This pilot study conducts feasibility research to develop adaptive intervention strategies
for conduct problems prevention. The adaptive model will stipulate for whom only brief
prevention strategies are sufficient and for whom more intensive strategies are necessary.
The research will involve youth (10-17 years of age) identified by law enforcement as early
offenders and who are referred for pre-court juvenile diversion programming.
This project proposes to conduct feasibility research to inform implementation of a future
full-scale SMART design (i.e., sequential, multiple assignment, randomized trial) that will
be used to construct adaptive intervention strategies (AIS) for conduct problems prevention.
AIS individualize treatment via decision rules that specify how the type (youth-focused or
parent focused) or intensity (low dosage or high dosage) of an intervention should be
formulated prior to the beginning of treatment based on youth and family characteristics
and/or repeatedly adjusted over time based on proximal outcomes collected during treatment.
AIS are needed in conduct problems prevention to address the heterogeneity of at-risk youth
and the variability in response to conventional fixed-type preventive interventions. With
the present SMART trial each participant will progress through two stages of intervention
using a stepped-care framework. In the first stage participants will be randomized to one of
two 'brief-type' intervention options, either the youth-focused Teen Intervene-Brief program
(TI-B; Winters & Leitten, 2007) or the parent-focused Everyday Parenting-Brief program
(EP-B; Dishion et al., 2003, 2010). Responders to either program will be stepped down and
monitored over time for maintenance. Non-responders to either program will be stepped up and
randomized to one of two second stage 'intensive-type' intervention options that feature
either (1) continuation of the first stage option with increased dosage (EP-Expanded or
TI-Expanded), or (2) switching to the alternative expanded intervention modality. This
feasibility study will enroll high risk youth (10-17 years of age) who have been arrested
for status or misdemeanor offenses and referred for pre-court juvenile diversion
programming. The aims of this feasibility research are to (1) develop practice
infrastructure for implementing a SMART design and assess practitioner adherence to the
various intervention sequences, (2) roll out the stepped-care intervention sequences and
obtain estimates of recruitment into SMART, attrition at both stages, and overall response
rate to first-stage intervention options, (3) describe the demographic and clinical
characteristics of the sample of diversion-referred youth who are enrolled in the study, (4)
create a latent construct for conduct problems that will be used as the distal outcome, and
(5) explore the utility of incorporating secondary tailoring variables (e.g., child and
family risk characteristics) in the adaptive intervention model.
- Youth ages 10-17
- Juvenile diversion referral (to community partner agency)
- Pervasive developmental disabilities
- Serious psychiatric disorders requiring specialized mental health treatment (e.g.
psychosis, bipolar disorder, etc.)
- Substance dependence