The effective transport of research-based interventions to community-based practice is a public health priority. To address this priority for youth with substance use problems, treatment and transportability strategies must address four major challenges. (1) Concerns about the extent to which treatment outcomes achieved under controlled conditions in efficacy trials can be achieved under usual care conditions. (2) The comorbidity of psychiatric disorders, particularly conduct and other disruptive behavior disorders with youth drug abuse. (3) Barriers to the adoption and implementation of empirically supported treatments arise at multiple levels of the service context. (4) Problems with the nation's substance abuse service infrastructure suggest other systems should be enlisted to meet the needs of youth with drug problems. This application proposes secondary analyses to leverage the 2.5 million research dollars and 15.6 million service dollars expended in a 41-site, NIMH-funded study of the transportability of an empirically supported treatment to 1950 youth with serious antisocial behavior, 415 of which have comorbid drug use problems. The design of that study, proposed collection of one additional year of follow-up data, and proposed secondary data analyses will enable us to address the aforementioned concerns by accomplishing three aims.
Aim 1 : Using a benchmarking strategy, compare the drug-related crime and general criminal outcomes through 2 years post-treatment of Transportability sample youths with co-occurring antisocial and substance use problems and the 2-year post-treatment outcomes achieved among such youths in randomized clinical trials of MST; and, compare the behavior problem, psychosocial functioning, and drug-related and general criminal outcomes through 1 year post-treatment in the Transportability and RCT samples.
Aim 2. To compare, within the Transportability sample, drug-related and general criminal outcomes 2 years post-treatment among youths with and without identified drug use problems; and, to compare 1 year post-treatment behavior problem, psychosocial functioning, and substance use problems of these two groups.
Aim 3 : Test a multivariate contextual model of treatment implementation and outcomes for youth with antisocial behavior with and without substance use problems. 3a. To examine the influence of system-level variables (referral and reimbursement source and type), organizational structure and climate, therapist adherence, and other therapist variables (training, experience, education) on treatment outcomes for youth with and without substance use problems. 3b. To examine the influence of referral and reimbursement source and type, organizational structure and climate, and therapist variables on therapist adherence when treating youth with and without substance use problems. 3c. To examine therapist adherence to MST for youths with and without substance use problems. Together, these analyses will test the proposition that certain treatment and transport strategies, if sufficiently comprehensive, can improve community-based care for youth with substance use problems outside of specialty substance abuse clinics.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
1R01DA018107-01A1
Application #
6918796
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Brady, Thomas M
Project Start
2005-03-01
Project End
2007-02-28
Budget Start
2005-03-01
Budget End
2006-02-28
Support Year
1
Fiscal Year
2005
Total Cost
$365,000
Indirect Cost
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425
Schoenwald, Sonja K; Chapman, Jason E; Henry, David B et al. (2012) Taking Effective Treatments to Scale: Organizational Effects on Outcomes of Multisystemic Therapy for Youth with Co-occurring Substance Use. J Child Adolesc Subst Abuse 21:1-31
Chapman, Jason E; Schoenwald, Sonja K (2011) Ethnic Similarity, Therapist Adherence, and Long-Term Multisystemic Therapy Outcomes. J Emot Behav Disord 19:3-16
Glisson, Charles; Schoenwald, Sonja K; Hemmelgarn, Anthony et al. (2010) Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. J Consult Clin Psychol 78:537-50
Schoenwald, Sonja K; Chapman, Jason E; Sheidow, Ashli J et al. (2009) Long-term youth criminal outcomes in MST transport: the impact of therapist adherence and organizational climate and structure. J Clin Child Adolesc Psychol 38:91-105
Schoenwald, Sonja K; Sheidow, Ashli J; Chapman, Jason E (2009) Clinical supervision in treatment transport: effects on adherence and outcomes. J Consult Clin Psychol 77:410-21
Schoenwald, Sonja K; Carter, Rickey E; Chapman, Jason E et al. (2008) Therapist adherence and organizational effects on change in youth behavior problems one year after multisystemic therapy. Adm Policy Ment Health 35:379-94
Schoenwald, Sonja K; Kelleher, Kelly; Weisz, John R et al. (2008) Building bridges to evidence-based practice: the MacArthur Foundation Child System and Treatment Enhancement Projects (Child STEPs). Adm Policy Ment Health 35:66-72
Letourneau, Elizabeth J; Chapman, Jason E; Schoenwald, Sonja K (2008) Treatment outcome and criminal offending by youth with sexual behavior problems. Child Maltreat 13:133-44
Schoenwald, Sonja K; Chapman, Jason E; Kelleher, Kelly et al. (2008) A survey of the infrastructure for children's mental health services: implications for the implementation of empirically supported treatments (ESTs). Adm Policy Ment Health 35:84-97