EBP Exchange - UMB School of Social Work

Outcomes for Youth Receiving Intensive In-Home Therapy or Residential Care

This very interesting article by James Derzon of Battelle uses meta-analysis to identify risk factors associated with substance abuse. Then, the occurrence of substance abuse among youth who have these risk factors is assessed. Most non users of alcohol and marijuana can be identified from having 5 or fewer risk factors. But, more interesting is the finding that it is not until 14 risk factors that the number of users of these substances becomes larger than the nonusers. That is, there are many youth with very high numbers of risk factors who are nonusers. Another way to look at this is that if you, then, targetted the intervention on children with 14 or more risk factors, you would exclude 71% of the users–greatly reducing your prevention effects. The paper goes on to predict true and false positive rates and selection accuracy using Monitoring the Future data and conclude that even though a less targetted program will result in smaller effect sizes for the intervention, the benefits of a universal program will be greater because there are so youth who could benefit from an effective intervention but would have been screened out. The methodology of this analysis could be instructive to the design of other prevention programs.  Deron, J. H. (2007).  Using correlational evidence to select youth for prevention programming. Journal of Primary Prevention, 28, 421-447.

Mark Lipsey and his colleagues have released a Campbell Collaborative Review on the use of CBT with criminal offenders which offers considerable promise. A brief summary of key findings is extracted below. The entire review is available at:

http://www.campbellcollaboration.org/doc-pdf/lipsey_CBT_finalreview.pdf. My experience is that few systematic reviews are this positive–many have difficulty making the case that interventions do what they promise.

Implications for Practice It thus appears to be the general CBT approach, and not any specific version, that is responsible for the overall positive effects on recidivism. Within that framework, inclusion of distinct anger control and interpersonal problem solving components in the CBT program enhances the effects while victim impact and behavior modification components appear to diminish it. What seems to most strongly characterize effective CBT programs is high qualityimplementation as represented by low proportions of treatment dropouts, close monitoring of the quality and fidelity of the treatment implementation, and adequate CBT training for theproviders. It suggests that any representative CBT program that is well-implemented might have results in practice that approach the very positive effects on recidivism produced by the most effective programs documented in the available research studies. It is also encouraging that the effects of CBT were greater for offenders with higher risk ofrecidivism than those with lower risk, contrary to any presumption that higher risk offendersmight be less amenable to treatment. The effectiveness of CBT with higher risk offenders isconsistent with the principles of effective correctional treatment that the best results occurwhen higher-risk offenders receive more intensive services that target criminogenic needs (e.g.,criminal thinking patterns) using cognitive behavioral and social learning approaches. 

Focal Point, the newsletter of the longstanding Research and Training Center at Portland State has a special issue on workforce issues in mental health.  Among the valuable pieces are brief descriptions about what it is like to implement such interventions as the Incredible Years and Multisystemic Therapy (MST) from different perspectives.  It’s worth a look, http://www.rtc.pdx.edu/PDF/fpW0804.pdf