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Biomedical subjects

Scott W Henggeler

Publications and source records attributed to Scott W Henggeler.

16 recordsLinked to original sources
PubMed2006

Juvenile drug court: enhancing outcomes by integrating evidence-based treatments.

Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence and determined whether the integration of evidence-based practices enhanced the outcomes of juvenile drug court. Over a 1-year period, a four-condition randomized design evaluated outcomes for family court with usual community services, drug court with usual community services, drug court with multisystemic therapy, and drug court with multisystemic therapy enhanced with contingency management for adolescent substance use, criminal behavior, symptomatology, and days in out-of-home placement. In general, findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior. Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration. In addition, findings supported the view that the use of evidence-based treatments within the drug court context improved youth substance-related outcomes. Clinical and policy implications of these findings are discussed.

Adolescent↗
PubMed2005

Beyond treatment effects: predicting emerging adult alcohol and marijuana use among substance-abusing delinquents.

Secondary analyses of a randomized clinical trial examined the effects of 4 putative risk factors and 2 protective factors in predicting drug use among 80 emerging adults treated 5 years earlier for delinquency and alcohol and/or marijuana use disorders. Frequency of marijuana use and the number of comorbid psychiatric disorders in adolescence predicted cannabis use in emerging adulthood. Increasing academic competence at high levels of social competence predicted less marijuana use. At emerging adulthood, greater use of alcohol and marijuana were associated with both criminality and psychopathology.

Adolescent↗
PubMed2005

Jousting with straw men: comment on Westen, Novotny, and Thompson-Brenner (2004).

Empirically supported treatments (ESTs) do not cure every patient, and the randomized trial is not a flawless methodology. Upon these often-noted and widely accepted points, D. Westen, C. M. Novotny, and H. Thompson-Brenner (2004a; see record 2004-15935-005) built a critique of ESTs and EST research. However, important work developing effective, clinically relevant treatments for serious problems was omitted from the Westen et al. (2004a) review. Little documentation was offered for the purported "assumptions" of EST methodology that Westen et al. (2004a) criticized; and different review standards were applied to studies supporting versus those disagreeing with Westen et al.'s (2004a) views. Finally, the correlational research designs proposed as a remedy by Westen et al. (2004a) have far more serious weaknesses than randomized trials, thoughtfully applied to real-world clinical care.

Empirical Research↗
PubMed2005

Predictors of treatment response for suicidal youth referred for emergency psychiatric hospitalization.

This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or youth report of attempted suicide. Overall, female gender, depressive affect, parental control, caregiver psychiatric distress, and caregiver history of psychiatric hospitalization were associated with suicide attempts. However, controlling for other variables, only depressive affect and parental control predicted treatment nonresponse. These results suggest the need to adapt existing treatments for suicidal youth to better address problems relating to youth depression.

Adolescent↗
PubMed2004

Heterogeneity in youth symptom trajectories following psychiatric crisis: predictors and placement outcome.

The authors examined heterogeneity in symptom trajectories among youths following psychiatric crises as well as the psychosocial correlates and placement outcomes associated with identified trajectories. Using semiparametric mixture modeling with 156 youths approved for psychiatric hospitalization, the authors identified 5 trajectories based on symptoms over the 16 months following crisis: high improved, high unimproved, borderline improved, borderline unimproved, and subclinical. Membership in unimproved symptom groups was associated with less suicidality, younger age, more youth hopelessness, and more caregiver empowerment. Improved symptom group membership predicted long-term decreases in days in out-of-home placements. More important, and in contrast with general impressions from the existing literature, findings suggest that a substantive proportion of youths with serious emotional disturbance sustain high levels of symptomatology following intensive mental health services.

Adolescent↗
PubMed2004

Decreasing effect sizes for effectiveness studies- implications for the transport of evidence-based treatments: comment on curtis, ronan, and borduin (2004).

The most important finding from the N. M. Curtis, K. R. Ronan, and C. M. Borduin (2004) meta-analysis for the broader field is likely the difference in effect sizes between multisys- multisystemic therapy efficacy versus effectiveness studies. This difference has important implications for research on the transport of evidence-based treatments to community practice settings. For example, factors rarely considered in efficacy research (e.g., funding structures, organizational climate, program maturity, site characteristics) are emerging as important determinants of treatment fidelity and, in turn, clinical outcomes for practice in real-world settings. Current research is clearly demonstrating that evidence-based practices can be successfully transported, but much remains to be learned regarding the optimal parameters of such transport.

Adolescent↗
PubMed2004

Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies.

OBJECTIVE: To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization. METHOD: Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1-year posttreatment follow-up. RESULTS: Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation. CONCLUSIONS: Results generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics.

Adolescent↗
PubMed2004

Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis.

OBJECTIVE: The authors conducted a cost analysis for multisystemic therapy, an evidence-based treatment that is used as an intensive community-based alternative to the hospitalization of youths presenting with psychiatric emergencies. METHODS: Data from a randomized clinical trial that compared multisystemic therapy with usual inpatient services followed by community aftercare were used to compare Medicaid costs and clinical outcomes during a four-month period postreferral and a 12-month follow-up period. Data were from 115 families receiving Medicaid (out of 156 families in the clinical trial). RESULTS: During the four months postreferral, multisystemic therapy was associated with an average net savings per youth treated of $1,617 compared with usual services. Costs during the 12-month follow-up period were similar between treatments. Multisystemic therapy demonstrated better short-term cost-effectiveness for each of the clinical outcomes (externalizing behavior, internalizing behavior, and global severity of symptoms) than did usual inpatient care and community aftercare. The two treatments demonstrated equivalent long-term cost-effectiveness. CONCLUSIONS: Among youths presenting with psychiatric emergencies, multisystemic therapy was associated with better outcomes at a lower cost during the initial postreferral period and with equivalent costs and outcomes during the 12-month follow-up period.

Adolescent↗
PubMed2003

Aggressive juvenile offenders transitioning into emerging adulthood: factors discriminating persistors and desistors.

Aggressive juvenile offenders (mean age = 15.6 years) were classified as persistors (n = 55) or desistors (n = 25) with aggressive crimes 5 years later (mean age = 20.6 years). At adolescence, desistors engaged in fewer aggressive acts, committed fewer property crimes, and behaved less aggressively and more positively toward peers. At emerging adulthood, desistors reported greater emotional support, higher job satisfaction, closer peer relationships, and fewer psychiatric problems. Findings largely remained significant after initial group differences were controlled.

Adolescent↗
PubMed2003

One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis.

OBJECTIVE: This study presents findings from a 1-year follow-up to a randomized clinical trial comparing multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, with inpatient psychiatric hospitalization. METHOD: One hundred fifty-six children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization followed by usual services. Assessments examining mental health symptoms, out-of-home placement, school attendance, and family relations were conducted at five times: within 24 hours of recruitment, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), at the completion of MST (average of 4 months postrecruitment), and 10 and 16 months postrecruitment. RESULTS: Based on placement and youth-report measures, MST was initially more effective than emergency hospitalization and usual services at decreasing youths' symptoms and out-of-home placements and increasing school attendance and family structure, but these differences generally dissipated by 12 to 16 months postrecruitment. Hospitalization produced a rapid, but short-lived, decrease in externalizing symptoms based on caregiver reports. CONCLUSION: Findings suggest that youths with serious emotional disturbance might benefit from continuous access to a continuum of evidence-based practices titrated to clinical need.

Adolescent↗
PubMed2003

Client-level predictors of adherence to MST in community service settings.

This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings.

Adolescent↗
PubMed2003

Conduct disorder and delinquency.

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed.

Adolescent↗
PubMed2002

Randomized clinical trials, developmental theory, and antisocial youth: guidelines for research.

The design of effective interventions for antisocial adolescents has been greatly influenced by research-based developmental theories. However, randomized clinical trials (RCTs) demonstrating effectiveness of these treatments have contributed minimally to alterations and refinements of these theories. In this article, nine guidelines for research that may enhance the contributions of RCTs to developmental theory are proposed: (1) use mediational analyses to test and refine theories of change; (2) use moderator analyses to test differential pathways to change; (3) assess change processes separately for different types of antisocial behavior; (4) use constructive and dismantling designs to isolate effects of intervention components on targeted mediators and outcomes; (5) assess the time-sensitive nature of change mechanisms with theoretically relevant spacing of multiple assessments and long-term follow-ups; (6) expand the nomological net of developmental theories by assessing intervention effects on nontargeted constructs; (7) use RCTs to disentangle direction of effects questions in developmental theories; (8) conduct secondary analyses of RCTs to assess extra-treatment influences on antisocial behavior; and (9) assess the generalizability of mediator and moderator effects. Use of these guidelines may promote a recursive and iterative relationship between RCTs and theory building. Improved developmental theories may yield more effective interventions, and theory-testing interventions may engender more comprehensive and better informed theories.

Antisocial Personality Disorder↗
PubMed2002

Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders.

OBJECTIVE: Although several treatments for adolescent substance abuse have been identified as promising by reviewers and federal agencies, treatment effects extending beyond 12 months have not been demonstrated in randomized clinical trials. The primary purpose of this report was to examine the 4-year outcomes of an evidence-based treatment of substance-abusing juvenile offenders. METHOD: Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after taking part in a randomized clinical trial comparing multisystemic therapy (MST) with usual community services. A multimethod (self-report, biological, and archival measures) assessment battery was used to measure the criminal behavior, illicit drug use, and psychiatric symptoms of the participating young adults. RESULTS: Analyses demonstrated significant long-term treatment effects for aggressive criminal activity (0.15 versus 0.57 convictions per year) but not for property crimes. Findings for illicit drug use were mixed, with biological measures indicating significantly higher rates of marijuana abstinence for MST participants (55% versus 28% of young adults). Long-term treatment effects were not observed for psychiatric symptoms. CONCLUSIONS: Findings provide some support for the long-term effectiveness of an evidenced-based family-oriented treatment of substance-abusing juvenile offenders. The clinical, research, and policy implications of these findings are noted.

Adolescent↗
PubMed2002

Transporting efficacious treatments to field settings: the link between supervisory practices and therapist fidelity in MST programs.

Validated a measure of clinical supervision practices, further validated a measure of therapist adherence, and examined the association between supervisory practices and therapist adherence to an evidence-based treatment model (i.e., multisystemic therapy [MST]) in real-world clinical settings. Evidence of linkages between supervisor adherence to the MST supervisory protocol, as assessed through therapist reports, and therapist adherence to MST principles, as assessed through caregiver reports, was obtained from 285 families of youths presenting serious clinical problems, and 74 therapists and 12 supervisors of 16 teams in 9 organizations providing MST across 3 states. The findings provide a valuable step in examining the determinants of therapist fidelity to complex treatments in real-world clinical settings.

Adolescent↗