Family-based treatments for serious juvenile offenders : a multilevel meta-analysis

Dissertation supervisor: Charles M. Borduin.Includes vita.Violent criminal acts and other serious crimes committed by youths result in considerable emotional, physical, and economic effects on these youths, their families, crime victims, and the larger community. Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, I used multilevel meta-analysis to (a) characterize the nature and quality of research on family-based treatments for serious juvenile offenders, (b) summarize the findings of this research by estimating an average effect size, and (c) examine the influence of moderators (e.g., characteristics of participants, treatments, and methods) on treatment outcomes. Results from 31 studies revealed a number of methodological strengths including frequent use of random assignment and comparison to usual treatment conditions. In addition, the meta-analysis synthesized 325 effect sizes from 29 of these studies and revealed that family-based treatments produced small but meaningful treatment effects (mean d = 0.26) relative to comparison conditions. Furthermore, moderator analyses revealed that certain characteristics of participants, study methods, and measures influenced the size of treatment effects; for example, effect sizes varied by domain of outcome measure such that measures of substance use showed the largest treatment effects and measures of peer relationships showed the smallest. Overall, the results of the present study have implications for policymakers, administrators, and treatment providers who make decisions about the dissemination and implementation of family-based treatments for serious juvenile offenders. In addition, researchers who seek to develop and study these treatments may wish to consider the current findings.Includes bibliographical references (pages 76-100)

Cost-benefit analysis of multisystemic therapy for serious and violent juvenile offenders and their siblings

Title from PDF of title page (University of Missouri--Columbia, viewed on November 2, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract, appears in the public.pdf file.Thesis advisor: Dr. Charles BorduinIncludes bibliographical references.M. A. University of Missouri--Columbia 2012."July 2012"This study investigated the economic benefits of an intensive family-based treatment (multisystemic therapy, MST) versus individual therapy (IT) using arrest data from 25-year follow-ups of referred serious and violent juvenile offenders (n = 176) and their closest-in-age siblings (n = 110). Three categories of benefits were evaluated: (1) taxpayer benefits (i.e., avoided criminal justice system costs), (2) tangible benefits to crime victims (i.e., avoided tangible losses), and (3) intangible benefits to crime victims (i.e., avoided pain and suffering). Results indicated that reductions in criminality for juvenile offenders and siblings in the MST versus IT conditions were associated with substantial benefits to both taxpayers and crime victims. Cumulative benefits of MST over IT ranged up to $34,955 per referred youth and up to$37,433 per family (i.e., when siblings were included). Overall, it was estimated that every dollar spent on MST recovered up to $4.98 in the years ahead by preventing future crimes. Sensitivity analyses also indicated that estimates of savings were robust to variations in crime victim intangible benefits, sibling juvenile arrest rates, and discount rates. The economic benefits of MST are important for administrators and policymakers to consider when allocating scarce financial resources to interventions for serious juvenile offenders

Mixed-method approaches to strengthen economic evaluations in implementation research

Abstract Background Guidance from economic evaluations on which implementation strategies represent the best return on investment will be critical to advancing the Triple Aim of health care: improving patient care and population health while minimizing per-capita cost. The results of traditional (quantitative) economic evaluations are limited by a remaining “qualitative residual” of contextual information and stakeholders perspectives, which cannot be captured by monetary values alone and is particularly prevalent in implementation science research. The emergence of qualitative methods for economic evaluation offers a promising solution. Main body To maximize the contributions of economic evaluations to implementation science, we recommend that researchers embrace a mixed-methods research agenda that merges traditional quantitative approaches with innovative, contextually grounded qualitative methods. Such studies are exceedingly rare at present. To assist implementation scientists in making use of mixed methods in this research context, we present an adapted taxonomy of mixed-method studies relevant to economic evaluation. We then illustrate the application of mixed methods in a recently completed cost-effectiveness evaluation, making use of an adapted version of reporting standards for economic evaluations. Conclusions By incorporating qualitative methods, implementation researchers can enrich their economic evaluations with detailed, context-specific information that tells the full story of the costs and impacts of implementation. We end by providing suggestions for building a research agenda in mixed-method economic evaluation, along with more resources and training to support investigators who wish to answer our call to action.https://deepblue.lib.umich.edu/bitstream/2027.42/146781/1/13012_2018_Article_850.pd

Family-based treatments for serious juvenile offenders: A multilevel meta-analysis

__Objective:__ Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, we used meta-analysis to summarize the findings of research on family-based treatments for serious juvenile offenders. __Method:__ We conducted a multilevel meta-analysis that modeled dependencies between multiple effect sizes from the same study. The meta-analysis synthesized 324 effect sizes from 28 studies that met inclusion criteria. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model. __Results:__ Across studies, family-based treatments produced modest, yet long-lasting, treatment effects (mean d = 0.25 for antisocial behavior, 0.24 overall) relative to comparison conditions. Furthermore, certain characteristics moderated the magnitude of treatment effects; for example, measures of substance use showed the largest effects and measures of peer relationships showed the smallest effects. __Conclusions:__ Policymakers, administrators, and treatment providers may find it useful to consider the effects of family-based treatments for serious juvenile offenders in their selection of treatments for this population. In addition, investigators who seek to develop and study such treatments may wish to consider the current findings in their future research efforts

Coordination of sustainable financing for evidence-based youth mental health treatments: Protocol for development and evaluation of the fiscal mapping process

BACKGROUND: Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, service agencies ). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD: Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies\u27 EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION: This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial

Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD

Practitioner use of and attitudes towards videoconferencing for the delivery of evidence-based telemental health interventions: A mixed methods study

The implementation of evidence-based psychosocial interventions using video-conference delivery (VCD) has the potential to increase accessibility to effective treatments, although its use remains limited and understudied. This study employed a mixed methods approach in surveying mental health practitioners about their attitudes regarding VCD of interventions that are considered evidence-based (i.e., have been shown to improve targeted outcomes in rigorous research). One hundred and eleven practitioners were sampled from several national and regional U.S. practice organizations and were administered quantitative surveys about their use of and attitudes towards VCD of evidence-based interventions (EBI). We examined the relationship between practitioner-level technology access, experience, and training with technology fluency and acceptability of using VCD. Quantitative results indicated the most frequently used adaptation for VCD was Tailoring and that practitioner education predicted attitudes towards EBIs. A subset (n = 20) of respondents were then purposively selected for qualitative interviews to further investigate accessibility, appropriateness, and feasibility of delivering EBIs via video conference. A conventional content analysis revealed that VCD was appropriate and acceptable for EBIs; however, many practitioners also described barriers related to feasibility of implementation. The results of this study have important implications for telemental health dissemination efforts which seek to extend services to populations not served well by traditional, in-person mental health services

Integrating implementation and user-centred design strategies to enhance the impact of health services: protocol from a concept mapping study

Abstract Background Innovative approaches are needed to maximise the uptake and sustainment of evidence-based practices in a variety of health service contexts. This protocol describes a study that will seek to characterise the potential of one such approach, user-centred design (UCD), which is an emerging field that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation. The use of UCD to enhance strategies for implementation of health services, although promising, requires a multidisciplinary perspective based on a firm understanding of how experts from each discipline perceives the interrelatedness and suitability of these strategies. Method This online study will use a combination of purposive and snowball sampling to recruit a sample of implementation experts (n = 30) and UCD experts (n = 30). These participants will each complete a concept mapping task, which is a mixed-method conceptualisation technique that will allow for identification of distinct clusters of implementation and/or UCD strategies. The research team has selected a set of implementation strategies and UCD strategies that each participant will sort and rate on dimensions of importance and feasibility. Data analyses will focus on describing the sample, identifying related clusters of strategies, and examining the convergences, divergences, and potential for collaboration between implementation science and UCD. Discussion By leading to a better understanding of the overlap between implementation science and UCD, grounded within established theoretical frameworks, this study holds promise for improving the impact and sustainability of evidence-based health services in community settings

Moving beyond Aim Three: a need for a transdisciplinary approach to build capacity for economic evaluations in implementation science.

BackgroundUnderstanding the costs and economic benefits of implementation has been identified by policymakers and researchers as critical to increase the uptake and sustainment of evidence-based practices, but this topic remains relatively understudied. Conducting team science with health economists has been proposed as a solution to increase economic evaluation in implementation science; however, these recommendations ignore the differences in goals and perspectives in these two fields. Our recent qualitative research identified that implementation researchers predominantly approach health economists to examine costs, whereas the majority of health economists expressed limited interest in conducting economic evaluations and a desire to be more integrated within implementation science initiatives. These interviews pointed to challenges in establishing fruitful partnerships when health economists are relegated to the "Third Aim" (i.e., lowest-priority research objective) in implementation science projects by their research partners.DiscussionIn this debate paper, we argue that implementation researchers and health economists need to focus on team science research principles to expand capacity to address pressing research questions that cut across the two fields. Specifically, we use the four-phase model of transdisciplinary research to outline the goals and processes needed to build capacity in this area (Hall et al., Transl Behav Med 2:415-30, 2012). The first phase focuses on the development of transdisciplinary research teams, including identifying appropriate partners (e.g., considering policy or public health researchers in addition to health economists) and building trust. The conceptual phase focuses on strategies to consider when developing joint research questions and methodology across fields. In the implementation phase, we outline the effective processes for conducting research projects, such as team learning. Finally, in the translation phase, we highlight how a transdisciplinary approach between health economists and implementation researchers can impact real-world practice and policy. The importance of investigating the economic impact of evidence-based practice implementation is widely recognized, but efforts have been limited due to the challenges in conducting team science across disciplines. Training in team science can help advance transdisciplinary efforts, which has the potential to increase the rigor and impact of economic evaluations in implementation science while expanding the roles taken by health economists

Lessons From an Implementation Evaluation of a Real-World Multi-City Initiative to Address COVID-19 Vaccination Inequities

The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color. To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles. In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes). Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis