Since it was first articulated, the Risk-Need-Responsivity model (RNR; Andrews, Bonta, & Hoge, 1990) has been extensively researched and is regarded as an empirically supported model for providing effective correctional treatment. It is comprised of three core principles: the risk principle, which provides direction for who should receive treatment; the need principle, which identifies intermediate treatment targets; and the responsivity principle, which states how treatment programs should be structured. The RNR model is purported to be relevant for all offender populations, including female offenders (Dowden & Andrews, 1999a), juvenile offenders (Dowden & Andrews, 1999b), violent offenders (Dowden & Andrews, 2000), and sexual offenders (Hanson, Bourgon, Helmus, & Hogdson, 2009). Yet, the majority of RNR research has examined the risk and need principles, and the responsivity principle remains understudied. The responsivity principle includes two sub-principles: general and specific (Andrews, & Bonta, 2010). The current research explored the general responsivity principle, which states that programs should use theoretically relevant models for individual change, specifically cognitive-behavioral and cognitive-social learning models (Andrews & Bonta, 2010). The following techniques are consistent with these models: "role-playing, modeling, repeated practice of alternative behaviors, cognitive restructuring to modify thoughts/emotions, skills building, or reinforcement" (Andrews & Bonta, 2010, p. 50). Despite empirical support, the RNR model has received minimal application to juveniles, and it has not been widely tested in the substance abuse treatment context. Additionally, it is not clear whether adherence to the RNR model is relevant for reducing substance use outcomes in youth. Adolescent substance abuse treatment programs were designed to address substance use among juveniles, and have been widely researched to determine their effectiveness; yet their effectiveness remains understudied among juvenile offenders. These studies include examinations of specific treatment interventions used, such as Multisystemic Therapy. Many of these interventions are considered to be "evidence-based treatment" (EBT), but there is a wide variety of repositories that classify interventions as "evidence-based" with varying criteria used to classify them. The juvenile drug treatment court model (JDTC) was specifically developed to address substance use and crime among juvenile offenders; however, findings from empirical studies have not demonstrated a strong treatment effect. To address these gaps in the literature, secondary analyses were conducted on data collected from 132 adolescent outpatient substance abuse treatment programs (AOPs) and 10 juvenile drug treatment courts nationwide. This research was an application of the general responsivity principle in the AOP and JDTC context to determine the impact of responsivity adherence on the odds of rearrest and substance use severity. The analyses also included an examination of evidence-based treatment (EBT) in both samples to determine the influence of EBT use scores on the odds of rearrests and substance use severity scores. To examine the AOP sample, multilevel models were used to examine the individual- and program-level impact of responsivity adherence and EBT use. To examine the JDTC sample, multivariate analyses were used to examine the individual-level impact of responsivity adherence and EBT use. Overall, responsivity adherence was not significantly associated with rearrests among AOP participants, nor was it significantly associated with substance use severity scores. Additionally, the odds of rearrest were significantly greater among individuals who received interventions with a higher EBT use score; though, there was no association between the average EBT use scores across programs and the odds of rearrest. There was no significant association between individual- and program-level EBT use scores and substance use severity. Among JDTC participants, an increase in responsivity adherence was associated with an increase in the odds of rearrest and substance use severity. A similar association emerged between EBT use scores and both outcomes, wherein increases in EBT use scores were significantly associated with an increase in the odds of rearrest and substance use severity. The results of the analyses suggest the need for further specification of both general responsivity adherence and "evidence-based" treatment for use in future research and theory; specifically, further elaboration of the general responsivity-adherent techniques and clear criteria for classifying interventions as "evidence-based treatment." The findings also imply that certain types of treatment interventions are more compatible with the JDTC model than other interventions. Additional analyses suggest the possibility that general responsivity adherence and evidence-based treatment may not be unique constructs. Future research may benefit through exploring evidence-based treatment as a criterion for adherence to the general responsivity principle. / Criminal Justice

The goal of the current study was to develop and test a rigorous measure of therapist adherence to a cognitive-behavioral, manual-based treatment for childhood and adolescent depression. This project employed data from the recently completed UCLAYouth Anxiety and Depression Treatment study. This study aimed to advance the literature by devoting the full focus of the project to the development of a manual-based measure that would demonstrate interrater reliability across multiple raters. This study reported on the psychometric development of the PASCET Manual Adherence Scale (PMAS) (e.g. scoring strategy, item development, reliability), a unique measure of therapist adherence that represents the content of the treatment manual for the "Primary and Secondary Control Enhancement Training" program (PASCET; Weisz et al., 1999). In sum, the P-MAS showed strong interrater reliability for most items of the scale. The items with poorer ICCs may have been influenced by instrumentation problems, small sample size, and range restriction. Some session content showed evidence that more meetings may be required to sufficiently cover the material, particularly for those that involve heavy in-vivo content, require the use of technology, or involve cognitive interventions which may be challenging for children and young teenagers. The results indicated that therapists adhered to slightly more than half of the prescribed manual content overall. The variability in adherence appeared greater for session-specific content than for standard session items, reflecting the variability within that content and the myriad of factors which may have influenced adherence to diverse material. Adherence for session-specific content demonstrated a slightly downward trend over time, with a significant drop off between the first and second phases of treatment and a leveling off between second and third phases. For all but two relevant sessions, therapist adherence to didactic content was significantly higher than adherence to in-vivo content, highlighting the challenges of engaging depressed youth in active learning. As this active involvement is theorized to be an essential component in addressing depressive symptoms, the challenges in implementation of this content may represent the most significant barrier to therapist adherence with this manual.

Family-based treatment for anorexia nervosa is a relatively recent form of therapy that is commonly used with families of child and adolescent patients. While current efficacy research of this treatment is promising, little research has been conducted on families' experiences of this treatment. This qualitative study investigates the experiences of parents who have participated in family-based treatment for a child or adolescent (ages 10-21) diagnosed with anorexia nervosa. Analytic induction (AI) methodology was used in this qualitative study to examine the various factors contributing the effectiveness of family-based treatment for families. Purposeful sampling was employed to obtain a wide variety of participants. In depth, semi-structured interviews were conducted with 15 parents via telephone or web-based chat. These interviews were coded and analyzed to generate themes, which were combined to form a theory regarding which factors influence families' treatment outcomes when using FBT-AN. Sufficient and necessary conditions of successful and unsuccessful treatment outcomes were identified. Two sufficient conditions of treatment success were identified--namely, that parents were provided with practical suggestions by their treatment teams and that parents were able to implement their treatment teams' advice at home. Eighteen themes were identified as being necessary, but not sufficient, conditions to treatment success. These themes related to aspects of treatment sessions and treatment providers' relationships with parents; parental, familial, and other supportive relationships; and the processes of re-feeding, exposure to food, and parental monitoring and oversight. Two necessary conditions of unsuccessful treatment outcome were identified. The first condition was that the time period during which the child or adolescent restored weight was prolonged, or greater than six months. The second necessary condition was that the child demonstrated inconsistent progress during FBT. Additional themes present across treatment outcomes were also explored. This study aims to highlight the diverse experiences of parents who have participated in family-based treatment for anorexia nervosa and to serve as a resource for clinicians and researchers providing this treatment. Potential clinical and research applications of the study's results are discussed.

This study examined the effectiveness of a school-based intervention process known as Prevent-Teach-Reinforce for children with a combination of externalizing and internalizing behaviors compared to children with only externalizing behaviors. The dependent variables examined were social skills, problem behaviors, and academic engaged time. Data for the current study were taken from archival data collected by the Florida Mental Health Institute that included students in kindergarten through 8th grade. A series of repeated-measures analysis of variance (ANOVA) was used to identify differences in improvement on the dependent variables for the two groups of students. Research questions focused on the main effects as well as interaction effects between the type(s) of behavioral problems displayed (i.e., externalizing only, combination of externalizing and internalizing). Behavior problem classification was determined by calculating students' individual subscale scores on the Social Skills Rating Scale. The current study found support for the use of the Prevent-Teach-Reinforce intervention for children with varying behavioral profiles. Significant improvements were found in social skills, behavioral problems, and academic engaged time for students. Additionally, results of this study indicate that internalizing behaviors did not serve as a moderator to treatment effectiveness for students with externalizing behavior problems who received the PTR intervention. That is, improvements were similar for both groups, demonstrating that PTR is a process that can be used in an equally-effective way for both populations.

Det övergripande syftet med studien var att undersöka hur personalen på en psykiatrisk mottagning upplevde den behandling som de ger för borderline personlighetsstörning, mentaliseringsbaserad terapi. Genom en kvalitativ metod och fokusgrupper söktes svar på frågeställningarna. Det empiriska materialet analyserades med hjälp av tematisk analys och resultatet visade att behandlingen generellt upplevdes ha förbättrat patienternas livskvalitet. De flesta av patienterna gjorde helt andra livsval efter avslutad behandling och en del uppfyllde inte längre de diagnostiska kriterierna för borderline personlighetsstörning. De som hade fullföljt behandlingen eller nästan fullföljt den var de som hade dragit mest nytta av den. De faktorer som ansågs som viktiga för förändringsprocessen rörde individvariabler, strukturella faktorer, gruppterapi, medicinering med psykofarmaka och personalvariabler. De berörde med andra ord behandlingens form snarare än de specifika interventionerna för mentaliseringsbaserad terapi. De fynd som gjorts inom ramen för denna studie skulle därmed kunna betraktas som viktiga komponenter för psykoterapeutisk behandling av borderline personlighetsstörning oavsett tillhörighet av psykoterapeutisk skolbildning. Resultatet skulle kunna indikera att de specifika behandlingsinterventionerna inte har någon nämnvärd effekt samtidigt som det skulle kunna tyda på att en behandling som ges i samma form som MBT, men med andra interventioner, skulle kunna åstadkomma ett än bättre resultat. / The overall purpose of this study was to examine how the professionals on a psychiatric clinic experienced the treatment they are using for borderline personality disorder, mentalization-based treatment. Through a qualitative approach and focus groups, answers to the questions were sought. The empirical material was analyzed by using thematic analysis and the results showed that the treatment generally had improved the patients’ quality of life, as perceived by the professionals. Most of the patients did completely different choices in life after the treatment was finished and some of them did no longer fulfill the diagnostic criteria’s for borderline personality disorder. Those who almost or fully completed the treatment where the ones who have had the most use of it. Important factors for the process of change were individual variables, structural factors, group therapy, medication with psychopharmacological drugs and personnel variables. In other words factors related to the structure of the treatment rather than the specific interventions for mentalization-based treatment. The findings within the scope of this study could hence be considered as vital components for psychotherapeutic treatment of borderline personality disorder independent of psychotherapeutic doctrine. The result could indicate that the specific treatment interventions do not have any significant effect but at the same time it could indicate that a treatment given in the same form as mentalization-based treatment, but with other interventions, could give an even better result.

Autism spectrum disorder (ASD) presents with difficulties in social communication, repetitive and/or restricted behaviors, as well as variable language development. Individuals with suspected ASD ideally participate in assessments which include measures of cognitive abilities, adaptive functioning, language functioning, and ASD specific measures (i.e., ADOS, ADI-R). Diagnosis of ASD can occur confidently at 2 years of age, however, the mean age at diagnosis is 4-5 years old. Delays in diagnosis are accounted for by lacking professionals and centers with the capabilities to assess ASD, as well as long waitlists for assessments. Early identification and intervention have been shown to provide the best improvements in ASD symptomology. The aim of the current study was to conduct a program evaluation of an autism treatment center that was designed to provide high quality evidence-based interventions. The study determined if treatment-as-usual in that center yields the expected gains in adaptive functioning and corresponding decreases in barriers to learning. Results indicated improvement in scores on standardized direct assessment of milestone achievement and barriers to learning, but no significant improvement in adaptive skills via secondary informant questionnaire measures following 6 months of treatment. The overall sample size was small due to COVID-19 complications, lack of institutional procedures, and limited client pool. Further investigation into the treatment practices and reevaluation strategies for individuals with ASD is required.

This thesis examines aspects of adolescent family mealtimes and psychopathology among both non-clinical (adolescents and mothers of adolescents) and clinical (adolescents with anorexia nervosa (AN)) samples. It contains seven studies employing quantitative methodology, which address three broad aims. First, to examine relationships between aspects of family mealtimes and psychopathology among adolescents. Second, to examine links between family mealtime emotions and psychopathology among mothers of adolescents. Finally, to examine associations between specific parental mealtime interactions and adolescent outcomes during a therapeutic meal session for adolescents with AN. Self-report questionnaires were completed by non-clinical adolescents and mothers of adolescents to examine associations between characteristics of family mealtimes (mealtime environment, mealtime emotions and parental feeding practices) and eating psychopathology, anxiety and depression. In addition, observational analyses were conducted on recordings of the family meal session (session two) of Family-Based Treatment (FBT) for adolescent AN. Key findings from this research include: identifying a new factor structure for the Eating Disorders Examination Questionnaire when used in research with adolescents; developing a measure to assess mealtime emotions in both adolescents and their parents; and, identifying the feeding strategies used by parents of adolescents with AN during the family meal session of FBT. Overall, the findings reported on in this thesis suggest that family mealtimes may have an important protective role in adolescent psychopathology. In addition to providing frequent family mealtimes, families should be encouraged to concentrate on the positivity of the mealtime environment and emotional experience, which may help to promote psychological well-being, and lower levels of eating psychopathology among adolescents. In relation to family mealtimes within adolescent AN, the findings increase understanding of the types of mealtime strategies parents use with their adolescent child to encourage food consumption during the family meal session of FBT. Furthermore, the research findings highlight that certain strategies may be effective in promoting eating during the session and weight gain later on in treatment. Consequently, such findings might provide a focus for therapists when supporting and coaching parents during the family meal session.

Introduction: Borderline Personality Disorder (BPD) is characterised by deficits in affect and impulse regulation, along with interpersonal difficulties (Lieb et al., 2004). It is thought to develop through a complex relationship between adverse childhood events, such as childhood abuse and genetics. A recent developmental model of BPD and one that is gaining popularity focuses on mentalization. Following their exposition of the mentalizing model of BPD, Bateman and Fonagy developed the Mentalization Based Treatment (MBT) intervention for BPD (Bateman & Fonagy 2006). This intervention includes both group and individual therapy with the focus on the patient’s relationship with the therapist and other members of the group. Promising evidence that MBT interventions are effective for treating symptoms of BPD is beginning to emerge. Methods: First a systematic review examining the prevalence of childhood abuse in BPD patients was conducted. Second, an empirical study of the efficacy of a group-only adaptation of the MBT intervention for BPD, delivered in a routine health service setting. Finally, planned exploratory analyses were conducted in order to ascertain what factors might predict group completion. Results: The results of the systematic review suggested that that emotional abuse (mean prevalence 63%) and emotional neglect (mean prevalence 63.1%) are the most common forms of abuse reported by this population followed by physical neglect (mean prevalence 40.89%) , sexual abuse (mean prevalence 36.9%) and physical abuse (mean prevalence 32.49%). The results of the second study revealed that the HUB is an acceptable treatment to participants, with indicators of treatment efficacy in relation to reducing overall psychiatric symptoms along with specific symptoms including interpersonal sensitivities, depression, phobic anxiety and paranoid ideation. Finally, exploratory analyses suggested that patients who were older and with less histrionic symptoms (as defined by the Personality Disorder Questionnaire-4) were more likely to complete the HUB. Conclusions: These findings demonstrate that a group-only MBT intervention displays promising effectiveness in treating core symptoms of BPD and is acceptable to patients. Further it suggests that group-only MBT interventions are worth continued investigation both into their efficacies and the potential efficiencies associated a group-based intervention.

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of “Adam,” a Caucasian male referred to a prison-based sex offender treatment program. Adam’s social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam’s individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

Adolescent engagement in home-based treatment is a challenge within the social work field. Studies have suggested that the foundation of clinical practice relies on the clinician's ability to understand the process of engaging adolescents in treatment, which may also include a period of adaptability, relatability, and connectedness within the treatment setting. The purpose of this study is to explore the clinical practice approaches, roles, and experiences utilized in home-based treatment to adolescents residing in a large city in northeastern United States. This study was grounded in the ecological systems theory which provides social workers with an opportunity to assess the relationships between an individuals behaviors and the environment. A qualitative research design was used in this study. Social work clinicians participated in focus groups to address the clinical roles, characteristics, and skills essential for reducing barriers related to adolescent engagement in home-based treatment and explore the clinical practice approaches and knowledge base related to adolescent engagement in home-based treatment, including the areas of competence, respect, empathy, and passion. Data were analyzed using audiotapes of the focus groups, the transcription process, coding, and a reliability check. Findings from this study suggest that effective social work practice techniques depend upon the clinician's ability to engage the adolescent throughout the entire treatment process. The outcomes for this action research study included both challenging and rewarding opportunities for clinicians to increase understanding of characteristics, skills, values, and experiences in providing home-based treatment to adolescents of a large city in the northeastern United States.