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

Trials

Rachel Haley⁶  James Wason¹  Sarah Byford⁵  Abdullah Kraam⁷  Peter Fuggle⁸  Ivan Eisler²  Stephen Pilling⁶  Stephen Scott²  David Cottrell³  Ian Goodyer⁴  Stephen Butler⁶  Peter Fonagy⁶ 

[1] MRC Biostatistics Unit, University of Cambridge, Cambridge, UK;Institute of Psychiatry, King’s College London, London, UK;Leeds Institute of Health Sciences, University of Leeds, Leeds, UK;Department of Psychiatry, University of Cambridge, Cambridge, UK;Centre for the Economics of Mental Health, Institute of Psychiatry, King’s College London, London, UK;Research Department of Clinical, Educational and Health Psychology, University College London, London, UK;University of Leeds and South West Yorkshire Partnership NHS Mental Health Trust, Leeds, UK;Islington Child and Adolescent Mental Health Services, London, UK

关键词: Youth;    United Kingdom;    Randomised controlled trial;    Multisystemic therapy;    Family;    Conduct disorder;    Antisocial behaviour;    Adolescent;   

Others  :  1093203
DOI  :  10.1186/1745-6215-14-265

 received in 2013-02-08, accepted in 2013-08-05,  发布年份 2013

【 摘 要 】

Background

There is an urgent need for clinically effective and cost-effective methods to manage antisocial and criminal behaviour in adolescents. Youth conduct disorder is increasingly prevalent in the UK and is associated with a range of negative outcomes. Quantitative systematic reviews carried out for the National Institute for Health and Clinical Excellence have identified multisystemic therapy, an intensive, multimodal, home-based, family intervention for youth with serious antisocial behaviour, as one of the most promising interventions for reducing antisocial or offending behaviour and improving individual and family functioning. Previous international trials of multisystemic therapy have yielded mixed outcomes, and it is questionable to what extent positive US findings can be generalised to a wider UK mental health and juvenile justice context. This paper describes the protocol for the Systemic Therapy for At Risk Teens (START) trial, a multicentre UK-wide randomised controlled trial of multisystemic therapy in antisocial adolescents at high risk of out-of-home placement.

Methods/Design

The trial is being conducted at 10 sites across the UK. Seven hundred participants and their families will be recruited and randomised on a 1:1 basis to multisystemic therapy or management as usual. Treatments are offered over a period of 3 to 5 months, with follow-up to 18 months post-randomisation. The primary outcome is out-of-home placement at 18 months. Secondary outcomes include offending rates, total service and criminal justice sector costs, and participant well-being and educational outcomes. Data will be gathered from police computer records, the National Pupil Database, and interview and self-report measures administered to adolescents, parents and teachers. Outcomes will be analysed on an intention-to-treat basis, using a logistic regression with random effects for the primary outcome and Cox regressions and linear mixed-effects models for secondary outcomes depending on whether the outcome is time-to-event or continuous.

Discussion

The START trial is a pragmatic national trial of sufficient size to evaluate multisystemic therapy, to inform policymakers, service commissioners, professionals, service users and their families about its potential in the UK. It will also provide data on the clinical and cost-effectiveness of usual services provided to youth with serious antisocial behaviour problems.

Trial registration

ISRCTN77132214

【 授权许可】

   
2013 Fonagy et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Henggeler SW, Borduin CM: Family Therapy and Beyond: A Multisystermic Approach to Treating the Behavior Problems of Children and Adolescents. Pacific Grove, CA: Brooks/Cole; 1990.
• [2]National Institute for Health and Clinical Excellence: Conduct Disorders and Antisocial Behaviour in Children and Young People: Recognition, Intervention and Management. London, UK: The British Psychological Society and The Royal College of Psychiatrists; 2013.
• [3]Riots Communities and Victims Panel: After the Riots: The Final Report of the Riots Communities and Victims Panel. London, UK: Riots Communities and Victims Panel; 2012.
• [4]Roe S, Ashe J: Young People and Crime: Findings from the 2006 Offending, Crime and Justice Survey. Home Office Statistical Bulletin 09/08. London, UK: Home Office; 2008.
• [5]Taylor TK, Biglan A: Behavioral family interventions for improving child-rearing: a review of the literature for clinicians and policy makers. Clin Child Fam Psychol Rev 1998, 1:41-60.
• [6]Hill J, Maughan B: Conduct Disorders in Childhood and Adolescence. New York, NY: Cambridge University Press; 2001.
• [7]Scott S, Knapp M, Henderson J, Maughan B: Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 2001, 323:191-194.
• [8]Loeber R, Farrington DP, Waschbusch DA: Serious and violent juvenile offenders. In Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions. Edited by Loeber R, Farrington DP. Thousand Oaks, CA: Sage Publications; 1998:13-29.
• [9]Welsh BC, Loeber R, Stevens BR, Stouthamer-Loeber M, Cohen MA, Farrington DP: Costs of juvenile crime in urban areas: a longitudinal perspective. Youth Violence Juv Justice 2008, 6:3-27.
• [10]Lahey BB, Pelham WE, Loney J, Lee SS, Willcutt E: Instability of the DSM-IV subtypes of ADHD from preschool through elementary school. Arch Gen Psychiatry 2005, 62:896-902.
• [11]Loeber R, Burke J, Pardini DA: Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. J Child Psychol Psychiatry 2009, 50:133-142.
• [12]Laub JH, Vaillant GE: Delinquency and mortality: a 50-year follow-up study of 1,000 delinquent and nondelinquent boys. Am J Psychiatry 2000, 157:96-102.
• [13]Colman I, Murray J, Abbott RA, Maughan B, Kuh D, Croudace TJ, Jones PB: Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 2009, 338:a2981.
• [14]Fergusson DM, Horwood LJ, Ridder EM: Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry 2005, 46:837-849.
• [15]Keenan K, Wakschlag LS: More than the terrible twos: the nature and severity of behavior problems in clinic-referred preschool children. J Abnorm Child Psychol 2000, 28:33-46.
• [16]Nock MK, Kazdin AE, Hiripi E, Kessler RC: Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol Med 2006, 36:699-710.
• [17]Collishaw S, Maughan B, Goodman R, Pickles A: Time trends in adolescent mental health. J Child Psychol Psychiatry 2004, 45:1350-1362.
• [18]Côté SM, Vaillancourt T, LeBlanc JC, Nagin DS, Tremblay RE: The development of physical aggression from toddlerhood to pre-adolescence: a nation wide longitudinal study of Canadian children. J Abnorm Child Psychol 2006, 34:71-85.
• [19]Fontaine N, Carbonneau R, Barker ED, Vitaro F, Hebert M, Cote SM, Nagin DS, Zoccolillo M, Tremblay RE: Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood: a 15-year longitudinal study. Arch Gen Psychiatry 2008, 65:320-328.
• [20]Perdikouri M, Rathbone G, Huband N, Duggan C: A comparison of adults with antisocial personality traits with and without childhood conduct disorder. Ann Clin Psychiatry 2007, 19:17-23.
• [21]Nock MK, Kazdin AE, Hiripi E, Kessler RC: Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry 2007, 48:703-713.
• [22]Burke JD, Loeber R, Lahey BB: Adolescent conduct disorder and interpersonal callousness as predictors of psychopathy in young adults. J Clin Child Adolesc Psychol 2007, 36:334-346.
• [23]Foster EM, Jones DE: The high costs of aggression: public expenditures resulting from conduct disorder. Am J Public Health 2005, 95:1767-1772.
• [24]Henggeler SW, Choenwald SK, Borduin CM, Rowland MD, Cunningham PB: Multisystemic Treatment of Antisocial Behavior in Children and Adolescents. New York, NY: Guilford Press; 1998.
• [25]Farrington DP: Conduct disorder, aggression and delinquency. In Handbook of Adolescent Psychology. Edited by Lerner RM, Steinberg L. New York, NY: John Wiley & Sons; 2003.
• [26]Bronfenbrenner U: The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press; 1979.
• [27]Loeber R, Farrington DP, Stouthamer-Loeber M, van Kammen WB: Antisocial Behaviour and Mental Health Problems: Explanatory Factors in Childhood and Adolescence. Mahwah, NJ: Lawrence Erlbaum; 1998.
• [28]Thornberry TP, Krohn MD (Eds): Taking Stock of Delinquency: An Overview of Findings from Contemporary Longitudinal Studies. New York, NY: Kluwer Academic/Plenum Publishers; 2003.
• [29]Lipsey MW, Derzon JH: Predictors of serious delinquency in adolescence and early adulthood: a synthesis of longitudinal research. In Serious and Violent Offenders: Risk Factors and Successful Interventions. Edited by Loeber R, Farrington DP. Thousand Oaks, CA: Sage Publications; 1998:86-105.
• [30]National Institute for Health and Clinical Excellence: Antisocial Personality Disorder: Treatment, Management and Prevention. London, UK: The British Psychological Society and the Royal College of Psychiatrists; 2010.
• [31]Curtis NM, Ronan KR, Borduin CM: Multisystemic treatment: a meta-analysis of outcome studies. J Fam Psychol 2004, 18:411-419.
• [32]Schaeffer CM, Borduin CM: Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders. J Consult Clin Psychol 2005, 73:445-453.
• [33]Borduin CM, Mann BJ, Cone LT, Henggeler SW, Fucci BR, Blaske DM, Williams RA: Multisystemic treatment of serious juvenile offenders: long-term prevention of criminality and violence. J Consult Clin Psychol 1995, 63:569-578.
• [34]Henggeler SW, Melton GB, Smith LA: Family preservation using multisystemic therapy: an effective alternative to incarcerating serious juvenile offenders. J Consult Clin Psychol 1992, 60:953-961.
• [35]Henggeler SW, Melton GB, Brondino MJ, Scherer DG, Hanley JH: Multisystemic therapy with violent and chronic juvenile offenders and their families: the role of treatment fidelity in successful dissemination. J Consult Clin Psychol 1997, 65:821-833.
• [36]Henggeler SW, Halliday-Boykins CA, Cunningham PB, Randall J, Shapiro SB, Chapman JE: Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. J Consult Clin Psychol 2006, 74:42-54.
• [37]Ogden T, Hagen KA: Multisystemic treatment of serious behaviour problems in youth: sustainability of effectiveness two years after intake. Child Adolesc Ment Health 2006, 11:142-149.
• [38]Curtis NM, Ronan KR, Heiblum N, Crellin K: Dissemination and effectiveness of multisystemic treatment in New Zealand: a benchmarking study. J Fam Psychol 2009, 23:119-129.
• [39]Sundell K, Hansson K, Lofholm CA, Olsson T, Gustle LH, Kadesjo C: The transportability of multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths. J Fam Psychol 2008, 22:550-560.
• [40]Olsson TME: Intervening in youth problem behaviour in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth. Int J Soc Welf 2010, 19:194-205.
• [41]Olsson TME: MST with conduct disordered youth in Sweden: costs and benefits after 2 years. Res Soc Work Pract 2010, 20:561-571.
• [42]Leschied AW, Cunningham A: Seeking Effective Interventions for Serious Young Offenders: Interim Results of a Four-year Randomized Study of Multisystemic Therapy in Ontario, Canada. London, Canada: Centre for Children and Families in the Justice System; 2002.
• [43]Borduin C, Schaeffer C: Multisystemic treatment of juvenile sexual offenders: a progress report. J Psychol Hum Sex 2001, 13:25-42.
• [44]Butler S, Baruch G, Hickey N, Fonagy P: A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. J Am Acad Child Adolesc Psychiatry 2011, 50:1220-1235. e1222
• [45]Ogden T, Halliday-Boykins CA: Multisystemic treatment of antisocial adolescents in Norway: replication of clinical outcomes outside of the US. Child Adolesc Ment Health 2004, 9:77-83.
• [46]Rowland MD, Halliday-Boykins CA, Henggeler SW, Cunningham PB, Lee TG, Kruesi MJP, Shapiro SB: A randomized trial of multisystemic therapy with Hawaii’s Felix Class Youths. J Emot Behav Disord 2005, 13:13-23.
• [47]Letourneau EJ, Henggeler SW, Borduin CM, Schewe PA, McCart MR, Chapman JE, Saldana L: Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. J Fam Psychol 2009, 23:89-102.
• [48]Henggeler SW, Pickrel SG, Brondino MJ: Multisystemic treatment of substance-abusing and dependent delinquents: outcomes, treatment fidelity, and transportability. Ment Health Serv Res 1999, 1:171-184.
• [49]Timmons-Mitchell J, Bender MB, Kishna MA, Mitchell CC: An independent effectiveness trial of multisystemic therapy with juvenile justice youth. J Clin Child Adolesc Psychol 2006, 35:227-236.
• [50]Huey SJ Jr, Henggeler SW, Brondino MJ, Pickrel SG: Mechanisms of change in multisystemic therapy: reducing delinquent behavior through therapist adherence and improved family and peer functioning. J Consult Clin Psychol 2000, 68:451-467.
• [51]Patterson GR, Crosby L, Vuchinich S: Predicting risk for early police arrest. J Quant Criminol 1992, 8:335-355.
• [52]Patterson GR, Forgatch MS, Yoerger KL, Stoolmiller M: Variables that initiate and maintain an early-onset trajectory for juvenile offending. Dev Psychopathol 1998, 10:531-547.
• [53]Loeber R, Green SM, Keenan K, Lahey BB: Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. J Am Acad Child Adolesc Psychiatry 1995, 34:499-509.
• [54]Piatigorsky A, Hinshaw SP: Psychopathic traits in boys with and without attention-deficit/hyperactivity disorder: concurrent and longitudinal correlates. J Abnorm Child Psychol 2004, 32:535-550.
• [55]Frick PJ, Cornell AH, Barry CT, Bodin SD, Dane HE: Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. J Abnorm Child Psychol 2003, 31:457-470.
• [56]Lynam DR: Pursuing the psychopath: capturing the fledgling psychopath in a nomological net. J Abnorm Psychol 1997, 106:425-438.
• [57]Caputo AA, Frick PJ, Brodsky SL: Family violence and juvenile sex offending: the potential mediating role of psychopathic traits and negative attitudes toward women. Crim Justice Behav 1999, 26:338-356.
• [58]Kruh IP, Frick PJ, Clements CB: Historical and personality correlates to the violence patterns of juveniles tried as adults. Crim Justice Behav 2005, 32:69-96.
• [59]Marsee MA, Silverthorn P, Frick PJ: The association of psychopathic traits with aggression and delinquency in non-referred boys and girls. Behav Sci Law 2005, 23:803-817.
• [60]Ogden T, Amlund Hagen K: What works for whom? Gender differences in intake characteristics and treatment outcomes following multisystemic therapy. J Adolesc 2009, 32:1425-1435.
• [61]Henggeler SW, Schoenwald SK, Borduin CM, Rowland MD, Cunningham PB: Multisystemic Treatment of Antisocial Behaviour in Children and Adolescents. New York, NY: Guilford Press; 1998.
• [62]Schoenwald SK: From policy pinball to purposeful partnership: the policy contexts of multisystemic therapy transport and dissemination. In Evidence-based Psychotherapies for Children and Adolescents. Edited by Kazdin AE, Weisz JR. New York, NY: Guilford Press; 2010:538-553.
• [63]Strother KB, Swenson ME, Schoenwald SK: Multisystemic Therapy Organizational Manual. Charleston, SC: MST Institute; 1998.
• [64]Chitsabesan P, Kroll L, Bailey S, Kenning C, Sneider S, MacDonald W, Theodosiou L: Mental health needs of young offenders in custody and in the community. Br J Psychiatry 2006, 188:534-540.
• [65]Cary M, Butler S, Baruch G, Hickey N, Byford S: Economic evaluation of multisystemic therapy for young people at risk for continuing criminal activity in the UK. PLos One 2013, 8:e61070.
• [66]Youth Justice Board: Key Elements of Effective Practice: Intensive Supervision and Surveillance Programmes. London, UK: HMSO; 2004.
• [67]Mann BJ, Borduin CM, Henggeler SW, Blaske DM: An investigation of systemic conceptualizations of parent–child coalitions and symptom change. J Consult Clin Psychol 1990, 58:336-344.
• [68]Henggeler SW, Rodick J, Borduin CM, Hanson C, Watson S, Urey J: Multisystemic treatment of juvenile offenders: effects on adolescent behavior and family interaction. Dev Psychol 1986, 22:132-141.
• [69]Henggeler SW, Letourneau EJ, Chapman JE, Borduin CM, Schewe PA, McCart MR: Mediators of change for multisystemic therapy with juvenile sexual offenders. J Consult Clin Psychol 2009, 77:451-462.
• [70]Goodman R: Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful? J Abnorm Child Psychol 1999, 27:17-24.
• [71]Conners CK: Conners’ Rating Scales-Revised: Technical manual. Toronto, Canada: Multi-Health Systems; 1995.
• [72]Messer SC, Angold A, Costello EJ, Loeber R, Van Kammen W, Stouthamer-Loeber M: Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: Factor composition and structure across development. Int J Methods Psychiatr Res 1995, 5:251-262.
• [73]Smith DJ, McVie S: Theory and method in the Edinburgh study of youth transitions and crime. Br J Criminol 2003, 43:169-195.
• [74]Butler SM, Leschied AW, Fearon P: Antisocial beliefs and attitudes in pre-adolescent and adolescent youth: the development of the antisocial beliefs and attitudes scales (ABAS). J Youth Adolesc 2007, 36:1058-1071.
• [75]Olson D: FACES IV and the Circumplex Model: validation study. J Marital Fam Ther 2011, 37:64-80.
• [76]Scott S, Briskman J, Dadds MR: Measuring parenting in community and public health research using brief child and parent reports. J Child Fam Stud 2011, 20:343-352.
• [77]Jaffee SR, Moffitt TE, Caspi A, Taylor A, Arseneault L: Influence of adult domestic violence on children’s internalizing and externalizing problems: an environmentally informative twin study. J Am Acad Child Adolesc Psychiatry 2002, 41:1095-1103.
• [78]Gerlsma C, Hale WW 3rd: Predictive power and construct validity of the Level of Expressed Emotion (LEE) scale. Depressed out-patients and couples from the general community. Br J Psychiatry 1997, 170:520-525.
• [79]Hale WW 3rd, Raaijmakers QAW, Gerlsma C, Meeus W: Does the Level of Expressed Emotion (LEE) questionnaire have the same factor structure for adolescents as it has for adults? Soc Psychiatry Psychiatr Epidemiol 2007, 42:215-220.
• [80]Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C: The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997, 27:191-197.
• [81]Wechsler D: Weschler Abbreviated Scale of Intelligence Manual. San Antonio, TX: Psychological Corporation; 1999.
• [82]Goodman R, Ford T, Richards H, Gatward R, Meltzer H: The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 2000, 41:645-655.
• [83]Barrett B, Byford S, Chitsabesan P, Kenning C: Mental health provision for young offenders: service use and cost. Br J Psychiatry 2006, 188:541-546.
• [84]Byford S, Barratt B, Roberts C, Wilkinson P, Dubika B, Kelvin RG, White L, Ford C, Breen S, Goodyer I: Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive-behavioural therapy in adolescents with major depression. Br J Psychiatry 2007, 191:521-527.
• [85]Clark A, O’Malley A, Woodham A, Barrett B, Byford S: Children with complex mental health problems: needs, costs and predictors over one year. Child Adolesc Ment Health 2005, 10:170-178.
• [86]Harrington R, Peters S, Green J, Byford S, Woods J, McGowan R: Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders. BMJ 2000, 321:1047-1050.
• [87]Beecham JK, Knapp MRJ: Costing psychiatric options. In Measuring Mental Health Needs. Edited by Thornicroft G, Brewin C, Wing J. Oxford, UK: Oxford University Press; 1992.
• [88]Drummond MF, O’Brien B, Stoddart GL: Methods for the Evaluation of Health Care Programmes. Oxford, UK: Oxford University Press; 1997.
• [89]Schoenwald SK, Sheidow AJ, Letourneau EJ, Liao JG: Transportability of multisystemic therapy: evidence for multilevel influences. Ment Health Serv Res 2003, 5:223-239.
• [90]Schoenwald SK, Sheidow AJ, Chapman JE: Clinical supervision in treatment transport: effects on adherence and outcomes. J Consult Clin Psychol 2009, 77:410-421.
• [91]Schoenwald SK, Chapman JE, Sheidow AJ, Carter RE: Long-term youth criminal outcomes in MST transport: the impact of therapist adherence and organizational climate and structure. J Clin Child Adolesc Psychol 2009, 38:91-105.
• [92]Gretton HM, Hare RD, Catchpole RE: Psychopathy and offending from adolescence to adulthood: a 10-year follow-up. J Consult Clin Psychol 2004, 72:636-645.
• [93]Hawes DJ, Dadds MR: The treatment of conduct problems in children with callous-unemotional traits. J Consult Clin Psychol 2005, 73:737-741.
• [94]Hinshaw SP: Psychosocial intervention for childhood ADHD: etiologic and developmental themes, comorbidity, and integration with pharmacotherapy. In Rochester Symposium on Developmental Psychopathology. Volume 9: Developmental approaches to prevention and intervention. Edited by Cicchetti D, Toth SL. Rochester, NY: University of Rochester Press; 1999:221-270.
• [95]Beauchaine TP, Hinshaw SP, Pang KL: Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: biological, environmental, and developmental mechanisms. Clin Psychol Sci Pract 2010, 17:327-336.
• [96]Essau CA, Sasagawa S, Frick PJ: Callous-unemotional traits in a community sample of adolescents. Assessment 2006, 13:454-469.
• [97]Schoenwald SK, Chapman JE, Henry DB, Sheidow AJ: Taking effective treatments to scale: organizational effects on outcomes of multisystemic therapy for youth with co-occurring substance use. J Child Adolesc Subst Abuse 2012, 21:1-31.
• [98]Killaspy H, Bebbington P, Blizard R, Johnson S, Nolan F, Pilling S, King M: The REACT study: randomised evaluation of assertive community treatment in north London. BMJ 2006, 332:815-820.
• [99]Hawes DJ, Dadds MR: Assessing parenting practices through parent-report and direct observation during parent-training. J Child Fam Stud 2006, 15:555-568.
• [100]Tighe A, Pistrang N, Casdagli L, Baruch G, Butler S: Multisystemic therapy for young offenders: families’ experiences of therapeutic processes and outcomes. J Fam Psychol 2012, 26:187-197.
• [101]Ritchie J, Spencer E: Qualitative data analysis for applied policy research. In Analyzing Qualitative Data. Edited by Bryman A, Burgess RG. London, UK: Routledge; 1994.
• [102]Roberts C: The implications of variation in outcome between health professionals for the design and analysis of randomized controlled trials. Stat Med 1999, 18:2605-2615.
• [103]Halliday-Boykins CA, Schoenwald SK, Letourneau EJ: Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. J Consult Clin Psychol 2005, 73:808-818.
• [104]Chapman JE, Schoenwald SK: Ethnic similarity, therapist adherence, and long-term multisystemic therapy outcomes. J Emot Behav Disord 2010, 19:3-16.
• [105]Grimbos T, Granic I: Changes in maternal depression are associated with MST outcomes for adolescents with co-occurring externalizing and internalizing problems. J Adolesc 2009, 32:1415-1423.