Family-based treatments for serious juvenile offenders : a multilevel meta-analysis

Dissertation supervisor: Charles M. Borduin.Includes vita.Violent criminal acts and other serious crimes committed by youths result in considerable emotional, physical, and economic effects on these youths, their families, crime victims, and the larger community. Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, I used multilevel meta-analysis to (a) characterize the nature and quality of research on family-based treatments for serious juvenile offenders, (b) summarize the findings of this research by estimating an average effect size, and (c) examine the influence of moderators (e.g., characteristics of participants, treatments, and methods) on treatment outcomes. Results from 31 studies revealed a number of methodological strengths including frequent use of random assignment and comparison to usual treatment conditions. In addition, the meta-analysis synthesized 325 effect sizes from 29 of these studies and revealed that family-based treatments produced small but meaningful treatment effects (mean d = 0.26) relative to comparison conditions. Furthermore, moderator analyses revealed that certain characteristics of participants, study methods, and measures influenced the size of treatment effects; for example, effect sizes varied by domain of outcome measure such that measures of substance use showed the largest treatment effects and measures of peer relationships showed the smallest. Overall, the results of the present study have implications for policymakers, administrators, and treatment providers who make decisions about the dissemination and implementation of family-based treatments for serious juvenile offenders. In addition, researchers who seek to develop and study these treatments may wish to consider the current findings.Includes bibliographical references (pages 76-100)

Cost-benefit analysis of multisystemic therapy for serious and violent juvenile offenders and their siblings

Title from PDF of title page (University of Missouri--Columbia, viewed on November 2, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract, appears in the public.pdf file.Thesis advisor: Dr. Charles BorduinIncludes bibliographical references.M. A. University of Missouri--Columbia 2012."July 2012"This study investigated the economic benefits of an intensive family-based treatment (multisystemic therapy, MST) versus individual therapy (IT) using arrest data from 25-year follow-ups of referred serious and violent juvenile offenders (n = 176) and their closest-in-age siblings (n = 110). Three categories of benefits were evaluated: (1) taxpayer benefits (i.e., avoided criminal justice system costs), (2) tangible benefits to crime victims (i.e., avoided tangible losses), and (3) intangible benefits to crime victims (i.e., avoided pain and suffering). Results indicated that reductions in criminality for juvenile offenders and siblings in the MST versus IT conditions were associated with substantial benefits to both taxpayers and crime victims. Cumulative benefits of MST over IT ranged up to $34,955 per referred youth and up to$37,433 per family (i.e., when siblings were included). Overall, it was estimated that every dollar spent on MST recovered up to $4.98 in the years ahead by preventing future crimes. Sensitivity analyses also indicated that estimates of savings were robust to variations in crime victim intangible benefits, sibling juvenile arrest rates, and discount rates. The economic benefits of MST are important for administrators and policymakers to consider when allocating scarce financial resources to interventions for serious juvenile offenders

The Potential of Pay‑for‑Success as a Financing Strategy for Evidence‑Based Practices: An Illustration with Multisystemic Therapy

There is a critical need to identify strategies for financing the implementation of evidence-based practices. We illustrate the potential of pay-for-success financing (PFS)—a strategy in which private investors fund implementation and receive a return on investment from a government payer—using multisystemic therapy as an example. We argue that standard multisystemic therapy (for serious juvenile offenders) and several of its adaptations (for other complex behavioral problems in youth) would be good candidates for PFS in the right contexts. Despite some challenges for policymakers and administrators, PFS has significant potential as a financing strategy for evidence-based practices

Expression and Differential Responsiveness of Central Nervous System Glial Cell Populations to the Acute Phase Protein Serum Amyloid A

Acute-phase response is a systemic reaction to environmental/inflammatory insults and involves hepatic production of acute-phase proteins, including serum amyloid A (SAA). Extrahepatically, SAA immunoreactivity is found in axonal myelin sheaths of cortex in Alzheimer's disease and multiple sclerosis (MS), although its cellular origin is unclear. We examined the responses of cultured rat cortical astrocytes, microglia and oligodendrocyte precursor cells (OPCs) to master pro-inflammatory cytokine tumour necrosis factor (TNF)-\u3b1 and lipopolysaccaride (LPS). TNF-\u3b1 time-dependently increased Saa1 (but not Saa3) mRNA expression in purified microglia, enriched astrocytes, and OPCs (as did LPS for microglia and astrocytes). Astrocytes depleted of microglia were markedly less responsive to TNF-\u3b1 and LPS, even after re-addition of microglia. Microglia and enriched astrocytes showed complementary Saa1 expression profiles following TNF-\u3b1 or LPS challenge, being higher in microglia with TNF-\u3b1 and higher in astrocytes with LPS. Recombinant human apo-SAA stimulated production of both inflammatory mediators and its own mRNA in microglia and enriched, but not microglia-depleted astrocytes. Co-ultramicronized palmitoylethanolamide/luteolin, an established anti-inflammatory/neuroprotective agent, reduced Saa1 expression in OPCs subjected to TNF-\u3b1 treatment. These last data, together with past findings suggest that co-ultramicronized palmitoylethanolamide/luteolin may be a novel approach in the treatment of inflammatory demyelinating disorders like MS

Mixed-method approaches to strengthen economic evaluations in implementation research

Abstract Background Guidance from economic evaluations on which implementation strategies represent the best return on investment will be critical to advancing the Triple Aim of health care: improving patient care and population health while minimizing per-capita cost. The results of traditional (quantitative) economic evaluations are limited by a remaining “qualitative residual” of contextual information and stakeholders perspectives, which cannot be captured by monetary values alone and is particularly prevalent in implementation science research. The emergence of qualitative methods for economic evaluation offers a promising solution. Main body To maximize the contributions of economic evaluations to implementation science, we recommend that researchers embrace a mixed-methods research agenda that merges traditional quantitative approaches with innovative, contextually grounded qualitative methods. Such studies are exceedingly rare at present. To assist implementation scientists in making use of mixed methods in this research context, we present an adapted taxonomy of mixed-method studies relevant to economic evaluation. We then illustrate the application of mixed methods in a recently completed cost-effectiveness evaluation, making use of an adapted version of reporting standards for economic evaluations. Conclusions By incorporating qualitative methods, implementation researchers can enrich their economic evaluations with detailed, context-specific information that tells the full story of the costs and impacts of implementation. We end by providing suggestions for building a research agenda in mixed-method economic evaluation, along with more resources and training to support investigators who wish to answer our call to action.https://deepblue.lib.umich.edu/bitstream/2027.42/146781/1/13012_2018_Article_850.pd

Toxicity of Volatile Methylated Species of Bismuth, Arsenic, Tin, and Mercury in Mammalian Cells In Vitro

The biochemical transformation of mercury, tin, arsenic and bismuth through formation of volatile alkylated species performs a fundamental role in determining the environmental processing of these elements. While the toxicity of inorganic forms of most of these compounds are well documented (e.g., arsenic, mercury) and some of them are of relatively low toxicity (e.g., tin, bismuth), the more lipid-soluble organometals can be highly toxic. In the present study we investigated the cyto- and genotoxicity of five volatile metal(loid) compounds: trimethylbismuth, dimethylarsenic iodide, trimethylarsine, tetramethyltin, and dimethylmercury. As far as we know, this is the first study investigating the toxicity of volatile metal(loid) compounds in vitro. Our results showed that dimethylmercury was most toxic to all three used cell lines (CHO-9 cells, CaCo, Hep-G2) followed by dimethylarsenic iodide. Tetramethyltin was the least toxic compound; however, the toxicity was also dependend upon the cell type. Human colon cells (CaCo) were most susceptible to the toxicity of the volatile compounds compared to the other cell lines. We conclude from our study that volatile metal(loid) compounds can be toxic to mammalian cells already at very low concentrations but the toxicity depends upon the metal(loid) species and the exposed cell type

Pilot evaluation of the Fiscal Mapping Process for sustainable financing of evidence-based youth mental health treatments: A comparative case study analysis

Background Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies. Supports are needed that can guide service agencies in accessing sustainable funding for EBTs. We conducted a pilot evaluation of the Fiscal Mapping Process, an Excel-based strategic planning tool that helps service agency leaders identify and coordinate financing strategies for their EBT programs. Method Pilot testing of the Fiscal Mapping Process was completed with 10 youth mental health service agencies over a 12-month period, using trauma-focused cognitive-behavioral therapy or parent–child interaction therapy programs. Service agency representatives received initial training and monthly coaching in using the tool. We used case study methods to synthesize all available data (surveys, focus groups, coaching notes, document review) and contrast agency experiences to identify key findings through explanation building. Results Key evaluation findings related to the process and outcomes of using the Fiscal Mapping Process, as well as contextual influences. Process evaluation findings helped clarify the primary use case for the tool and identified the importance—and challenges—of engaging external collaborators. Outcome evaluation findings documented the impacts of the Fiscal Mapping Process on agency-reported sustainment capacities (strategic planning, funding stability), which fully explained reported improvements in outcomes (extent and likelihood)—although these impacts were incremental. Findings on contextual factors documented the influence of environmental and organizational capacities on engagement with the tool and concerns about equitable impacts, but also the view that the process could usefully generalize to other EBTs. Conclusions Our pilot evaluation of the Fiscal Mapping Process was promising. In future work, we plan to integrate the tool into EBT implementation initiatives and test its impact on long-term sustainment outcomes across various EBTs, while increasing attention to equity considerations

Intracellular Calcium Disturbances Induced by Arsenic and Its Methylated Derivatives in Relation to Genomic Damage and Apoptosis Induction

Arsenic and its methylated derivatives are contaminants of air, water, and food and are known as toxicants and carcinogens. Arsenic compounds are also being used as cancer chemotherapeutic agents. In humans, inorganic arsenic is metabolically methylated to mono-, di-, and trimethylated forms. Recent findings suggest that the methylation reactions represent a toxification rather than a detoxification pathway. In recent years, the correlation between arsenic exposure, cytotoxicity and genotoxicity, mutagenicity, and tumor promotion has been established, as well as the association of arsenic exposure with perturbation of physiologic processes, generation of reactive oxygen species, DNA damage, and apoptosis induction. Trivalent forms of arsenic have been found to induce apoptosis in several cellular systems with involvement of membrane-bound cell death receptors, activation of caspases, release of calcium stores, and changes of the intracellular glutathione level. It is well known that calcium ion deregulation plays a critical role in apoptotic cell death. A calcium increase in the nuclei might lead to toxic effects in the cell. In this review, we highlight the relationship between induced disturbances of calcium homeostasis, genomic damage, and apoptotic cell death caused by arsenic and its organic derivatives

Family-based treatments for serious juvenile offenders: A multilevel meta-analysis

__Objective:__ Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, we used meta-analysis to summarize the findings of research on family-based treatments for serious juvenile offenders. __Method:__ We conducted a multilevel meta-analysis that modeled dependencies between multiple effect sizes from the same study. The meta-analysis synthesized 324 effect sizes from 28 studies that met inclusion criteria. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model. __Results:__ Across studies, family-based treatments produced modest, yet long-lasting, treatment effects (mean d = 0.25 for antisocial behavior, 0.24 overall) relative to comparison conditions. Furthermore, certain characteristics moderated the magnitude of treatment effects; for example, measures of substance use showed the largest effects and measures of peer relationships showed the smallest effects. __Conclusions:__ Policymakers, administrators, and treatment providers may find it useful to consider the effects of family-based treatments for serious juvenile offenders in their selection of treatments for this population. In addition, investigators who seek to develop and study such treatments may wish to consider the current findings in their future research efforts

Coordination of sustainable financing for evidence-based youth mental health treatments: Protocol for development and evaluation of the fiscal mapping process

BACKGROUND: Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, service agencies ). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD: Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies\u27 EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION: This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs