Being “SMART” About Adolescent Conduct Problems Prevention: Executing a SMART Pilot Study in a Juvenile Diversion Agency

August, Gerald J.; Piehler, Timothy F.; Bloomquist, Michael L.

doi:10.1080/15374416.2014.945212

Cited by 25 publications

(21 citation statements)

References 41 publications

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“…August, Piehler, and Bloomquist (2014) present the design and rationale of a SMART pilot study to examine feasibility and acceptability considerations in the development of an adaptive preventive intervention for youth (ages 13–17) identified by law enforcement as early stage offenders and referred to pre-court juvenile diversion programming. The goal of the adaptive interventions is to prevent subsequent conduct disorder or substance use disorder.…”

Section: Overview Of the Articles In The Special Issuementioning

confidence: 99%

Adaptive Interventions in Child and Adolescent Mental Health

Almirall

Chronis‐Tuscano

2016

Journal of Clinical Child & Adolescent Psychology

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The treatment or prevention of child and adolescent mental health (CAMH) disorders often requires an individualized, sequential approach to intervention, whereby treatments (or prevention efforts) are adapted over time based on the youth’s evolving status (e.g., early response, adherence). Adaptive interventions are intended to provide a replicable guide for the provision of individualized sequences of interventions in actual clinical practice. Recently, there has been great interest in the development of adaptive interventions by investigators working in CAMH. The development of such replicable, real-world, individualized, sequences of decision rules to guide the treatment or prevention of CAMH disorders represents an important “next step” in interventions research. The primary purpose of this special issue is to showcase some recent work on the science of adaptive interventions in CAMH. In this overview article, we review why individualized sequences of interventions are needed in CAMH, provide an introduction to adaptive interventions, briefly describe each of the articles included in this special issue, and describe some exciting areas of ongoing and future research. A hopeful outcome of this special issue is that it encourages other researchers in CAMH to pursue creative and significant research on adaptive interventions.

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Section: Overview Of the Articles In The Special Issuementioning

confidence: 99%

Adaptive Interventions in Child and Adolescent Mental Health

Almirall

Chronis‐Tuscano

2016

Journal of Clinical Child & Adolescent Psychology

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“…Unfortunately, programs of this ilk are often costly to deliver, participation and completion rates are generally poor, and modest effect sizes have been reported on key outcomes with considerable variability in individual response [8]. To address these limitations, some prevention scientists have called for Bpersonalized^ap-proaches [9][10][11][12][13]. Personalized health care (i.e., personalized medicine, precision medicine) uses an individual's unique characteristics (genetic profiles, biomarkers, environmental exposures) to make decisions regarding the best intervention strategy for an individual [14].…”

Section: Discussionmentioning

confidence: 99%

Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective

Thibodeau

August

Cicchetti

et al. 2015

Behav. Med. Pract. Policy Res.

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Preventive interventions that target high-risk youth, via one-size-fits-all approaches, have demonstrated modest effects in reducing rates of substance use. Recently, substance use researchers have recommended personalized intervention strategies. Central to these approaches is matching preventatives to characteristics of an individual that have been shown to predict outcomes. One compelling body of literature on person × environment interactions is that of environmental sensitivity theories, including differential susceptibility theory and vantage sensitivity. Recent experimental evidence has demonstrated that environmental sensitivity (ES) factors moderate substance abuse outcomes. We propose that ES factors may augment current personalization strategies such as matching based on risk factors/severity of problem behaviors (risk severity (RS)). Specifically, individuals most sensitive to environmental influence may be those most responsive to intervention in general and thus need only a brief-type or lower-intensity program to show gains, while those least sensitive may require more comprehensive or intensive programming for optimal responsiveness. We provide an example from ongoing research to illustrate how ES factors can be incorporated into prevention trials aimed at high-risk adolescents. Keywords Substance use, Prevention, Environmental sensitivity, R i s k s e v e r i t y, D i ff e r e n t i a l s u s c e p t i b i l i t y, PersonalizationAlcohol and other drug use among adolescents is a serious public health concern in the USA. For example, by late adolescence, over 78 % of teens will have experimented with alcohol, over 47 % will be engaged in regular drinking habits, and over 14 % will have met criteria for lifetime abuse [1]. Despite herculean efforts over the previous five decades to stem the rising tide of substance use, treatment approaches (largely based on behavioral parent training and cognitive behavioral therapy principles) have been modest at best; there is considerable variability in outcomes, and no one model works similarly for all youth [2]. Even among those who experience initial success following treatment, relapse rates are high [3].

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“…Before and during the trial it would be important to meet with stakeholders (e.g., focus groups with parents, teachers, administrators) to tailor the interventions to what would be acceptable for all individuals involved. August et al, 2014 discuss establishing buy-in in the community through the creation of a steering committee with monthly meetings, education and training sessions for agency and research staff, and a pre-pilot study with a small sample of individuals to refine the protocol and gain experience. If intervention implementation is of great concern, a pilot SMART is an excellent approach to gain buy-in, develop fidelity, address feasibility concerns and refine components of the trial (Almirall, Compton, Gunlicks-Stoessel, Duan, & Murphy, 2012).…”

Section: Challenges Of a Smart Designmentioning

confidence: 99%

“…However, the application of AIs is broad in that they can guide any approach that includes two or more interventions used in sequence when subsequent intervention depends on response to the previous intervention or the ordering of interventions may affect overall effectiveness. For example, AIs have also been applied to guide the effective use of a judicial supervision system for drug-abusing defenders (Marlowe, Festinger, Dugosh, Lee, & Benasutti, 2007), effective interventions for weight loss (Almirall, Nahum-Shani, Sherwood, & Murphy, 2014), the timing and type of programs used to prevent adolescent conduct problems (August, Piehler, & Bloomquist, 2014), and the implementation of a mood disorder program in outpatient clinics(Kilbourne et al, 2014). …”

mentioning

confidence: 99%

“…SMARTs have been implemented in a community or classroom setting (August et al, 2014; Kasari et al, 2014; Pelham & Fabiano, 2008), but continue to be lesser known and applied in education and community settings than in the health sciences. Thus, we use the backdrop of a Head Start program to illustrate how a hypothetical SMART could be implemented in a community or education-based structure that might be involved in evaluation efforts.…”

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confidence: 99%

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Adaptive Interventions and SMART Designs

Kidwell

Hyde

2016

American Journal of Evaluation

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Heterogeneity between and within people necessitates the need for sequential personalized interventions to optimize individual outcomes. Personalized or adaptive interventions (AIs) are relevant for diseases and maladaptive behavioral trajectories when one intervention is not curative and success of a subsequent intervention may depend on individual characteristics or response. AIs may be applied to medical settings and to investigate best prevention, education, and community-based practices. AIs can begin with low-cost or low-burden interventions and followed with intensified or alternative interventions for those who need it most. AIs that guide practice over the course of a disease, program, or school year can be investigated through sequential multiple assignment randomized trials (SMARTs). To promote the use of SMARTs, we provide a hypothetical SMART in a Head Start program to address child behavior problems. We describe the advantages and limitations of SMARTs, particularly as they may be applied to the field of evaluation.

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Being “SMART” About Adolescent Conduct Problems Prevention: Executing a SMART Pilot Study in a Juvenile Diversion Agency

Cited by 25 publications

References 41 publications

Adaptive Interventions in Child and Adolescent Mental Health

Adaptive Interventions in Child and Adolescent Mental Health

Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective

Adaptive Interventions and SMART Designs

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