore needed to address female youth offending.
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Affiliation(s)
- Stacey Lim
- 1 The University of Auckland, Auckland, New Zealand
| | - Ian Lambie
- 1 The University of Auckland, Auckland, New Zealand
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Gardner F, Leijten P, Melendez-Torres GJ, Landau S, Harris V, Mann J, Beecham J, Hutchings J, Scott S. The Earlier the Better? Individual Participant Data and Traditional Meta-analysis of Age Effects of Parenting Interventions. Child Dev 2018; 90:7-19. [PMID: 30216433 DOI: 10.1111/cdev.13138] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Strong arguments have been made for early intervention for child problems, stating that early is more effective than later, as the brain is more malleable, and costs are lower. However, there is scant evidence from trials to support this hypothesis, which we therefore tested in two well-powered, state-of-the-art meta-analyses with complementary strengths: (a) Individual participant data (IPD) meta-analysis of European trials of Incredible Years parenting intervention (k = 13, n = 1696; age = 2-11); (b) Larger, trial-level robust variance estimation meta-analysis of a wider range of parenting programs (k = 156, n = 13,378, Mage = 2-10) for reducing disruptive behavior. Both analyses found no evidence that intervention earlier in childhood was more effective; programs targeted at a narrower age range were no more effective than general ones.
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Lebow JL. Editorial: Effectiveness Research in Couple and Family Therapy. FAMILY PROCESS 2018; 57:271-274. [PMID: 29786133 DOI: 10.1111/famp.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jay L Lebow
- Family Process, and Family Institute at Northwestern, Evanston, IL
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Mustafa FA. Randomised controlled trials for multisystemic therapy: when is enough, enough? Lancet Psychiatry 2018; 5:390. [PMID: 29699737 DOI: 10.1016/s2215-0366(18)30098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Feras Ali Mustafa
- Northamptonshire Healthcare NHS Foundation Trust, Northampton NN1 3EB, UK.
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30
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Fonagy P. Randomised controlled trials for multisystemic therapy: when is enough, enough? - Authors' reply. Lancet Psychiatry 2018; 5:390. [PMID: 29699738 DOI: 10.1016/s2215-0366(18)30131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, UK.
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Maughan B, Gardner F. Multisystemic therapy not superior to management as usual for adolescent antisocial behaviour in an English trial. Lancet Psychiatry 2018; 5:94-95. [PMID: 29307526 DOI: 10.1016/s2215-0366(18)30002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 11/20/2022]
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