Zoekresultaten

Bridging the implementation gab

Evidence concerning psychosocial interventions for children and young people with externalizing behavior problems has amassed at an impressive pace in recent years. Interventions that have been proven effective are now considered vehicles through which the knowledge of “what works” can be applied in practice. Outcomes for children, young people, and their families, however, have not improved in line with these advances in knowledge. This difference between the knowledge of “what works” and the application of this knowledge in real-life practice has become known as the “implementation gap”. This dissertation explores questions considering the implementation gap, with a focus on whether professionals are delivering the interventions as intended (treatment integrity).The results of the research underlying this dissertation show that 1) although measuring treatment integrity is important, it is often missing or not examined under adequate circumstances in studies, 2) applying interventions with a high level of treatment integrity makes a real difference to the end-users of the services and 3) targeted and continued support to professionals with a focus on providing feedback on levels of treatment integrity is necessary to enable them to deliver interventions as intended. Organizing support around common factors of interventions can be a first step in integrating and providing feasible support for professionals that provide more than one intervention.

Do personality traits affect responsiveness of juvenile delinquents to treatment?

Leren implementeren

De jeugdzorg is regelmatig in het nieuws. Heel positief is dat meestal niet. Er zijn inmiddels door allerlei partijen rapporten en adviezen uitgebracht over de jeugdzorg. Een kernprobleem dat in alle publicaties genoemd wordt is de behoefte aan wat ‘hoogwaardige jeugdzorg’ genoemd wordt, met toepassing van actuele kennis en effectieve interventies. Toepassing van actuele kennis en effectieve interventies vergt consequente en systematische aandacht voor implementatie. Deze rede gaat in op de vraag hoe we dit kunnen aanpakken. Na introductie van de context van de jeugdzorg, wordt onderbouwd hoe kwalitatief goede toepassing van centrale bouwstenen van jeugdzorg, de effectiviteit kan verhogen. Kwalitatief goede toepassing van de centrale bouwstenen gaat niet vanzelf en vergt een effectief implementatieproces en een context die implementatie faciliteert. Het mogelijk maken van leren op de werkvloer is de basis van goede implementatie en in de rede komen de stappen aan de orde die dat mogelijk maken.

Brief report: Follow-up outcomes of multisystemic therapy for adolescents with an intellectual disability and the relation with parental intellectual disability

Research on follow-up outcomes of systemic interventions for family members with an intellectual disability is scarce. In this study, short-term and long-term follow-up outcomes of multisystemic therapy for adolescents with antisocial or delinquent behaviour and an intellectual disability (MST-ID) are reported. In addition, the role of parental intellectual disability was examined. Outcomes of 55 families who had received MST-ID were assessed at the end of treatment and at 6-month, 12-month and 18-month follow-up. Parental intellectual disability was used as a predictor of treatment outcomes. Missing data were handled using multiple imputation. Rule-breaking behaviour of adolescents declined during treatment and stabilized until 18 months post-treatment. The presence or absence of parental intellectual disability did not predict treatment outcomes. This study was the first to report long-term outcomes of MST-ID. The intervention achieved similar results in families with and without parents with an intellectual disability.

Heterogeneity in Response during Multisystemic Therapy: Exploring Subgroups and Predictors

Multiple studies have shown that Multisystemic Therapy (MST) is, at group level, an effective treatment for adolescents showing serious externalizing problem behavior. The current study expands previous research on MST by, first, examining whether subgroups of participants who respond differently to treatment could be identified. Second, we investigated if the different trajectories of change during MST could be predicted by individual (hostile attributions) and contextual (parental sense of parenting competence and deviant and prosocial peer involvement) pre-treatment factors. Participants were 147 adolescents (mean age = 15.91 years, 104 (71%) boys) and their parents who received MST. Pre-treatment assessment of the predictors and 5 monthly assessments of externalizing behavior during treatment took place using both adolescent and parents’ self-reports. Six distinct subgroups, showing different trajectories of change in externalizing problem behavior during MST, were identified. Two of the 6 trajectories of change showed a poor treatment response, as one class did not change in externalizing problem behavior and the other class even increased. The remaining 4 trajectories displayed a positive effect of MST, by showing a decrease in externalizing behavior. Most of these trajectories could be predicted by parental sense of parenting competence. Additionally, lower involvement with prosocial peers was a predictor of the group that appeared to be resistant to MST. Adolescents do respond differently to MST, which indicates the importance of personalizing treatment. Protective factors, such as parental sense of parenting competence and prosocial peers, seem to require additional attention in the first phase of MST.

Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents

Background: An adaptation of multisystemic therapy (MST) was piloted to find out whether it would yield better outcomes than standard MST in families where the adolescent not only shows antisocial or delinquent behaviour, but also has an intellectual disability. Method: To establish the comparative effectiveness of MST‐ID (n = 55) versus standard MST (n = 73), treatment outcomes were compared at the end of treatment and at 6‐month follow‐up. Pre‐treatment differences were controlled for using the propensity score method. Results: Multisystemic therapy‐ID resulted in reduced police contact and reduced rule breaking behaviour that lasted up to 6 months post‐treatment. Compared to standard MST, MST‐ID more frequently resulted in improvements in parenting skills, family relations, social support, involvement with pro‐social peers and sustained positive behavioural changes. At follow‐up, more adolescents who had received MST‐ID were still living at home. Conclusions: These results support further development of and research into the MST‐ID adaptation.