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Biomedical subjects

Elizabeth J Letourneau

Publications and source records attributed to Elizabeth J Letourneau.

9 recordsLinked to original sources
PubMed2005

Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment.

The effects of caregiver-therapist ethnic similarity on youth outcomes from multisystemic therapy (MST), as implemented in dissemination sites, were examined. Consistent with hypotheses, findings confirmed that youths whose caregivers were ethnically matched with their therapists demonstrated greater decreases in symptoms, longer times in treatment, and increased likelihood of discharge for meeting treatment goals relative to youths whose caregivers and therapists were not ethnically matched. In addition, for youths whose caregivers were of mixed ethnic heritage, caregiver-therapist ethnic match was associated with greater improvements in psychosocial functioning. Ethnic match effects on both treatment length and discharge success were partially mediated by therapist adherence to MST. This study shows the importance of examining the effects of both client and therapist ethnicity on outcomes from empirically based treatments.

Adolescent↗
PubMed2005

Juvenile sex offenders: a case against the legal and clinical status quo.

The past two decades have seen a movement toward harsher legal sanctions and lengthy, restrictive treatment programs for sex offenders. This has not only been the case for adults, but also for juveniles who commit sex offenses. The increased length and severity of legal and clinical interventions for juvenile sex offenders appear to have resulted from three false assumptions: (1) there is an epidemic of juvenile offending, including juvenile sex offending; (2) juvenile sex offenders have more in common with adult sex offenders than with other juvenile delinquents; and (3) in the absence of sex offender-specific treatment, juvenile sex offenders are at exceptionally high risk of reoffending. The available data do not support any of the above assumptions; however, these assumptions continue to influence the treatment and legal interventions applied to juvenile sex offenders and contributed to the application of adult interventions to juvenile sex offending. In so doing, these legal and clinical interventions fail to consider the unique developmental factors that characterize adolescence, and thus may be ineffective or worse. Fortunately, a paradigm shift that acknowledges these developmental factors appears to be emerging in clinical areas of intervention, although this trend does not appear as prevalent in legal sanctions.

Adolescent↗
PubMed2005

Predicting therapist adherence to a transported family-based treatment for youth.

This study examined relations between therapist, caregiver, and youth characteristics and therapist adherence to multisystemic therapy (MST). Participants were 405 therapists in 45 organizations and the 1,711 families they treated with MST. Therapist perceptions that the flexible hours required to implement MST are problematic predicted lower adherence. Therapist demographic variables, professional training and experience, endorsement of the MST model, perceived difficulty and rewards of doing MST, and perceived similarity to treatments previously used did not predict adherence. Therapist-caregiver similarity on ethnicity and gender predicted higher adherence. Low caregiver education and African American ethnicity predicted higher adherence. With the exception of youth psychosocial functioning, indicators of severity of youth problems did not predict adherence.

Adult↗
PubMed2004

Children and adolescents with sexual behavior problems.

Youth with substantial sexual behavior problems (n = 166) were compared with youth from the same sample with few sexual behavior problems (n = 413) and with no sexual behavior problems (n = 943). It was hypothesized that youth with significant sexual behavior problems would be characterized by higher rates of sexual and physical abuse and higher rates of internalizing problems relative to youth without sexual behavior problems and that all youth would evidence a positive treatment response to multisystemic therapy. Relative to youth with no sexual behavior problems, youth with significant sexual behavior problems were more likely to have been sexually or physically abused and had higher rates of internalizing and externalizing behavior problems. These youth were also more likely to include girls, were younger, and had more social problems than youth with no sexual behavior problems. Youth in all groups responded with clinically relevant and statistically significant reductions in problem behaviors at posttreatment.

Adolescent↗
PubMed2004

Toward effective quality assurance in evidence-based practice: links between expert consultation, therapist fidelity, and child outcomes.

This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.

Adolescent↗
PubMed2003

Transportability of multisystemic therapy: evidence for multilevel influences.

This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.

Adolescent↗
PubMed2002

A comparison of objective measures of sexual arousal and interest: visual reaction time and penile plethysmography.

This study assessed the reliability and validity of a visual reaction time (VRT) measure of sexual interest (G. G. Abel, J. Huffman, B. Warberg, & C. L. Holland, 1998) and the penile plethysmograph (PPG) with audio stimuli. A sample of 57 sex offenders incarcerated at a high-security military prison completed physiological and self-report measures of sexual interest, including the VRT and the PPG. Results indicated adequate internal consistency for both measures. Convergent validity and an assessment of clinical usefulness for both measures indicated that (a) both measures accurately identified offenders against young boys; (b) the VRT, but not the PPG, significantly identified offenders against adolescent girls; (c) neither measure reached statistical significance in identifying offenders against adult women; and (d) the VRT did not reach statistical significance in identifying offenders against young girls and the PPG did reach statistical significance but in the opposite direction as was expected (i.e., men with female child victims had significantly lower arousal to female child stimuli than did men in other victim choice categories).

Adolescent↗
PubMed2002

Transporting efficacious treatments to field settings: the link between supervisory practices and therapist fidelity in MST programs.

Validated a measure of clinical supervision practices, further validated a measure of therapist adherence, and examined the association between supervisory practices and therapist adherence to an evidence-based treatment model (i.e., multisystemic therapy [MST]) in real-world clinical settings. Evidence of linkages between supervisor adherence to the MST supervisory protocol, as assessed through therapist reports, and therapist adherence to MST principles, as assessed through caregiver reports, was obtained from 285 families of youths presenting serious clinical problems, and 74 therapists and 12 supervisors of 16 teams in 9 organizations providing MST across 3 states. The findings provide a valuable step in examining the determinants of therapist fidelity to complex treatments in real-world clinical settings.

Adolescent↗