***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The mechanisms through which multisystemic therapy ( MST ) decreased delinquent behavior were assessed in 2 sample s of juvenile offenders . Sample 1 included serious offenders who were predominantly rural , male , and African American . Sample 2 included substance-abusing offenders who were predominantly urban , male , and Caucasian . Therapist adherence to the MST protocol ( based on multiple respondents ) was associated with improved family relations ( family cohesion , family functioning , and parent monitoring ) and decreased delinquent peer affiliation , which , in turn , were associated with decreased delinquent behavior . Furthermore , changes in family relations and delinquent peer affiliation mediated the relationship between caregiver-rated adherence and reductions in delinquent behavior . The findings highlight the importance of identifying central change mechanisms in determining how complex treatments such as MST contribute to ultimate outcomes OBJECTIVE We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 r and omized controlled trials testing multidimensional family therapy ( MDFT ) , an established evidence -based therapy for adolescent drug abuse and delinquency . METHOD The first study compared 2 evidence -based adolescent substance abuse treatments : individually focused cognitive-behavioral therapy and MDFT in a sample of 224 urban , low-income , ethnic minority youths ( average age = 15 years , 81 % male , 72 % African American ) . The second compared a cross-systems version of MDFT ( MDFT-detention to community ) with enhanced services as usual for 154 youths , also primarily urban and ethnic minority ( average age = 15 years , 83 % male , 61 % African American , 22 % Latino ) , who were incarcerated in detention facilities . RESULTS In both studies , the analyses supported the distinctiveness of 2 classes of substance use severity , characterized primarily by adolescents with higher and lower initial severity ; the higher severity class also had greater psychiatric comorbidity . In each study , the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses . Further , in both studies ,  MDFT  was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses . CONCLUSIONS Results indicate that for youths with more severe drug use and greater psychiatric comorbidity , MDFT produced superior treatment outcomes A small r and omized trial investigated a new family-based intervention for Hispanic adolescents who met DSM-IV criteria for substance abuse disorder . The Culturally Informed and Flexible Family-Based Treatment for Adolescents ( CIFFTA ) is a tailored/adaptive intervention that includes a flexible treatment manual and multiple treatment components . The study used an " add on " design to isolate the effects on substance abuse , behavior problems , and parenting practice s attributable to the newly developed components . Twenty-eight Hispanic adolescents and their families were r and omized either to the experimental treatment or to traditional family therapy ( TFT ) and were assessed at baseline and 8-month follow-up . Despite the small sample , results revealed statistically significant time × treatment effects on both self-reported drug use ( marijuana + cocaine ) , F(1 , 22 ) = 10.59 , p < .01 , η² = .33 and adolescent reports of parenting practice s , F(1 , 22 ) = 9.01 , p < .01 , η² = .29 . Both sets of analyses favored CIFFTA participants . There was a significant time × treatment effect , F(1 , 22 ) = 6.72 , p = .02 , η² = .23 , favoring CIFFTA on parent report of parenting practice s using a composite that matched the variables used for adolescents , but only a nonsignificant trend , F(1 , 22 ) = 2.43 , p = .13 , η² = .10 , with a composite that used all parenting subscales . Parent reports of adolescent behavior problems did not show a significant time or time × treatment effect . These results show the promise of this adaptive treatment for substance abuse in Hispanic adolescents and suggest the need for a larger r and omized trial to fully investigate this treatment Evaluated the effectiveness of juvenile drug court  for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence and determined whether the integration of evidence -based practice s enhanced the outcomes of juvenile drug court .  Over a 1-year period , a four-condition r and omized design evaluated outcomes for family court with usual community services , drug court with usual community services , drug court with multisystemic therapy , and drug court with multisystemic therapy enhanced with contingency management  for adolescent substance use , criminal behavior , symptomatology , and days in out-of-home placement . In general , findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior . Possibly due to the greatly increased surveillance of youths in drug court , however , these relative reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration . In addition , findings supported the view that the use of evidence -based treatments within the drug court context improved youth substance-related outcomes . Clinical and policy implication s of these findings are discussed OBJECTIVE A r and omized trial assessed the effectiveness of a 2-level strategy for implementing evidence -based mental health treatments for delinquent youth . METHOD A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors : ( a ) the r and om assignment of delinquent youth within each county to a multisystemic therapy ( MST ) program or usual services and ( b ) the r and om assignment of counties to the ARC ( for availability , responsiveness , and continuity ) organizational intervention for implementing effective community-based mental health services . The design created 4 treatment conditions ( MST plus ARC , MST only , ARC only , control ) . Outcome measures for 615 youth who were 69 % male , 91 % Caucasian , and aged 9 - 17 years included the Child Behavior Checklist and out-of-home placements .  RESULTS A multilevel , mixed-effects , regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a non clinical level and significantly lower than in other conditions . Total problem behavior was equivalent and at non clinical levels in all conditions by the 18-month follow-up , but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate ( 16 % ) than youth in the control condition ( 34 % ) . CONCLUSIONS Two-level strategies that combine an organizational intervention such as ARC and an evidence -based treatment such as MST are promising approaches to implementing effective community-based mental health services . More research is needed to underst and how such strategies can be used effectively in a variety of organizational context s and with other types of evidence -based treatments Runaway youth report a broader range and higher severity of substance-related , mental health and family problems relative to non-runaway youth . Most studies to date have collected self-report data on the family and social history ; virtually no research has examined treatment effectiveness with this population . This study is a treatment development project in which 124 runaway youth were r and omly assigned to ( 1 ) ecologically based family therapy ( EBFT ) or ( 2 ) service as usual ( SAU ) through a shelter . Youth completed an intake , posttreatment , 6 and 12 months follow-up assessment . Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions . Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth Due to the continuing prevalence of adolescent substance abuse , promising treatment models need to be developed and evaluated . Thus , the purpose of this study was to evaluate the efficacy of two promising models , Strengths Oriented Family Therapy ( SOFT ) and The Seven Challenges(R ) ( 7C ) .  Adolescents who qualified for outpatient treatment and agreed to participate in our study were r and omly assigned to one of the two treatments and assessed at 3 and 6-months following baseline . Using a two-part , r and om-effects model , we examined the odds of achieving abstinence or full symptom remission between treatments and over time . For those not achieving full abstinence or full problem remission , we investigated whether frequency of use or symptom severity were reduced at follow-up . Participants in both SOFT and 7C demonstrated significant reductions in substance use and related problems , but treatments did not differ at 3 and 6 months following baseline . Overall , treatment services were delivered as planned . Both SOFT and 7C were efficacious with adolescents who abuse substances , as participants in both conditions were significantly more likely to be in symptom remission or abstinent at follow-up interviews versus at baseline . Replication studies are needed that address this study 's limitations Many family therapies for adolescent drug use include ecological interventions . The purpose of this r and omized clinical trial was to establish whether ecological interventions contribute to the impact of family therapy above and beyond the contributions of family process-only interventions . A family-based ecological approach , structural ecosystems therapy ( SET ) , was compared with family process-only condition ( FAM ) and community services control ( CS ) .  One hundred ninety substance-abusing or dependent African American and Hispanic adolescents were r and omized to SET , FAM , or CS . Follow-up assessment s were conducted at 3 , 6 , 12 , and 18 months postr and omization . SET was significantly more efficacious than FAM and CS in reducing adolescent drug use . However , these improvements were limited to Hispanic adolescents . The study demonstrates the importance of investigating changes in adolescent drug use as a result of treatment condition across more than 1 racial/ethnic group This article examined the long-term effects of multisystemic therapy ( MST ) vs. individual therapy ( IT ) on the prevention of criminal behavior  and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes . Results from multiagent , multi method assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members . Moreover , results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior , including violent offending . The implication s of such findings for the design of violence prevention programs are discussed OBJECTIVE Although several treatments for adolescent substance abuse have been identified as promising by review ers and federal agencies , treatment effects extending beyond 12 months have not been demonstrated in r and omized clinical trials . The primary purpose of this report was to examine the 4-year outcomes of an evidence -based treatment of substance-abusing juvenile offenders . METHOD Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after taking part in a r and omized clinical trial comparing multisystemic therapy ( MST ) with usual community services . A multi method ( self-report , biological , and archival measures ) assessment battery was used to measure the criminal behavior , illicit drug use , and psychiatric symptoms of the participating young adults . RESULTS Analyses demonstrated significant long-term treatment effects for aggressive criminal activity ( 0.15 versus 0.57 convictions per year ) but not for property crimes . Findings for illicit drug use were mixed , with biological measures indicating significantly higher rates of marijuana abstinence for MST participants ( 55 % versus 28 % of young adults ) . Long-term treatment effects were not observed for psychiatric symptoms . CONCLUSIONS Findings provide some support for the long-term effectiveness of an evidence d-based family-oriented treatment of substance-abusing juvenile offenders . The clinical , research , and policy implication s of these findings are noted OBJECTIVE Although current evidence suggests that the positive effects of multisystemic therapy ( MST ) on serious crime reach as far as young adulthood , the longer term impact of MST on criminal and noncriminal outcomes in midlife has not been evaluated . In the present study , the authors examined a broad range of criminal and civil court outcomes for serious and violent juvenile offenders who participated on average 21.9 ( range = 18.3 - 23.8 ) years earlier in a clinical trial of MST ( C. M. Borduin et al. , 1995 ) . METHOD Participants were 176 individuals who were originally r and omized to MST or individual therapy ( IT ) during adolescence and averaged 3.9 arrests for felonies prior to treatment .  Arrest , incarceration , and civil suit data were obtained in middle adulthood when participants were on average 37.3 years old . RESULTS Intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants ( 34.8 % vs. 54.8 % , respectively ) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants . In addition , the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants . CONCLUSIONS The present study represents the longest follow-up to date of an MST clinical trial and demonstrates that the positive impact of an evidence -based youth treatment such as MST can last well into adulthood . Implication s of the authors ' findings for policymakers and service providers are discussed Hospitalization and out-of-home placement data for 113 youth participating in a r and omized trial comparing home-based multisystemic therapy ( MST ; n = 57 ) with hospitalization(n = 56 ) for psychiatric crisis stabilization were analyzed following the completion of 
    Output:
    
There is a sound evidence base for the efficacy of systemic therapy  for children and adolescents ( and their families ) diagnosed with externalizing disorders