Heterogeneity in Trajectories of Child Maltreatment Severity: A Two-Part Growth Mixture Model.

This study examined the trajectories of maltreatment severity and substantiation over a 24-month period among children (N = 82,396) with repeated maltreatment reports. Findings revealed 2 different longitudinal patterns. The first pattern, Elevated Severity, showed a higher level of maltreatment during the initial incident and increased maltreatment severity during subsequent incidents, but the substantiation rates for this class decreased over time. The second pattern, Lowered Severity, showed a much lower level of severity, but the likelihood of substantiation increased over time. The Elevated Severity class was composed of children with an elevated risk profile because of both individual and contextual risk factors including older age, female gender, caregivers' substance use problems, and a higher number of previous maltreatment reports. Implications of the findings are discussed.

Gender and ethnicity as moderators: Integrative data analysis of multidimensional family therapy randomized clinical trials.

This study examined gender and ethnicity as moderators of Multidimensional Family Therapy (MDFT) effectiveness for adolescent drug abuse and illustrated the utility of integrative data analysis (IDA; Bauer & Hussong, 2009) for assessing moderation. By pooling participant data from 5 independent MDFT randomized clinical trials (RCTs), IDA increased power to test moderation. Participants were 646 adolescents receiving treatment for drug use, aged 11 to 17 years (M = 15.31, SD = 1.30), with 19% female (n = 126), 14% (n = 92) European American, 35% (n = 225) Hispanic, and 51% (n = 329) African American. Participants were randomized to MDFT or active comparison treatments, which varied by study. Drug use involvement (i.e., frequency and consequences) was measured at study entry, 6-, and 12-months by a 4-indicator latent variable. Growth curve change parameters from multiple calibration samples were regressed on treatment effects overall and by moderator subgroups. MDFT reduced drug use involvement (p < .05) for all participant groups. Pooled comparison groups reduced drug use involvement only for females and Hispanics (ps < .05). MDFT was more effective than comparisons for males, African Americans, and European Americans (ps <.05; Cohen's d = 1.17, 1.95, and 1.75, respectively). For females and Hispanics, there were no significant differences between MDFT and pooled comparison treatments, Cohen's d = 0.63 and 0.19, respectively. MDFT is an effective treatment for drug use among adolescents of both genders and varied ethnicity with males, African American, and European American non-Hispanic adolescents benefitting most from MDFT.

The temporal "pulse" of drinking: Tracking 5 years of binge drinking in emerging adults.

Binge drinking is associated with clinically significant individual-level and public health consequences. The topography of binge drinking may influence the emergence of consequences, but studies of topography require a higher level of temporal resolution than is typically available in epidemiological research. To address topography across the 5 "peak" years of binge drinking (18 to 23 years), we assessed daily binge drinking via successive 90-day timeline follow-back interviews of 645 young adults (resulting in almost 700,000 data points). Results showed a weekend "pulse" of binge drinking that remained consistent across the entire 5 year span, with occasional holiday-based perturbations. Two-part latent growth curve modeling applied to this dataset showed that the often-observed decrease in drinking associated with "maturing out" was due more to decreased participation in binge drinking occasions, rather than to amounts consumed when drinking (intensity). Similarly, the number of binge drinkers varied by day of the week, but the intensity of binge drinking, for those drinking, varied little by day of the week. This approach also showed distinctive predictors for participation and intensity; baseline expectancies and sociability accounted for individual differences in participation, whereas impulsivity-sensation seeking predicted intensity. Individual patterns of binge drinking participation and intensity also predicted drinking consequences over the 5 years of the study. Given these results, binge drinking patterns may serve as a useful phenotype for future research on pathological drinking.

A randomized clinical trial of family therapy in juvenile drug court.

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court--family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)--on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n = 55) or group therapy (n = 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d = .51), externalizing symptoms (average d = 2.32), rearrests (average d = 1.22), and substance use (average d = 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d = 0.39), commission of serious crimes (d = .38), and felony arrests (d = .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes. TRIAL REGISTRY NAME: Clinical Trials.gov, Identified NCT01668303.

Stress, Mental Health and Substance Abuse Problems In a Sample of Diversion Program Youth: An Exploratory Latent Class Analysis.

Reflective of interest in mental health and substance abuse issues among youths involved with the justice system, we performed a latent class analysis on baseline information collected on 100 youths involved in two diversion programs. Results identified two groups of youths: Group 1: a majority of the youths, who had high levels of delinquency, mental health and substance abuse issues, Group 2: youths with low levels of these problems. Comparison of these two groups on a variety of psychosocial measures and parent/guardian reports found differences between them that were consistent with their problem group classification. Follow-up analysis confirmed problem behavior that was consistent with the youths' latent class placement. Implications of the findings for research and practice will be presented.

Emotional/psychological and related problems among truant youths: An exploratory latent class analysis.

Latent class analysis was conducted on the psychosocial problems experienced by truant youths. Data were obtained from baseline interviews completed on 131 youths and their parents/guardians involved in a NIDA-funded, Brief Intervention Project. Results identified two classes of youths: Class 1(n=94): youths with low levels of delinquency, mental health and substance abuse issues, Class 2(n=37): youths with high levels of these problems. Comparison of these two classes on their urine analysis test results and parent/guardian reports of traumatic events found significant (p<.05) differences between them that were consistent with their problem group classification. Our results have important implications for research and practice.

PROBLEM PROFILES OF AT-RISK YOUTH IN TWO SERVICE PROGRAMS: A MULTI-GROUP, EXPLORATORY LATENT CLASS ANALYSIS.

Baseline data collected in two brief intervention projects (BI-Court and Truancy Project) were used to assess similarities and differences in subgroups of at-risk youth. Classifications of these subgroups were based on their psychosocial characteristics (e.g., substance use). Multi-group latent class analysis (LCA) identified two BI-Court subgroups of youth, and three Truant subgroups. These classes can be viewed as differing along two dimensions, substance use involvement and emotional/behavioral issues. Equality tests of means across the latent classes for BI-Court and Truancy Project youths found significant differences that were consistent with their problem group classification. These findings highlight the importance of quality assessments and allocating appropriate services based on problem profiles of at-risk youth.

Drinking style and dating violence in a sample of urban, alcohol-using youth.

OBJECTIVE: This study examined childhood abuse, problem behavior, drinking style, and dating violence (DV). Our goal was to assess whether (a) alcohol use-related beliefs and behaviors ("drinking style") would be associated with DV perpetration and victimization, (b) drinking style would mediate the relationship between childhood abuse and DV, and (c) the drinking style-DV relationship would be attributable to propensity for problem behavior. METHOD: Cross-sectional survey data were collected from 456 youth ages 14-21 years who were patients in an urban emergency department. Participants were eligible if they were unmarried and reported past-month alcohol use and dating in the past year. By design, the sample was 50% female. Data were analyzed using structural equation modeling. RESULTS: For both males and females, past-year DV was associated with a more risky drinking style, characterized by more frequent alcohol use, alcohol-aggression expectancies, drinking to cope, and beliefs that alcohol is disinhibiting and that being drunk provides a "time-out" from behavioral expectations. Drinking style mediated the childhood victimization-DV relationship for males and females. However, when propensity for problem behavior was included in the model, the effect of drinking style on DV was no longer significant. Substantial path differences for males and females were observed. CONCLUSIONS: The current study examined adolescent drinking style as a potential mediator between childhood victimization and DV. Drinking style was associated with DV for males and females and mediated the relationship between childhood victimization and DV. The relationship between drinking style and DV appeared to reflect adolescents' propensity for problem behavior. Variations in males' and females' pathways to DV were observed. The implications of these findings are discussed.

Community characteristics and implementation factors associated with effective systems of care.

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

Multilevel confirmatory factor analysis of the Systems of Care Implementation Survey (SOCIS).

A major impediment to obtaining national information on systems of care implementation has been the lack of a psychometrically sound large-scale survey instrument. The present study provided information on the factorial and concurrent validity of the Systems of Care Implementation Survey scales. Multilevel confirmatory factor analysis and multilevel regression analysis were used to test these indicators of internal and external validity. Two hundred twenty-five counties were randomly selected and stratified by population size and poverty level. Nine hundred ten informants responded to the survey questionnaire, M = 4.04 informants per county (SD = 3.17). Results indicated that all models had at least adequate fit to the data, with nine of the 14 factor models having excellent fit. Overall, 11 of the 14 factors had some indication that receiving federal funding to create systems of care was associated with higher scores on the factors. Implications for future research were discussed.

Development of a measure to assess the implementation of children's systems of care: the Systems of Care Implementation Survey (SOCIS).

The children's system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children's systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children's systems of care in a nationally representative sample of counties throughout the U.S.

Multilevel Confirmatory Factor Analysis of a Scale Measuring Interagency Collaboration of Children's Mental Health Agencies.

Multilevel confirmatory factor analysis was used to evaluate the factor structure underlying the 12-item, three-factor Interagency Collaboration Activities Scale (IACS) at the informant level and at the agency level. Results from 378 professionals (104 administrators, 201 service providers, and 73 case managers) from 32 children's mental health service agencies supported a correlated three-factor model at each level and indicated that the item loadings were not significantly (p < .05) different across levels. Reliability estimates of the three factors (Financial and Physical Resource Activities, Program Development and Evaluation Activities, and Collaborative Policy Activities) at the agency level were .81, .60, and .72, respectively, while these estimates were .79, .82, and .85 at the individual level. These multilevel results provide support for the construct validity of the scores from the IACS. When the IACS was examined in relation to level-1 and level-2 covariates, results showed that participants' characteristics (i.e., age, job role, gender, educational level, and number of months employed) and agency characteristics (i.e., state location and number of employees) were not significantly (p > .05) related to levels of interagency collaboration.

Levels of system of care implementation: a national study.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

How many versus how much: 52 weeks of alcohol consumption in emerging adults.

In previous research using timeline follow-back methods to closely monitor drinking and related variables over the first year of college (9 months), we showed that drinking varied considerably over time in accord with academic requirements and holidays. In a new community sample (N = 576) of emerging adults (18- and 19-year-olds who reported having begun drinking prior to recruitment), we used similar methods to compare drinking patterns in college and noncollege individuals over a full calendar year (including summer). To reduce the extreme distortion in computations of average drinking over restricted time spans (i.e., 1 week) that arise because large numbers of even regular drinkers may not consume any alcohol, we analyzed data using recently developed two-part latent growth curve modeling. This modeling distinguished consumption levels from numbers of individuals drinking in a given period. Results showed that drinking levels and patterns generally did not differ between college and noncollege drinkers, and that both groups responded similarly to even those contexts that may have seemed unique to one (i.e., spring break). We also showed that computation of drinking amounts without accounting for "zero drinkers" could seriously distort estimates of mean drinking on some occasions; for example, mean consumption in the total sample appeared to increase on Thanksgiving, whereas actual average consumption for those who were drinking diminished.

Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: report from two randomized controlled trials.

OBJECTIVE: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. METHOD: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive-behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age = 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT-detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age = 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. RESULTS: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. CONCLUSIONS: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes.

Gender Differences in Drug Use, Sexually Transmitted Diseases, and Risky Sexual Behavior among Arrested Youths.

Data were collected on arrested youths processed at a centralized intake facility, including youths released back to the community and those placed in secure detention. This paper reports the results of a test of a structural model involving newly arrested male and female youths' sexually transmitted diseases (STD) test results, urine analysis results for recent cocaine and marijuana use, and self-reported engaging in risky sexual behavior. The across gender, multiple group model involved: (1) a confirmatory factor analysis of these variables, reflecting a latent variable labeled Risk, (2) a regression of Risk on the youths' age, and (3) an examination of the covariance between Risk and the youths' race and seriousness of arrest charge. Results indicate the youths' STD status, drug use, and reported risky sexual behavior are interrelated phenomena, similarly experienced across gender. Age was the only correlate of Risk status that demonstrated a significant gender group difference. The youths' race and seriousness of arrest charges did not significantly affect Risk, regardless of gender. Research and policy implications of the findings are discussed.

Exploring the Latent Structures of Psychological Constructs in Social Development Using the Dimensional-Categorical Spectrum.

This paper provides an introduction to a recently developed conceptual framework-the dimensional-categorical spectrum-for utilizing general factor mixture models to explore the latent structures of psychological constructs. This framework offers advantages over traditional latent variable models that usually employ either continuous latent factors or categorical latent class variables to characterize the latent structure and require an a priori assumption about the underlying nature of the construct as either purely dimension or purely categorical. The modeling process is discussed in detail and then illustrated with data on the delinquency items of Achenbach's child behavior checklist from a sample of children in the National Adolescent and Child Treatment Study.

Survey of mental health consultation and referral among primary care pediatricians.

OBJECTIVE: To determine availability of and test whether on-site mental health providers (MHP) is associated with greater odds of reported mental health consultation and referral among primary care pediatricians. METHODS: Pediatricians were identified from the American Medical Association's 2004 physician directory and stratified by region. Six hundred were randomly selected to receive a mail survey. The main independent variable was on-site MHP. The dependent variable was reported frequency (4-point rating) of mental health consultation and referral. Estimates were weighted to account for survey design and nonresponse. RESULTS: Overall response rate was 51%. The majority of respondents were male (56%), age > or =46 years old (59%), white (68%), and practicing in suburban locations (52%). Approximately half reported consultation with (44%) or referral to (51%) MHP always or often, but a few (17%) reported on-site MHP. After adjustment for demographic and practice characteristics, pediatricians with on-site MHP were more likely to consult (odds ratio [OR] 6.58, 95% confidence interval [95% CI] 3.55- 12.18) or refer (OR 4.25, 95% CI 2.19-8.22) than those without on-site MHP. Among those without on-site MHP, pediatricians with greater practice burden were less likely to consult (OR 0.69, 95% CI 0.48-0.99) or refer (OR 0.75, 95% CI 0.54-1.04) than those with lesser burden. CONCLUSIONS: Most pediatricians in the United States experienced practice-related burdens that limit mental health collaboration, but those with co-located services reported a greater likelihood of consultation and referral. Policy changes that encourage co-location of mental health services and limit practice burden may facilitate mental health consultation and referral.

Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial.

Research has established the dangers of early onset substance use for young adolescents and its links to a host of developmental problems. Because critical developmental detours can begin or be exacerbated during early adolescence, specialized interventions that target known risk and protective factors in this period are needed. This controlled trial (n = 83) provided an experimental test comparing multidimensional family therapy (MDFT) and a peer group intervention with young teens. Participants were clinically referred, were of low income, and were mostly ethnic minority adolescents (average age = 13.73 years). Treatments were manual guided, lasted 4 months, and were delivered by community agency therapists. Adolescents and parents were assessed at intake, at 6-weeks post-intake, at discharge, and at 6 and 12 months following treatment intake. Latent growth curve modeling analyses demonstrated the superior effectiveness of MDFT over the 12-month follow-up in reducing substance use (effect size: substance use frequency, d = 0.77; substance use problems, d = 0.74), delinquency (d = 0.31), and internalized distress (d = 0.54), and in reducing risk in family, peer, and school domains (d = 0.27, 0.67, and 0.35, respectively) among young adolescents.

Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy.

AIM: To examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT). DESIGN: A 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling. SETTING: Community-based drug abuse clinic in the northeastern United States. PARTICIPANTS: A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse. MEASUREMENTS: Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day frequency of alcohol use; (iv) 30-day frequency of other drug use; and (v) 30-day abstinence. FINDINGS: Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. CONCLUSION: Both interventions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.