Top PDF Evaluation of Multisystemic Therapy for adolescent problematic sexual behavior

Evaluation of Multisystemic Therapy for adolescent problematic sexual behavior

Evaluation of Multisystemic Therapy for adolescent problematic sexual behavior

In terms of evaluation and use of specific measures by MST-PSB teams, it is noteworthy that MST-PSB teams currently record their outcomes relating to antisocial behaviour, education, and the degree to which the goals of the family have been met. There is also the use of routine outcome reviews of goal and the main behaviours targeted by the intervention. At this point, we would recommend for MST-PSB teams to consider to routine use of standardized measures to complement these outcomes that would not be too burdensome for the family. It would be useful for the MST-PSB teams to decide to what degree they want to be involved in explicitly evaluating changes in problematic sexual behaviour in a more standardized way (beyond offending) and to what degree systematic qualitative evaluations of the clients, and the wider system, would be useful, as these are areas not routinely assessed. It may also be helpful to better define the population in relation to co-occurring mental health conditions that may characterize a substantial subgroup of young people (for example, trauma), and, in doing so, determine the degree of relevance. Finally, it may be useful to record, and begin to think about, characteristics of offences based on the literature that is part of this research, such as age differential between perpetrator and victim.
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Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS B): study protocol for a randomized controlled trial

Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS B): study protocol for a randomized controlled trial

MST-PSB is therefore the only evidence-based inter- vention currently available for adolescents showing problem sexual behaviour. However, despite some initial positive findings, there are several unresolved issues relating to transporting MST-PSB to other health and social care systems and jurisdictions outside the United States. First, the effectiveness of MST-PSB needs to be carefully assessed in the UK mental health, juvenile just- ice and social care systems. The pattern of results found in the transportability of RCT evaluations of standard MST in Canada and Europe suggest that the effective- ness of MST-PSB needs to be demonstrated by inde- pendent investigators and outside the United States. Specifically, the magnitude of the associations between standard MST and treatment outcomes are substantially higher in trials that involved the developers of the inter- vention (effect size = 0.81) than in studies conducted without their close involvement (effect size = 0.27) [33], suggesting a possible ‘developer effect’ (for example, therapists supervised by developers adhere more to the MST guidelines or are more motivated and engaged). Thus, an independent transportability trial is necessary to demonstrate that MST-PSB can be delivered with fidelity by UK-trained therapists. This is crucial, given that the MST-PSB adaptation requires additional skills and practices that are not part of standard MST, such as addressing parents’ and adolescents’ denial of problem- atic sexual behaviour. Furthermore, the intervention is being applied by MST therapists to a highly stigmatized population against which there are very strong cultural biases and prejudices. The clinical competency of UK psychologists and social workers to deliver MST-PSB with fidelity, relative to their counterparts in the United States, may also be influenced by curriculum and train- ing differences. In addition, the relative success of stand- ard MST may be due to the relative quality of the usual services for managing antisocial behaviour in the United States compared with usual services in other countries. MST may produce better outcomes only when usual services produce weak, null or even negative effects. Thus, the superiority and cost-effectiveness of MST-PSB needs to be demonstrated outside the United States, in studies where the therapists delivering MST are inde- pendent of the MST-PSB developers, where the com- parison services or ‘management as usual’ (MAU) is consistent with the options currently available for young people showing problem sexual behaviour in that region, and where the sentencing policy within the justice sys- tem does not result in comparison with alternatives such as custodial sentences. Moreover, as noted by Littell [34] following a detailed Cochrane review of the ef- fectiveness of MST [35], it is crucial that the research evaluation team and the developers who deliver the clinical service be completely independent.
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Evaluation of multisystemic therapy pilot services in the Systemic Therapy for At Risk Teens (START) trial: study protocol for a randomised controlled trial

Evaluation of multisystemic therapy pilot services in the Systemic Therapy for At Risk Teens (START) trial: study protocol for a randomised controlled trial

In the first RCT of MST to be conducted in the US without the direct involvement of the treatment devel- opers, reoffending rates in the MST group remained high even though the intervention significantly reduced reoffending compared with TAU (66.7% versus 86.7%) [49]. Effect sizes associated with efficacy are substantially higher in trials of MST that involved the developers (0.81) than in studies conducted without their close in- volvement (0.27) [31]. This pattern of results leaves open the possibilities of ‘developer effects’ and that the rela- tive success of MST may be due to the poor quality of the standard services for managing CD in the US. Thus, for MST to be considered valuable, its superiority should be demonstrated outside the US in care systems meeting the following three conditions: the evidence base for TAU (associated with socialised healthcare systems) is stronger than for TAU in earlier clinical trials initiated by the developers of MST (for example, individual psy- chotherapy); the motivation of the therapists delivering MST to demonstrate favourable outcomes associated with the therapy is lower than that of those who were involved in the development of MST; and sentencing policy within the justice system does not result in a comparison with al- ternatives, such as custodial sentences.
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Multisystemic Therapy - Family Integrated Transitions (MST-FIT) : a feasibility study

Multisystemic Therapy - Family Integrated Transitions (MST-FIT) : a feasibility study

Although these preliminary local costing data are promising, they do not reflect a comprehensive health economic evaluation that would be the ideal evidence-based standard. Moreover, the small sample sizes in our feasibility study precluded effective analysis. Rather, we have co-ordinated this aspect of our evaluation with Dr Lisa Holmes of Loughborough University, who has developed a cost proforma, created in Excel, for future use by the National Implementation Service (NIS) and local authorities, to explore the cost effectiveness of MST-FIT as the programme becomes embedded into practice and is introduced into new local authority areas. The pro forma has been developed for 2 purposes: for use by the NIS to report nationally on the cost effectiveness of MST-FIT and to inform future scale and growth strategies, and for use by individual local
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The Impact of Technology on Adolescent Behavior

The Impact of Technology on Adolescent Behavior

Contemporary society is in a massive process of change, called digitalization. A part of the communication models and existing behavior is redefined, they are reintegrated in a technological approach with new content, adapted to the contemporary profile of a changing society. Information and communication technology has overcome geographical boundaries and territories, giving life a new dynamic. Extension and expansion of the use of technologies after 1970, as television, electronic mail, mobile phones and optical cables significantly influenced the way we communicate. After 1990, with the invention of the web, began to generate a new space called virtual space or virtual world, which reached in 2008 about 48 billion web pages. The beginning of this millennium marked the growth of computer networks (internet use), making possible the connection of people worldwide without any social, gender, cultural, economic, time and racial distinction. Europe is the region with the highest level of internet spread in the world (75%), in second place is USA with 61%. (ITU).
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Review of Problems of Adolescent Sexual Behavior and the Role of Millennium Development Goals 4, 5 and 6 in Nigeria

Review of Problems of Adolescent Sexual Behavior and the Role of Millennium Development Goals 4, 5 and 6 in Nigeria

Introduction: The problems of adolescents’ sexual behavior are grave and far-reaching. Methods: Review of exiting literature via Google scholar, AJOL, Pubmed, HINARI and other relevant data bases on the common problems of adolescents’ inappropriate sexual behavior. Result: Adolescent sexual behavior could result in adolescent pregnancy which prevalence varies widely throughout Nigeria perhaps due to differences in culture and development. Abortion, the willful termination of pregnancy is another problem which is often undertaken for pregnancies resulting from incest and sexual abuse. Also common is trans-generational sex which occurs when an adolescent has non-marital sex in the last 12 months with a man who is at least 10 years older than her. Also re- lated to this, is transactional sex found in both committed and casual relationships. It is not always done for survival because in some cultures, sex for favor is carried out for reasons other than sub- sistence. Furthermore, multiple sexual partners are the engagement in sex with more than one partner over a particular time frame. It may be sequential or concurrent. The high prevalence of these problems in Nigeria raises a question of the possibility of achieving the millennium devel- opment goals (MDGs) 4, 5 and 6 specifically targeted at reducing child mortality, improving ma- ternal health and combating HIV/AIDS, malaria and other diseases respectively. Conclusion: Poli- cies and strategies such as family life and HIV/AIDs education (FLHE) curriculum on adolescent reproductive health should be pursued with greater vigor in our secondary schools in addition to establishing HIV counseling centers and vocational training programs for out-of-school adoles- cents. WHO support and commitment to key action areas for countries and member states will build and strengthen their capacity to improve reproductive and sexual health.
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Care of the Adolescent Sexual Assault Victim

Care of the Adolescent Sexual Assault Victim

cent increase in the rate of adolescent acquaintance rape has been associated with the illegal availability of flunitrazepam (Rohypnol, manufactured by Roche Pharmaceuticals Inc, outside of the United States). This so-called “date rape drug” is a benzodiazepine sedative/hypnotic. The effects of flunitrazepam be- gin 30 minutes after ingestion, peak within 2 hours, and can persist for up to 8 to 12 hours. Drug effects include somnolence, decreased anxiety, muscular re- laxation, and profound sedation. There may also be amnesia for the time that the drug exerts its action. This drug can go undetected if added to any drink, thus increasing the risk of sexual assault, especially in the adolescent population. 16 –19
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Care of the Adolescent Sexual Assault Victim

Care of the Adolescent Sexual Assault Victim

common and need to be prepared to counsel their ado- lescent patients to avoid high-risk situations. Screening of adolescents for sexual victimization should be part of visits for psychological problems, sexuality issues, con- traception or substance abuse, and health supervision. Physicians should include information about ways to prevent sexual assault as part of anticipatory guidance with adolescents with and without disabilities, tailored to cognitive abilities to understand. Adolescents should be asked direct questions without their parents present regarding their past sexual experiences. These questions should include those that explore age of first sexual experience, use of the Internet to find romantic or sex- ual partners, and unwanted or forced sexual acts. Explo- ration of gender roles and relationship parameters (eg, exploitative, nonconsensual versus healthy) are critical. Adolescents who have been sexually assaulted need the opportunity to describe the experience at their own pace and in their own words. 47,63–65,70
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Adolescent Sexual Health: Time to Engage

Adolescent Sexual Health: Time to Engage

As Christine Markham and colleagues highlight in the first article of this edition, the United States has a teen birth rate higher than any other developed country and also leads in rates of sexually transmitted infections among young people. Yet, we know a fair amount about how and why this occurs. Their excellent analysis underscores that this does not need to be the inheritance of the next generation of American youth if changes in both policy and program followed the evidence by, among other things, providing a comprehensive approach to sex education and access to sexual health care services. Dr. Markham and colleagues also delve more deeply into the data as it relates to sexual health behaviors among teens in Texas, providing sobering evidence that Texas continues to have poorer outcomes than much of the nation. Together, their piece provides both a state and national clarion call that frames the rest of the journal.
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The Continuing Use of Problematic Sexual Stereotypes in Judicial Decision-Making

The Continuing Use of Problematic Sexual Stereotypes in Judicial Decision-Making

depending on the type of complainant, being firm with “a tarty little number with a mini-skirt around her neck who‟s brassy and will give as good as she gets” (2000, p. 230) and sympathetic and gentle with “some little mouse … because you‟ll get more out of her” (2000, p. 230). Most, if not all, members of the English and Welsh legal system are aware that they might be criticised if they do not at least appear to be „politically correct‟, but the barristers in Temkin‟s study still felt that they could pursue „politically incorrect‟ courtroom tactics. 65 This article has argued that, like the barristers in Temkin‟s study, certain senior judges in this jurisdiction are still willing to openly employ questionable sexual stereotypes in their judgments notwithstanding the pressure on them to at least appear to be „politically correct‟ and the guidance on this issue from the JSB. The open use of these sexual stereotypes may indicate that feminism still needs to make more progress in the English and Welsh legal system: if certain senior judges are still willing to openly employ questionable sexual stereotypes in their judgments or reluctant to challenge the use of these stereotypes, there may be many more judges who are willing to covertly use these sexual stereotypes in their legal decision-making. It would be a mistake to assume that English and Welsh law no longer features the use of obvious sexual stereotypes except in certain isolated areas, such as rape cases: as this article has shown, the judicial use of such stereotypes still occurs in a variety of areas, such as the law on section 47 of the Offences against the Person Act 1861 and the law dealing with claims arising from workplace stress. Unfortunately, the solution to this problem is not straightforward: employing more women as senior judges is not necessarily the
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Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy

Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy

It is important to recognize that these results were achieved with two theoretically distinct therapies both delivered in a standard service format (i.e. weekly, office- based psychotherapy) and not as part of a comprehensive treatment program. The fact that improvement in sub- stance use was found in two treatments, fairly modest in duration and dose, is an important indicator of the promise of CBT and especially MDFT in adolescent drug abuse treatment. Although the data show efficacy, clearly there is room for improvement and treatment develop- ment. For example, the success of comprehensive treat- ments [38], family preservation service delivery models [39] and well-organized case management and other aftercare services [40] suggests that even more gains might be achieved by integrating the psychotherapeutic models tested here with specific ingredients such as a team-based intervention framework; a systematic and fully comprehensive focus on social–ecological influ- ences, particularly schools and juvenile justice; integrat- ing case management activities into the treatments; service delivery format of home-based therapy sessions delivered more than once per week; and low case-loads [18,19]. The results also suggest that interventions incor- porating principles of both family therapy and CBT might lead to improved outcomes [6,9] as well (note that MDFT includes a significant component of work focusing upon the individual adolescent in both individual and family sessions).
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Transgender Adolescent Suicide Behavior

Transgender Adolescent Suicide Behavior

our estimations of past suicide behavior might be underestimated. Future longitudinal work is needed to examine subgroup differences in suicide behaviors among transgender adolescents by using multiple indices of suicidality. Given that data for this study were last collected in 2015, it is critical to examine whether the rates documented in this study have remained stable, increased, or decreased. Additionally, although the study was national in scope, it was not nationally representative, and it is unlikely that the participants were representative of the larger transgender adolescent population. Compared with national statistics, adolescents who are white, non- Latino, Asian American, and multiracial and/or of multiple ethnicities were overrepresented in our sample, whereas Hispanic or Latino and black or African American adolescents were
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Driving Safety and Adolescent Behavior

Driving Safety and Adolescent Behavior

Subsequent studies have strongly suggested that the number of nighttime fatal motor vehicle accidents has been reduced in states that raised the legal drinking age.8’9 In Michigan, the d[r]

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Care of the Adolescent After an Acute Sexual Assault

Care of the Adolescent After an Acute Sexual Assault

also need to be able to identify and avoid high-risk situations, including attending parties or social activities with unknown people, meeting strangers with whom they have had contact on the Internet, walking alone at night, allowing themselves to be photographed nude or in sexually explicit poses or situations, or sexting. Teenagers should be advised that if they ever are assaulted, they should seek medical care immediately. Factors that may increase the likelihood of assaults (eg, use of drugs or alcohol) and strategies to prevent sexual assaults (eg, “buddying up, ” not drinking from a vessel that has been left unattended, abstaining from or moderating alcohol intake, and not accepting drinks from strangers) can be discussed, and associated educational materials can be made available and distributed by pediatricians, particularly during the adolescent years and at the precollege visit. 134– 136 College health
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Male Adolescent Sexual and Reproductive Health Care

Male Adolescent Sexual and Reproductive Health Care

perience of sexual abuse. Assess for comfort with changes in one’s body, masturbation, knowledge about how to use a condom correctly, hormonal contraception methods, and emer- gency contraception. Among sexually experienced males, assess pressure to have sex, access to condoms, use of alcohol or other substances when hav- ing sex, experience of pregnancy or fa- therhood, experience of being a perpe- trator or victim of verbal/physical abuse or force to have sex in a relation- ship, whether sex is pleasurable, and/or problems with sexual perfor- mance. Among patients who state a high number of partners or are hesi- tant to share their number of partners, consider and ask about whether they are exchanging sex for money or drugs. Among non–sexually active young men, assess for dating, pres- sure or plans to initiate sex, and knowl- edge about ways of preventing STIs/ HIV and pregnancy. During childhood, encourage and provide resources to parents and families to have develop- mentally appropriate conversations with their sons that continue through adolescence about sexuality, sex, and other sensitive topics. 37
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Adolescent Bystander Perceptions of Sexual Violence Scenarios

Adolescent Bystander Perceptions of Sexual Violence Scenarios

Sexual violence in Canada continues to be an ongoing concern. In 2008, over 13,600 sexual assaults of youth under the age of 18 were reported to police, with 82% of victims being female (Statistics Canada, 2008). Due to the gender specificity of the crimes, most rape prevention specialists are now opposed to focusing on risk reduction strategies for women since this model risks placing the responsibility and blame on victims (Rozee & Koss, 2001). As a result, the focus of violence prevention has shifted to the “bystanders”, a term that describes any person who is present in an act of harassment, abuse, or violence but is neither the perpetrator nor the victim (Katz, Heisterkamp, & Fleming, 2011). As these individuals can potentially interrupt or prevent violence, many prevention programs such as the Mentors in Violence Prevention Program (MVP) are being recognized around the world (Katz, 1995). The MVP program utilizes realistic scenario questions and group discussion to facilitate awareness, and has been implemented in many schools, athletic organizations, and even military bases in the United States (Katz et al., 2011). By building on this foundational work, there exists the potential of preventing sexual assaults at an even earlier age if
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Adolescent Sexual Aggression: Risk and Protective Factors

Adolescent Sexual Aggression: Risk and Protective Factors

Students reporting perpetration of sexual violence were com- pared with those who indicated that they had never forced some- one into a sexual act. The independent variables examined fell into 9 categories: 1) demographic characteristics (school grade classi- fied as 9th or 12th, ethnicity classified as white, black, Hispanic, American Indian, Asian American, or other/mixed race, and fam- ily structure defined as one- or two-parent families or other situ- ations); 2) family substance use problems (family alcohol prob- lems and family drug problems); 3) family violence (victim of physical abuse and witnessing physical abuse in the family); 4) sexual abuse (intrafamilial and extrafamilial); 5) substance use (alcohol use frequency, illegal substance use frequency, anabolic steroid use during the past year); 6) emotional status (self-esteem, emotional health, suicide risk); 7) caring and connectedness (feel- ings about family interactions, community connectedness); 8) ac- ademic performance (usual grades received); and 9) activities (gang involvement and hours per week spent “hanging out”). Of the 20 factors examined, 14 were measured by a single survey question and 6 by a scale. None of the questions used had more than 6.5% missing data, and all but four of the questions had less than 2.5% missing data.
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Adolescent and caregivers’ experiences of electronic adherence assessment in paediatric problematic severe asthma

Adolescent and caregivers’ experiences of electronic adherence assessment in paediatric problematic severe asthma

The EMD was experienced by some as a form of health surveillance which undermined young people's and caregivers’ confidence in taking responsibility for medication use with potentially problematic long-term consequences for disease management. Viewed in this light the EMD forms part of wider advances in medical technology that enable clinicians to monitor the degree to which patients adhere to treatment regimes and protocols and indeed the increasing use of technology to monitor fitness and physiological parameters more generally, such as Fitbit and the Apple Watch. Use of such technology has raised important issues linked with privacy and autonomy (e.g. Levy, 2014) and connects with more widespread concerns about the
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Parenting perspective on the psychosocial correlates of adolescent sexual and reproductive health behavior among high school adolescents in Ethiopia

Parenting perspective on the psychosocial correlates of adolescent sexual and reproductive health behavior among high school adolescents in Ethiopia

While parents and families are a crucial part of the so- cial environment in which adolescents live, learn and earn, they could play important roles in the healthy de- velopment of adolescents [16 – 18]. However, the parent- ing challenge of adolescence is to offer opportunities for adolescents to develop and practice autonomy while providing protection from danger and the consequences of poor decisions [18]. Identifying parental variables pre- dictive of adolescents ’ behavioural outcomes has been of greatest interest to researchers. Parenting style is typic- ally defined by level of parental warmth and control with four key parenting styles have been distin- guished: authoritarian parents (strict control without being supportive); permissive/ indulgent parents (high support in the absence of strict control); neg- lectful/ uninvolved parents (neither supportive nor controlling); authoritative parents (high support and strict control). The research on parenting practices as they relate to adolescent behavioural outcomes has focused on several important parenting con- structs including, but not limited to, parental moni- toring; and parent-child communications [18].
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Parental Behavior of Adolescent Mothers

Parental Behavior of Adolescent Mothers

The results of multiple studies suggest that young maternal age has an adverse effect on infant cog- nitive development.7377 In a study of 48,193 eleven- year-old children, Record and as[r]

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