Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care.

OBJECTIVE: This article reports outcomes from the Child STEPs randomized effectiveness trial conducted over a 2-year period to gauge the longer term impact of protocol design on the effectiveness of evidence-based treatment procedures. METHOD: An ethnoracially diverse sample of 174 youths ages 7- 13 (N = 121 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, or disruptive behavior were treated by community therapists randomly assigned to 1 of 3 conditions: (a) standard, which involved the use of 1 or more of 3 manualized evidence-based treatments, (b) modular, which involved a single modular protocol (Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems; MATCH) having clinical procedures similar to the standard condition but flexibly selected and sequenced using a guiding clinical algorithm, and (c) usual care. RESULTS: As measured with combined Child Behavior Checklist and Youth Self-Report Total Problems, Internalizing, and Externalizing scales, the rate of improvement for youths in the modular condition was significantly better than for those in usual care. On a measure of functional impairment (Brief Impairment Scale), no significant differences were found among the 3 conditions. Analysis of service utilization also showed no significant differences among conditions, with almost half of youths receiving some additional services in the 1st year after beginning treatment, and roughly one third of youths in the 2nd year. CONCLUSIONS: Overall, these results extend prior findings, supporting incremental benefits of MATCH over usual care over a 2-year period.

Alcohol, tobacco, other drug use, and violent behavior among Native Hawaiians: ethnic pride and resilience.

The present study includes data from a sample of 88 Native Hawaiians living in a rural community on an outer island. Alcohol, tobacco, and other drug (ATOD) use, and violent behavior were examined, including age at first experience, lifetime and 30-day frequency of experience, and interference related to substance use, along with other resilience indicators such as self-reported health, happiness, and ethnic identity. The data suggested that age at first use of alcohol, tobacco, and other drugs appeared to occur within the same period of time, at approximately age 16. With respect to violent behavior, educational attainment was higher for individuals whose age at first victimization was later. Two relationships were found between ATOD use and violent behavior. First, the data suggest that the age at first use of alcohol was significantly correlated with lifetime frequency of violence exposure including witnessing, perpetrating, and being a victim of violence. Second, age at first victimization was correlated with current marijuana use, while age at first perpetration of violence was correlated with current crystal methamphetamine use. Lastly, individuals reporting very strong ethnic pride had significantly fewer lifetime instances of witnessing, perpetrating, and being the victim of violence. Thirty-day frequencies of perpetrating and being the victim of violence were also significantly different between respondents who reported very strong ethnic pride and those who reported being less proud, suggesting that ethnic pride is an important protective factor against experiencing violent behavior and may encourage resilience in this group.

Temperament, anxiety, and depression: comparisons across five ethnic groups of children.

Extending analyses from a large school-based sample of children and adolescents (N = 1,126; Chorpita, 2002), this study examined anxiety and depression assessment with 5 ethnic groups in Hawaii. Ethnic differences in anxiety and depression symptoms, along with 2 temperamental characteristics-negative affectivity (NA) and positive affectivity (PA)-were examined within the context of the tripartite model of anxiety and depression (Clark & Watson, 1991). Minimal between-group differences in temperamental characteristics were found. Good fit was found for a multisample model relating NA and PA to anxiety and depressive dimensions consistently across all groups. However, significant mean level differences among ethnic groups were found for several specific anxiety dimensions, suggesting that factors outside of the tripartite model explain observed ethnic differences. Further support for the generalizability of the tripartite model was also found.