General Responsivity and Evidence-Based Treatment: Individual and Program Predictors of Treatment Outcomes during Adolescent Outpatient Substance Abuse Treatment
AdvisorHiller, Matthew L.
Committee memberBelenko, Steven R.
Roman, Caterina Gouvis
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/3963
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AbstractSince it was first articulated, the Risk-Need-Responsivity model (RNR; Andrews, Bonta, & Hoge, 1990) has been extensively researched and is regarded as an empirically supported model for providing effective correctional treatment. It is comprised of three core principles: the risk principle, which provides direction for who should receive treatment; the need principle, which identifies intermediate treatment targets; and the responsivity principle, which states how treatment programs should be structured. The RNR model is purported to be relevant for all offender populations, including female offenders (Dowden & Andrews, 1999a), juvenile offenders (Dowden & Andrews, 1999b), violent offenders (Dowden & Andrews, 2000), and sexual offenders (Hanson, Bourgon, Helmus, & Hogdson, 2009). Yet, the majority of RNR research has examined the risk and need principles, and the responsivity principle remains understudied. The responsivity principle includes two sub-principles: general and specific (Andrews, & Bonta, 2010). The current research explored the general responsivity principle, which states that programs should use theoretically relevant models for individual change, specifically cognitive-behavioral and cognitive-social learning models (Andrews & Bonta, 2010). The following techniques are consistent with these models: "role-playing, modeling, repeated practice of alternative behaviors, cognitive restructuring to modify thoughts/emotions, skills building, or reinforcement" (Andrews & Bonta, 2010, p. 50). Despite empirical support, the RNR model has received minimal application to juveniles, and it has not been widely tested in the substance abuse treatment context. Additionally, it is not clear whether adherence to the RNR model is relevant for reducing substance use outcomes in youth. Adolescent substance abuse treatment programs were designed to address substance use among juveniles, and have been widely researched to determine their effectiveness; yet their effectiveness remains understudied among juvenile offenders. These studies include examinations of specific treatment interventions used, such as Multisystemic Therapy. Many of these interventions are considered to be "evidence-based treatment" (EBT), but there is a wide variety of repositories that classify interventions as "evidence-based" with varying criteria used to classify them. The juvenile drug treatment court model (JDTC) was specifically developed to address substance use and crime among juvenile offenders; however, findings from empirical studies have not demonstrated a strong treatment effect. To address these gaps in the literature, secondary analyses were conducted on data collected from 132 adolescent outpatient substance abuse treatment programs (AOPs) and 10 juvenile drug treatment courts nationwide. This research was an application of the general responsivity principle in the AOP and JDTC context to determine the impact of responsivity adherence on the odds of rearrest and substance use severity. The analyses also included an examination of evidence-based treatment (EBT) in both samples to determine the influence of EBT use scores on the odds of rearrests and substance use severity scores. To examine the AOP sample, multilevel models were used to examine the individual- and program-level impact of responsivity adherence and EBT use. To examine the JDTC sample, multivariate analyses were used to examine the individual-level impact of responsivity adherence and EBT use. Overall, responsivity adherence was not significantly associated with rearrests among AOP participants, nor was it significantly associated with substance use severity scores. Additionally, the odds of rearrest were significantly greater among individuals who received interventions with a higher EBT use score; though, there was no association between the average EBT use scores across programs and the odds of rearrest. There was no significant association between individual- and program-level EBT use scores and substance use severity. Among JDTC participants, an increase in responsivity adherence was associated with an increase in the odds of rearrest and substance use severity. A similar association emerged between EBT use scores and both outcomes, wherein increases in EBT use scores were significantly associated with an increase in the odds of rearrest and substance use severity. The results of the analyses suggest the need for further specification of both general responsivity adherence and "evidence-based" treatment for use in future research and theory; specifically, further elaboration of the general responsivity-adherent techniques and clear criteria for classifying interventions as "evidence-based treatment." The findings also imply that certain types of treatment interventions are more compatible with the JDTC model than other interventions. Additional analyses suggest the possibility that general responsivity adherence and evidence-based treatment may not be unique constructs. Future research may benefit through exploring evidence-based treatment as a criterion for adherence to the general responsivity principle.
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Putting the Community back into Therapeutic Community: Examining the Role of the Treatment Group in Prison-Based Substance Abuse TreatmentWelsh, Wayne N.; Hiller, Matthew L.; Taylor, Ralph B. (Temple University. Libraries, 2012)This dissertation conceptualized and evaluated the moderating effect of the treatment group on treatment responsiveness and recidivism among a sample of drug-involved offenders who received in-prison substance abuse treatment. Few studies of drug treatment simultaneously consider individual level variables and the context of group treatment. Those that have typically operationalize the treatment context with organizational indicators such as attributes of the staff, staff perceptions of the program, therapeutic orientation, and program accreditation. In contrast, the current work operationalized context from the perspective of the participant using as indicators client-based measures of treatment progress and satisfaction. 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The research was guided by three central questions: 1) Do significant differences on recidivism exist between treatment groups? 2) Does the treatment group moderate the impacts of psychosocial and treatment process variables on recidivism? 3) Does treatment modality have an effect on recidivism? To examine these questions, data from an evaluation of the treatment programs at the State Correctional Institution (SCI) at Chester, PA, were used (Welsh, 2006). The sample consisted of 618 adult male offenders who were randomly assigned to either the therapeutic community (TC) or the less-intensive group counseling treatment modality, each of which was 12 months in duration. A multilevel framework was applied to the data, as the offenders (level-1) were nested within 12 treatment units (level-2) in a single prison. 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The data were analyzed using hierarchical generalized linear modeling (HGLM). This was the appropriate method because the data were nested and the outcomes were the binary measures of reincarceration and rearrest. Notably, multilevel models revealed significant variation on the reincarceration outcome across treatment units (level-2), controlling for treatment modality. This supported the first hypothesis that treatment effects could be attributed to something other than individual level variables or type of treatment received. A similar significant finding across treatment units (level-2), however, was not detected for the rearrest variable. Further, this method allowed for the examination of treatment group impacts on the individual psychosocial functioning and treatment process measures controlling for the type of treatment received. The second hypothesis stated that the treatment group would differentially affect the impact of these variables on recidivism. To reduce the number of individual-level predictors, the various subscales were entered into a second order principal components factor analysis. Three factors emerged: negative affect, positive attitude, and treatment satisfaction. Controlling for the composition of the group, the negative affect factor had a significant, positive direct effect on reincarceration. When the slopes of the three factors were allowed to vary, the model with treatment satisfaction and positive attitude as random effects fit the model best, as the treatment group significantly affected the impact these variables had on reincarceration. With regard to the third research question, in no analyses conducted did the treatment modality have a significant effect on the outcome. The third hypothesis that stated TC participants would have lower rates of reincarceration and rearrest, therefore, was not supported. 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This study takes an important first step in the direction of a more complete view of treatment experiences and outcomes that considers individuals nested within treatment groups.
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Targeting Parental Accommodation in the Treatment of Youth with Anxiety: A Comparison of Two Cognitive Behavioral TreatmentsKendall, Philip C.; Olino, Thomas M.; Heimberg, Richard G.; Gosch, Elizabeth A.; Giovannetti, Tania; McCloskey, Michael (Temple University. Libraries, 2019)Parental accommodation refers to the ways in which a parent modifies his/her behavior to avoid or reduce the distress their child experiences. Parental accommodation of youth anxiety is common, and reduction in accommodation is associated with reduced anxiety after treatment. The current study evaluated the efficacy of an adapted cognitive-behavioral therapy program (CBT) designed to address parental accommodation (Accommodation Reduction Intervention; ARI). Sixty children and adolescents (age 7-17) and their parents were evaluated for youth anxiety and parental accommodation before and after 16 weeks of treatment. Thirty youth received ARI and 30 received Coping Cat (CC). Both youth anxiety and parental accommodation were significantly reduced from pre to posttreatment in youth who received ARI as well as those who received CC. No significant difference was found between the two treatment conditions on any measure of anxiety or accommodation. Findings indicate that an adapted CBT that focuses on parent accommodation (ARI) produced favorable outcomes comparable to Coping Cat. Clinical implications and future directions are discussed.