Adaptive Intervention Strategies in Conduct Problems Prevention

预防行为​​问题的适应性干预策略

• 批准号: 8827851
• 负责人: GERALD J AUGUST
• 金额: $ 22.8万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-15 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8827851
• 关键词: 15 year old; Address; Adherence; Adolescent; Caring; Characteristics; Child; Child Rearing; Chronic; Client; Clinical; Comorbidity; Conduct Disorder; Data; Distal; Diversion Program; Enrollment; Evidence based program; Family; Family Characteristics; Feasibility Studies; Future; Goals; Growth; Health; Heterogeneity; Individual; Intervention; Law Enforcement; Long-Term Effects; Maintenance; Measures; Modality; Modeling; Monitor; Outcome; Parent-Child Relations; Parents; Participant; Phase; Pilot Projects; Population; Prevention; Prevention strategy; Preventive Intervention; Procedures; Protocols documentation; Psychiatric Diagnosis; Randomized; Recommendation; Research; Research Infrastructure; Research Personnel; Risk; Sampling; Services; Specific qualifier value; Staging; Teenagers; Time; Youth; base; conduct problem; cost; court; design; deviant; dosage; high risk; individualized medicine; innovation; intervention effect; offender; peer; potency testing; prevent; programs; randomized trial; response; satisfaction; skills training; social cognition; social stigma; stress management

DESCRIPTION (provided by applicant): We propose to conduct feasibility research to inform implementation of a future full-scale SMART design (i.e., sequential, multiple assignment, randomized trial) that will be used to construct adaptive intervention strategies (AIS) for conduct problems prevention. AIS individualize treatment via decision rules that specify how the type (youth-focused or parent focused) or intensity (low dosage or high dosage) of an intervention should be formulated prior to the beginning of treatment based on youth and family characteristics and/or repeatedly adjusted over time based on proximal outcomes collected during treatment. AIS are needed in conduct problems prevention to address the heterogeneity of at-risk youth and the variability in response to conventional fixed-type preventive interventions. With the present SMART each participant will progress through two stages of intervention using a stepped-care framework. In the first stage participants will be randomized to one of two 'brief-type' intervention options, either the youth-focused Teen Intervene Brief program (TI-B; Winters & Leitten, 2007) or the parent-focused Parenting Wisely-Brief program (PW-B; Gordon, 2000). Responders to either program will be stepped down and monitored over time for maintenance. Non- responders to either program will be stepped up and randomized to one of two second stage 'intensive-type' intervention options that feature either (1) continuation of the first stage option with increased dosage (PW- Expanded or TI-Expanded), or (2) switching to the alternative expanded intervention modality. This feasibility study will enroll high risk youh (10-15 years of age) who have been arrested for status or misdemeanor offenses and referred for pre-court juvenile diversion programming. The aims of this feasibility research are to (1) develop practice infrastructure for implementing a SMART design and assess practitioner adherence to the various intervention sequences, (2) roll out the stepped-care intervention sequences and obtain estimates of recruitment into SMART, attrition at both stages, and overall response rate to first-stage intervention options, (3) describe the demographic and clinical characteristics of the sample of diversion-referred youth who are enrolled in the study, (4) create a latent construct for conduct problems that will be used as the distal outcome, and (5) explore the utility of incorporating secondary tailoring variables (e.g., child and family risk characteristics) in the adaptive intervention model.

描述（由申请人提供）：我们建议进行可行性研究，为未来全面 SMART 设计（即序贯、多重分配、随机试验）的实施提供信息，该设计将用于构建适应性干预策略（AIS）以进行实施 问题预防。 AIS 通过决策规则进行个体化治疗，该决策规则指定如何在开始治疗之前根据青少年和家庭特征和/或重复制定干预措施的类型（以青少年为中心或以家长为中心）或强度（低剂量或高剂量）根据治疗期间收集的近期结果随时间进行调整。行为问题预防需要 AIS，以解决高危青少年的异质性以及对传统固定类型预防干预措施反应的差异性。通过目前的 SMART，每个参与者将使用分级护理框架经历两个阶段的干预。在第一阶段，参与者将被随机分配到两个“简短型”干预选项中的一个，即以青少年为中心的青少年干预简短计划（TI-B；Winters & Leitten，2007）或以家长为中心的明智育儿简短计划（PW-B；戈登，2000）。对任一计划的响应者都将被下台并随着时间的推移进行监控以进行维护。对任一计划无反应的人将被升级并随机接受两个第二阶段“强化型”干预选项之一，其特点是 (1) 继续第一阶段选项并增加剂量（PW-扩展或 TI-扩展）， (2) 改用替代的扩大干预方式。这项可行性研究将招募因身份或轻罪而被捕并转介参加法庭前青少年转移计划的高风险青少年（10-15 岁）。本可行性研究的目的是 (1) 开发实施 SMART 设计的实践基础设施并评估从业者对各种干预序列的遵守情况，(2) 推出阶梯式护理干预序列并获得 SMART 招募、人员流失的估计两个阶段以及对第一阶段干预方案的总体响应率，(3) 描述参加研究的转移转介青少年样本的人口统计和临床特征，(4) 创建 将用作远端结果的行为问题的潜在构造，以及（5）探索在适应性干预模型中纳入二级定制变量（例如儿童和家庭风险特征）的效用。