The use of propensity scores to control for pretreatment imbalances on observed variables in non-randomized or observational studies examining the causal effects of treatments or interventions has become widespread over the past decade. For settings with two conditions of interest such as a treatment and a control, inverse probability of treatment weighted estimation with propensity scores estimated via boosted models has been shown in simulation studies to yield causal effect estimates with desirable properties. There are tools (e.g., the twang package in R) and guidance for implementing this method with two treatments. However, there is not such guidance for analyses of three or more treatments. The goals of this paper are twofold: (1) to provide step-by-step guidance for researchers who want to implement propensity score weighting for multiple treatments and (2) to propose the use of generalized boosted models (GBM) for estimation of the necessary propensity score weights. We define the causal quantities that may be of interest to studies of multiple treatments and derive weighted estimators of those quantities. We present a detailed plan for using GBM to estimate propensity scores and using those scores to estimate weights and causal effects. We also provide tools for assessing balance and overlap of pretreatment variables among treatment groups in the context of multiple treatments. A case study examining the effects of three treatment programs for adolescent substance abuse demonstrates the methods.

/pdf/a-tutorial-on-propensity-score-estimation-for-multiple-updijrl0nu.pdf

A tutorial on propensity score estimation for multiple treatments using generalized boosted models.

Summary Investment in the development of measurement feedback systems is needed to enhance clinical judgment and increase effectiveness of treatment. Clinical utility and consumer appeal need to be key considerations for measures intended to be used in everyday clinical practice. Most importantly, we must harness the power of technology and advances in measurement to provide clinicians with the tools to use effectively the systematic data provided through frequent measurement with measurement feedback systems.

/pdf/beyond-outcomes-monitoring-measurement-feedback-systems-in-3ikpqzn4mc.pdf

Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice.

Responding to urgent calls for effective interventions to address young offenders' multiple and interconnected problems, a new variant of an existing empirically-validated intervention for drug-using adolescents, Multidimensional Family Therapy (MDFT)-Detention to Community (DTC) was tested in a two-site controlled trial. This article (a) outlines the rationale and protocol basics of the MDFT-DTC intervention, a program for substance-using juvenile offenders that links justice and substance abuse treatment systems to facilitate adolescents' post-detention community reintegration; (b) presents implementation outcomes, including fidelity, treatment engagement and retention rates, amount of services received, treatment satisfaction, and substance abuse-juvenile justice system collaboration outcomes; and (c) details the implementation and sustainability challenges in a cross-system (substance abuse treatment and juvenile justice) adolescent intervention. Findings support the effectiveness of the MDFT-DTC intervention, and the need to develop a full implementation model in which transfer and dissemination issues could be explored more fully, and tested experimentally.

Implementation Outcomes of Multidimensional Family Therapy–Detention to Community: A Reintegration Program for Drug-Using Juvenile Detainees

https://www.robertjmeyersphd.com/pdf/ACRA.pdf

Exposure to Adolescent Community Reinforcement Approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome.

Implementation frameworks in child, youth and family services – Results from a scoping review

This article describes the Strengthening Communities for Youth (SCY) initiative using data from 1,297 adolescents in eight US cities (Oakland, CA; Tucson, AZ; Iowa City, IA; Bloomington, IL; St Louis, MO; Cleveland, OH; Louisville, KY, New York, NY) to better understand the pattern of services they received, how these services varied by need, and how services were associated with initial treatment outcomes Data include adolescent reports collected with the Global Assessment of Individual Needs (GAIN) at treatment intake and 90 days post-intake, information on early therapeutic alliance using a modified Working Alliance Inventory (WAI), and staff reports from service logs Cluster analysis identified four patterns of treatment received: (1) substance abuse and mental health treatment, (2) primarily residential treatment, (3) interrupted treatment, and (4) primarily outpatient treatment Outcomes examined included changes in substance use, substance abuse/dependence problems, recovery environment risk, as well as risk from social peers, illegal activity and emotional problems Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas The exception was for cluster 1, for whom emotional problems actually increased Implications for placement, treatment planning and future research are discussed

The Strengthening Communities for Youth (SCY) initiative: a cluster analysis of the services received, their correlates and how they are associated with outcomes.

Similar to implementing an evidence-based practice (EPB), implementing an evidence-based assessment (EBA) is a long, complex process that can take several years to complete. Between 2002 and 2007, the state of Missouri first piloted the Global Appraisal of Individual Needs-Initial (GAIN-I; Dennis et al. 2006) assessment at one state-contracted adolescent substance abuse treatment program and then implemented the GAIN statewide. This case study documents the implementation process through Fixsen and colleagues' (2005) six stages of implementation, from exploration and adoption through sustainability, and outlines challenges and solutions encountered at the external, organizational, and individual staff level. Strengths of this project included recognition that implementation is an ongoing multistep process, strong support by state-level staff, contracting with an external purveyor for ongoing technical assistance at the agency level as well as training of front-line clinicians, and an implementation team comprised of stakeholders at multiple levels.

Michelle K. White

Papers

The Strengthening Communities for Youth (SCY) initiative: a cluster analysis of the services received, their correlates and how they are associated with outcomes.

An implementation story: moving the GAIN from pilot project to statewide use.