Maryann Davis - US grants

[unreadable] DESCRIPTION (provided by applicant): Despite extremely high arrest rates into young adulthood among chronic users of public child mental health systems (CMH population) little is known about the details of this offending. Targeted crime prevention efforts with this population would be beneficial because their arrest rate is high and they are accessible for prevention efforts by virtue of their system involvement. This study will examine lifetime within-individual longitudinal arrest patterns (criminal careers) to age 25 in the CMH population. This study will describe these criminal careers and their correlates, examine the impact of standard MH treatments on them, and directly compare criminal careers of CMH and non-CMH general offenders, all within gender. This will provide policymakers with knowledge about who offends, and when, practices to steer youth towards or away from, and a basis from which to decide whether practices based in the criminology literature of the general population applies well to the CMH population. The following are the Specific Aims of this study. 1. In a statewide study, describe different within-individual longitudinal arrest patterns and identify their individual, family, and socio-environmental correlates within the CMH population. 2. Examine the impact of standard MH services on justice system involvement patterns to the age of 25 among those in the CMH population. 3. Compare arrest patterns to the age of 25, between youth in the Child Mental Health System and youth in the general offending population. These areas will be investigated in the proposed study using a database that combines two statewide administrative data bases and Census tract information to generate individuals' demographic, clinical, family, and neighborhood characteristics, full lifetime arrest histories, and use of key mental health services for adolescent case management clients of the Massachusetts Department of Mental Health. It will also contain demographic and neighborhood characteristics, and lifetime arrest histories of a matched sample of general offenders. Our approach, which mixes the methods and perspectives of criminology and mental health services research, provides a solid platform for learning about the criminal careers of CMH youth, and guiding future research in this much-neglected area. [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): The overall aim of this R34 application is to develop an adaptation of the strongest evidence based program to reduce juvenile offending, Multisystemic Therapy (MST), for offending reduction and increased role functioning in transition age youth (ages 18-25) receiving intensive public mental health services. Avoiding negative civic functioning, namely criminal offending is a cornerstone of adult functioning. Recent findings suggest that the majority of transition age youth with serious mental health conditions will be arrested by age 25, most with multiple arrests, and for serious charges. Because of the serious implications such offending poses for youths, their families, and society, an intervention that proved effective in limiting offending among members of this population would contribute substantially to the public good. To develop such an intervention, adaptations to MST are drawn from the literature of malleable causes of offending and desistance in adolescents and adults, with and without mental health conditions. The proposed project will specify and refine the clinical approach, protocols, and fidelity process, and determine the feasibility of the treatment and research protocols through a 4 stage course in which the first stage (months 1-2) obtains written input from national experts, and through focus groups of providers, youth, and family members on the proposed clinical adaptations. The second phase (months 3 to 7) will consist of development cycles of the MST-TAY program. In each cycle, we will draft a version of the intervention, test it with 5-10 clinical cases, obtain feedback from clients and MST clinicians, then generate a new version of the intervention. In the third phase (months 8 to 30), we will conduct a larger pilot for the purpose of determining feasibility of the research approach, using the stable, final version of the intervention. The pilot will enroll 30 18-25 year olds who are identified through their case manager. Half of the participants will be randomized to receive the intervention and half to services as usual. Phase 4 data analyses will examine rates of research and treatment attrition, mean number of research and treatment sessions completed, mean treatment satisfaction ratings, and estimate the effect size of the intervention. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04- MH-105: Conduct pilot studies to develop and test developmentally appropriate, evidence-based prevention interventions and service delivery models for youth with who are at high risk for, or experiencing severe mental illnesses who are transitioning to adulthood. As they move into adulthood transition age youth (TAY;ages 17-25) with serious mental health conditions have alarmingly poor functioning;high rates of homelessness (30%), arrests (60%), school dropout (42%), and unemployment (see1). These problems could be reduced by good mental health (MH) treatment. However, among adults who seek MH care, TAY are consistently the most likely to drop out of treatment (e.g.2), and they complete the fewest number of sessions among those older or younger.3 There is no MH treatment without treatment retention (TR). A simple and potentially cost-effective step to improving TAY functioning is to develop effective TR interventions for the most commonly used MH treatment;office-based outpatient psychotherapy.4 There are currently no clinical trials underway or published TR interventions for TAY. The proposed study develops and pilots a new TR intervention for office-based outpatient psychotherapy tailored for TAY, and pilot tests an existing intervention not yet examined in this age group. Though the specific causes of treatment dropout in TAY have not been investigated, they are likely manifold. Multiple causes of treatment dropout have been identified in adults5 with no predominant factor emerging from the research. Mature adults and TAY likely share some causes of premature termination, but because of the unique developmental and life stage features of the transition period (see6) it is unlikely that successful TR interventions in adults are as effective with TAY. Some of the unique developmental characteristics that can contribute to compromised TR in TAY include: " Age-typical rejection of authority that can interfere with therapeutic relationships, and immature cognitive development that can interfere with the abstract task of therapeutic goal-setting " Immature responsibility-taking that may interfere with attending sessions and embracing the work of therapy, especially since parental influence diminishes during the transition to adulthood " The stigma of needing mental health treatment is keenly felt because of the centrality of peer acceptance and pursuit of romantic relationships at these ages, and may reduce TR. The proposed research will begin the work of testing Motivational Interviewing (MI)7 as a TR intervention in TAY. MI is a widely used intervention to enhance motivation and reduce ambivalence about change, that has increased treatment adherence in older and younger age groups. MI is additionally appealing because it can readily be added to standard therapy. In addition, a second TR intervention will be developed that targets mechanisms of TR that are likely unique to TAY and are different than those targeted in MI. The proposed research undertakes the initial steps towards determining the efficacy of these two approaches in increasing TAY TR. The research will initiate development and feasibility assessment of the developmentally tailored TR intervention, and feasibility of the research design to pilot test both TR interventions in comparison to "services as usual." It is the preliminary step to determine whether sufficient evidence can be found to justify a full scale clinical trial. The two TR interventions are: " Peer Therapy Coach (PTC);this web-based peer intervention that focuses on supporting participation in outpatient psychotherapy will be developed in the proposed research " Motivational Interviewing (MI);this therapist-implemented intervention has been used to increase treatment adherence among adults and adolescents in addictions, health, and MH treatment, but has not specifically been tested as a TR strategy in transition age youth. Aim 1. Specify implementation and training protocols and a fidelity measure for a new outpatient MH psychotherapy TR intervention (PTC). Aim 2. Determine the feasibility of the PTC approach and randomized clinical trial research design comparing Motivational Interviewing and PTC to services as usual. This research will jump start progress towards retaining more transition age youth in widely used treatments by simultaneously developing a tailored TR intervention and testing a successful one not tried in this age group. It will be consistent with the President's Recovery and Reinvestment Act by putting 97% of its direct cost budget towards personnel, and providing jobs for youth with psychiatric disabilities. Youth with mental health needs during the transition to adulthood have tremendously compromised functioning in working, living independently, and staying out of trouble with the law. Office-based mental health treatment is accessed by 760,000 transition age youth (ages 17- 25) each year, but the impact of this widely available treatment is compromised in this age group because they are particularly prone to drop out of treatment. If the two promising treatment dropout prevention interventions pilot tested in the proposed research are successful, more transition age youth in the future will remain in treatment long enough for it to have its beneficial impact on symptoms and by extension, functioning.

? DESCRIPTION (provided by applicant): Serious antisocial behavior, including criminal offending, is extremely costly to society. Rates of such behavior are highest during emerging adulthood. Antisocial behavior is especially high among emerging adults (EAs) with mental illness (MI); findings suggest the majority of EAs with MI will be arrested by age 25, most with multiple arrests, and for serious charges. Thus, there is a clear public health need for effective treatments to reduce serious antisocial behavior in EAs with MI. Astonishingly, there are no established interventions with evidence of efficacy to reduce serious antisocial behavior among EAs, with or without MI. Effective antisocial behavior interventions in adolescents address the comprehensive causes of that behavior. Similarly, this team has developed and completed research on a well-defined age-tailored intervention for EAs with MI and serious antisocial behavior that addresses the correlates of EA antisocial behavior, and provides MI treatment. The intervention is an adaptation of the well-established effective juvenile antisocial behavior intervention, Multisystemic Therapy (MST). MST-EA is a single source that targets the EA correlates of antisocial behavior, including gainful activity (school, work, housing, and positive relationships) and reduced substance use, in part by targeting the proximal mechanism of poor self-regulation. MST-EA also addresses these correlates through reducing MI symptoms. The investigative team has already established the safety, feasibility, and preliminary efficacy of thi type of intervention in a successfully completed community-based open trial (R34MH081374-01, PI: Davis). The proposed study will rigorously evaluate the effectiveness of MST- EA for reducing serious antisocial behavior. Specifically, 240 EAs with MI and recent arrests or release from justice facilities will be randomized to receive MST-EA or Treatment as Usual (TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with confirmation of outcome data using collateral reports and system records. The first aim will be to evaluate the effect over time of MST-EA for improving the ultimate outcome of treatment: reduced serious antisocial behavior. The second aim is to evaluate the effect of MST-EA on (a) the key proximal target of treatment (self-regulation) and (b) the proposed intermediate outcomes of treatment (gainful activity, substance use, and MI problems). The final aim will be to determine whether MST-EA's effect on the ultimate outcome is the result of its effect on the proximal target and intermediate outcomes of treatment. There is a current absence of any antisocial behavior treatments with demonstrated efficacy in this age group. The ultimate effect of the proposed research would be decreased antisocial behavior and other public health-related behaviors (MI symptoms, substance use, homelessness, unemployment) among one of the highest-risk population of individuals with MI. With an emphasis on treatment mechanisms and the near absence of MI research focused on EAs, this innovative research has high potential to advance the field.