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Administration and Policy in Mental Health and Mental Health Services Research

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16.02.2016 | Original Article

Multidimensional Predictors of Treatment Outcome in Usual Care for Adolescent Conduct Problems and Substance Use

verfasst von: Aaron Hogue, Craig E. Henderson, Adam T. Schmidt

Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research | Ausgabe 3/2017

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Abstract

This study investigated baseline client characteristics that predicted long-term treatment outcomes among adolescents referred from school and community sources and enrolled in usual care for conduct and substance use problems. Predictor effects for multiple demographic (age, sex, race/ethnicity), clinical (baseline symptom severity, comorbidity, family discord), and developmental psychopathology (behavioral dysregulation, depression, peer delinquency) characteristics were examined. Participants were 205 adolescents (52 % male; mean age 15.7 years) from diverse backgrounds (59 % Hispanic American, 21 % African American, 15 % multiracial, 6 % other) residing in a large inner-city area. As expected, characteristics from all three predictor categories were related to various aspects of change in externalizing problems, delinquent acts, and substance use at one-year follow-up. The strongest predictive effect was found for baseline symptom severity: Youth with greater severity showed greater clinical gains. Higher levels of co-occurring developmental psychopathology characteristics likewise predicted better outcomes. Exploratory analyses showed that change over time in developmental psychopathology characteristics (peer delinquency, depression) was related to change in delinquent acts and substance use. Implications for serving multiproblem adolescents and tailoring treatment plans in routine care are discussed.

For completeness, we compared model fit for two-part models with linear growth in the multivariate delinquency and substance use two-part models to model fit for quadratic terms for both parts of these models. In both cases, the linear models indicated superior fit: BIC for the linear model for delinquency = 1120.850; BIC for the quadratic model for delinquency = 1132.177; BIC for the linear model for substance use = 1670.006; BIC for the quadratic model for substance use: 1689.973.

To condense space, and to keep focus on primary outcomes, we have focused results on predictors of change over time. However, there were some significant findings for associations between covariates and model intercepts, an effect that reflects the degree to which the given covariate predicts baseline variability, which we summarize here. For the multivariate model for externalizing problems, delinquency was significantly related to the baseline externalizing values, with more delinquency being associated with more externalizing (b = 1.89, SE 0.18, pseudo z 10.64, p < 0.001). For delinquency, other than the baseline values of delinquency, there were no significant predictors of the multivariate model intercept. Finally, for substance use, peer delinquency was significantly associated with the categorical part of the multivariate model (b = 1.41, SE 0.57, pseudo z 2.49, p = 0.013).

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Titel: Multidimensional Predictors of Treatment Outcome in Usual Care for Adolescent Conduct Problems and Substance Use
verfasst von: Aaron Hogue
Craig E. Henderson
Adam T. Schmidt
Publikationsdatum: 16.02.2016
Verlag: Springer US
Erschienen in: Administration and Policy in Mental Health and Mental Health Services Research / Ausgabe 3/2017
Print ISSN: 0894-587X
Elektronische ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-016-0724-7

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