Examining Change in Therapeutic Alliance to Predict Youth Mental Health Outcomes

Objective—To examine the link between therapeutic alliance and youth outcomes. Method—The study was conducted at a group-home with 112 youth with a disruptive-behavior diagnosis. Therapeutic alliance was collected routinely via youth and staff report. Outcome data were collected using youth and staff reports of externalizing behavior as well as behavioral incidents occurring during care. Outcome data were collected following intake into services and at 6 and 12 months of care. Data were analyzed to examine (1) if youth behavior problems at intake were predictive of therapeutic alliance and (2) if changes in alliance were predictive of subsequent youth outcomes. These were conducted with a 6-month service-delivery model and replicated with a 12-month model. Results—There was some support for the first hypothesis, that initial levels of youth externalizing behavior would be related to alliance ratings; however, most of the effects were marginally significant. The second hypothesis, that changes in therapeutic alliance would be related to subsequent youth outcomes, was supported for the 6-month model, but not the 12-month model. Conclusions—Changes in therapeutic alliance may be predictive of youth outcomes during care. Additional research into examining therapeutic alliance trajectories is warranted to improve mental health services for youth

Effects of multidimensional treatment foster care on psychotic symptoms in girls

Objective Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence—a period of heightened risk for a wide range of psychopathology. Method This study was a randomized controlled trial (RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic Interview Schedule for Children [DISC]). Results Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a 24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted beyond the initial intervention period. Conclusion Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial registration information—Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626

Depressive symptom trajectories among girls in the juvenile justice system: 24-month outcomes of an RCT of Multidimensional Treatment Foster Care

Youth depression is a significant and growing international public health problem. Youth who engage in high levels of delinquency are at particularly high risk for developing problems with depression. The present study examined the impact of a behavioral intervention designed to reduce delinquency (Multidimensional Treatment Foster Care; MTFC) compared to a group care intervention (GC; i.e., services as usual) on trajectories of depressive symptoms among adolescent girls in the juvenile justice system. MTFC has documented effects on preventing girls' recidivism, but its effects on preventing the normative rise in girls' depressive symptoms across adolescence have not been examined. This indicated prevention sample included 166 girls (13-17 years at T1) who had at least one criminal referral in the past 12 months and who were mandated to out-of-home care; girls were randomized to MTFC or GC. Intent-to-treat analyses examined the main effects of MTFC on depression symptoms and clinical cut-offs, and whether benefits were greatest for girls most at risk. Depressive symptom trajectories were specified in hierarchical linear growth models over a 2 year period using five waves of data at 6 month intervals. Depression clinical cut-off scores were specified as nonlinear probability growth models. Results showed significantly greater rates of deceleration for girls in MTFC versus GC for depressive symptoms and for clinical cut-off scores. The MTFC intervention also showed greater benefits for girls with higher levels of initial depressive symptoms. Possible mechanisms of effect are discussed, given MTFC's effectiveness on targeted and nontargeted outcomes. © 2013 Society for Prevention Research

Developmental trajectories of marital happiness in continuously married individuals: a group-based modeling approach

Most contemporary studies of change in marital quality over time have used growth curve modeling to describe continuously declining mean curves. However, there is some evidence that different trajectories of marital quality exist for different sub-populations. Group-based trajectory modeling provides the opportunity to conduct an empirical investigation of the variance in marital quality trajectories. We applied this method to analyze data from continuously married individuals from the Marital Instability over the Life Course Study (N = 706). Instead of a single continuously declining trajectory of marital happiness, we found 5 distinct trajectories. Nearly two thirds of participants reported high and stable levels of happiness over time, and the other one third showed either a pattern of continuous low happiness, low happiness that subsequently declined, or a curvilinear pattern of high happiness, decline, and recovery. Marital problems, time spent in shared activities, and (to a lesser degree) economic hardship were able to distinguish trajectory group membership. Our results suggest that marital happiness may have multiple distinct trajectories across reasonably diverse populations. Implications for theory, research, and practice are discussed

The State of Experimental Research on Community Interventions to Reduce Greenhouse Gas Emissions—A Systematic Review

This paper reviews research on community efforts to reduce greenhouse gas emissions. We conducted a systematic search of the relevant literature, and supplemented our findings with an analysis of review papers previously published on the topic. The results indicate that there have been no peer-reviewed experimental evaluations of community-wide interventions to reduce greenhouse gases involving electricity, refrigeration, or food. The lack of findings limits the conclusions which can be made about the efficacy of these efforts. As a result, we are not accumulating effective interventions, and some communities may be implementing strategies that are not effective. We advocate for the funding of experimental evaluations of multi-sector community interventions to reduce greenhouse gas emissions. Such interventions would attempt to engage every sector of the community in identifying and implementing policies and practices to reduce emissions. Comprehensive multi-sector interventions are likely to have synergistic effects, such that the total impact is greater than the sum of the impact of the individual components. We describe the value of interrupted time-series designs as an alternative to randomized trials, because these designs confer particular advantages for the evaluation of strategies in entire communities