Treatment Process Predictors of Program Completion or Dropout among Minority Adolescents Enrolled in a Brief Motivational Substance Abuse Intervention

Cordaro, Millie; Tubman, Jonathan G.; Wagner, Eric F.; Morris, Staci Leon

doi:10.1080/1067828x.2012.636697

Cited by 18 publications

(19 citation statements)

References 76 publications

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“…In line with other adolescent clienteles (Cordaro et al, 2012;Garcia & Weisz, 2002), therapeutic alliance appears as an important issue for adolescents with BPD. Constructively engaging in therapy may conflict with an adolescent's striving for autonomy (Oetzel & Scherer, 2003).…”

Section: Discussionmentioning

confidence: 83%

“…It has been demonstrated that perceived irrelevance of treatment, as well as poor relations between parents and therapists, are associated with premature termination amongst families of preteens referred for oppositional, aggressive, and antisocial behaviours (Kazdin, Holland, & Crowley, 1997). Adolescent and parents' alliances with therapists were also found to discriminate between dropouts and completers (Cordaro, Tubman, Wagner, & Morris, 2012;Garcia & Weisz, 2002;Robbins et al, 2006;Stevens, Kelleher, Ward-Estes, & Hayes, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Desrosiers

St-Jean

Laporte

et al. 2020

Preprint

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Background: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Studies of specialized care for adolescents with BPD show that almost 40% of them do not complete treatment. Given that recurrence of suicidal behaviour is one of the main symptoms of BPD, and that the presence of past suicidal attempts is a strong predictor of subsequent attempts in young people, difficulties with treatment engagement in this population needs to be given special consideration. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD.Methods: A constructivist grounded theory method was used. Thirty-three interviews with 3 groups of informants (adolescent, parent, clinician) were conducted to document 11 treatment trajectories.Results: Disengagement is preceded by engagement complications, which may sometimes go unnoticed. These will unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment, followed by treatment interfering attitudes and openly disengaged behaviours. These engagement complications lead the way towards the development of a “zone of turbulence” which creates a vulnerable and unstable therapeutic process.Conclusion: Engagement complications which arise during therapy illustrate how the initial engagement of adolescents with BPD and of their parents for treatment is neither static nor certain, but subject to fluctuating emotions and perceptions. This implies that engagement can never be taken for granted and must constantly be monitored during the therapeutic process. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Desrosiers

St-Jean

Laporte

et al. 2020

Preprint

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“…While the high proportion of females may make the results less generalizable to a juvenile justice population, the ethnic and economic diversity of the sample is representative of many youth with treatment needs in the community. This diversity is another strength of the current study as there are few previous investigations of the role of therapeutic alliance in the treatment of underserved minority adolescents (but see Cordaro, Tubman, Wagner, & Morris, 2012 and Flicker, Turner, Waldron, Brody, & Ozechowski, 2008 for notable exceptions). Also, the high rates of depression in the study sample are indicative of the frequent co-morbidity of internalizing and externalizing symptoms in adolescents, and not inconsistent with recent research that suggests depressive symptoms are present in CU-youth (Fink, 2010; Wolff & Ollendick, 2006).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic alliance and treatment outcome in the outpatient treatment of urban adolescents: The role of callous–unemotional traits.

Mattos¹,

Schmidt

Henderson

et al. 2017

Psychotherapy

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Callous-unemotional (CU) traits designate a unique subset of youth with externalizing psychopathology who have a severe pattern of aggressive behavior and tend to have worse outcomes in treatment. However, little research has addressed how CU traits relate to different components of psychotherapy, such as the therapeutic alliance. The current study examined the role of CU traits in predicting therapeutic alliance in 59 adolescents (M age = 15.3, 51% female, 64% Hispanic American, 15% African American) who were part of a larger randomized naturalistic trial of outpatient behavioral psychotherapy. Multilevel regression analysis further investigated the role of therapeutic alliance in predicting treatment outcome (as measured by self-reported delinquency) and the moderating role of CU traits. Results suggested that regardless of the severity of their externalizing problems, youth with higher levels of CU traits reported more positive ratings of therapeutic alliance. In addition, a positive therapeutic alliance predicted reductions in delinquent behavior, and this association was even stronger for youth higher in CU traits. Our results suggest that CU traits are related to improvement in the formation of the therapeutic alliance among youth with externalizing psychopathology, perhaps because these youth lack many of the social and emotional deficits that other youth with conduct problems possess. Adolescents high in CU traits should not be viewed as untreatable. Indeed, the therapeutic alliance may be an important mechanism for affecting meaningful change in these adolescents’ lives.

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“…For example, studies suggest that motivational enhancement approaches may be particularly well suited for ethnic minority youth (Cordaro, Tubman, Wagner, & Morris, 2012; D’Amico, Miles, Stern, & Meredith, 2008; Feldstein-Ewing et al, 2012; Gil, Wagner, & Tubman, 2004). In a study of a brief one-on-one motivational interviewing intervention for substance abuse conducted with predominately Hispanic adolescents, objective coder ratings of therapist warmth and friendliness and client involvement/engagement predicted treatment completion (Cordaro et al, 2012). In addition, past ME interventions conducted with predominately Hispanic and African American substance-abusing adolescents led to positive treatment outcomes (D’Amico, Miles, Stern, & Meredith, 2008; Feldstein Ewing et al, 2012; Gil, Wagner, & Tubman, 2004).…”

Section: Group Ethnic Composition and Mechanisms Of Changementioning

confidence: 99%

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups

et al. 2016

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Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e. where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e. African-American vs. Hispanic vs. non-Hispanic White). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic White majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic White groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

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Treatment Process Predictors of Program Completion or Dropout among Minority Adolescents Enrolled in a Brief Motivational Substance Abuse Intervention

Cited by 18 publications

References 76 publications

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Therapeutic alliance and treatment outcome in the outpatient treatment of urban adolescents: The role of callous–unemotional traits.

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups

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