David G. Scherer

Multisystemic therapy with violent and chronic juvenile offenders and their families: the role of treatment fidelity in successful dissemination

The effects of multisystemic therapy (MST) in treating violent and chronic juvenile offenders and their families in the absence of ongoing treatment fidelity checks were examined. Across 2 public sector mental health sites, 155 youths and their families were randomly assigned to MST versus usual juvenile justice services. Although MST improved adolescent symptomology at posttreatment and decreased incarceration by 47% at a 1.7-year follow-up, findings for decreased criminal activity were not as favorable as observed on other recent trials of MST. Analyses of parent, adolescent, and therapist reports of MST treatment adherence, however, indicated that outcomes were substantially better in cases where treatment adherence ratings were high. These results highlight the importance of maintaining treatment fidelity when disseminating complex family-based services to community settings.

Female Juvenile Delinquency: Misunderstood by the Juvenile Justice System, Neglected by Social Science

The study of juvenile delinquency has focused primarily on conduct disorder and aggression in males, while relatively little attention has been paid to females who commit delinquent acts. This article offers a critical review of the existing theories of and research on female delinquency and the juvenile justice systems response to female delinquency. The inadequacies and persistence of historical theories and the conceptual and methodological strengths and weaknesses of contemporary perspectives in female delinquency are reviewed. Understanding and treatment of female and male delinquency could be enhanced through the adoption of a gender-integrated theory of delinquency that is informed by the comprehensive study of developmental, psychological, and social-ecological determinants.

Therapeutic Engagement With Adolescents in Psychotherapy.

Therapeutic engagement of adolescents is critical to maximizing the success of any psychotherapy intervention. Therapists have found that engaging adolescents is especially challenging and that there are several reasons for this. Most psychotherapy models are based on treatments that work for adults. These methods are frequently not conducive to engaging adolescents because of their developmental

The Capacities of Minors to Exercise Voluntariness in Medical Treatment Decisions

The legal standard for informed consent to medical treatment requires that the consenter be informed, competent, and acting voluntarily. The voluntary requirement of a valid consent was investigated by comparing forty 9- and 10-year-old children and forty 14- and 15-year-old adolescents (both generally presumed to be incapable of voluntary consent) with 47 young adults ranging in age from 21 to 25 (legally presumed to be deciding voluntarily) on responses to three hypothetical medical decision vignettes. The degree of parental influence was varied within each vignette to study the salience of parental influence in medical decision making. In two of three medical decision vignettes, most participants were deferent to parental wishes and few differences were found between children, adolescents, and young adults in their responses to parental influence. Differences between age groups were found in response to a kidney donation vignette. Children were significantly more likely to defer to parents than either adolescents or young adults. Adolescents were more likely to defer to parents than young adults, although this finding only approximated statistical significance. Implications of these findings for legal authorities, social policy makers, and families are discussed.

Multisystemic Family Preservation Therapy: Preliminary Findings from a Study of Rural and Minority Serious Adolescent Offenders.

The increase in the number of serious offenses by adolescents, particularly among minority populations, has drawn attention to these difficult-to-treat youths. This article provides preliminary findings from the Diffusion of Multisystemic Family Preservation (MFP) Services Project, which conducted work with rural African-American and White families who have a chronic or violent adolescent offender at imminent risk for incarceration. Analyses assessed the impact of multisystemic therapy on family functioning (parental monitoring, family communications, family structure, etc.) and on the problem behavior of the delinquent adolescent (conduct problems, aggression, and criminal activity). In general, the MFP group demonstrated improvements in amount of problem behavior and mother psychological distress, and in aspects of family functioning following treatment. These results generally replicate the previous successes that MFP has shown in the treatment of samples of serious juvenile offenders in urban areas.

Voluntary Assent in Biomedical Research With Adolescents: A Comparison of Parent and Adolescent Views

An informed consent and voluntary assent in biomedical research with adolescents is contingent on a variety of factors, including adolescent and parent perceptions of research risk, benefit, and decision-making autonomy. Thirty-seven adolescents with asthma and their parents evaluated a high or low aversion form of a pediatric asthma research vignette and provided an enrollment decision; their perceptions of family influence over the participation decision; and evaluations of risk, aversion, benefit, and burden of study procedures. Adolescents and their parents agreed on research participation decisions 74% of the time, yet both claimed ultimate responsibility for the participation decision. Both rated most study procedures as significantly more aversive than risky. Parents were more likely to rate aspects of the hypothetical study as beneficial and to provide higher risk ratings for procedures. Disagreements concerning research participation decisions and decision-making autonomy have implications for the exercise of voluntary assent in biomedical research.

Family and Physician Influence on Asthma Research Participation Decisions for Adolescents: The Effects of Adolescent Gender and Research Risk

OBJECTIVE. There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. STUDY DESIGN: Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. RESULTS: Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. CONCLUSIONS: Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians’ views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research participation decision-making in biomedical research are discussed.

Empirically Derived Knowledge on Adolescent Assent to Pediatric Biomedical Research

Background: There has been a recent growth in empirical research on assent with pediatric populations, due in part to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. Methods: The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the effects of various social context variables on adolescent research participation decision making; and the interrelatedness of these psychological and social factors. Results: Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents’ psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time according adolescents appropriate decision-making autonomy. Conclusions: Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.

Ethical Issues in Adolescent and Parent Informed Consent for Pediatric Asthma Research Participation

This article reviews the empirical literature related to knowledge, competence, volition, and financial compensation in the biomedical research decision-making of children, adolescents, and parents. Research findings indicate there are differences in adolescent and parent understanding and appreciation of research risks and procedures, that opinions about decision-making authority and physician influence for research participation are different in adolescents and parents, and that financial compensation can be a salient factor in the research-related decision-making process. Pediatric asthma researchers can consider these psychological factors involved in adolescent and parent research participation decision-making processes to develop effective informed consent procedures.

Conceptualizing the Role of Research Literacy in Advancing Societal Health

‘Research literacy’ is proposed as a key concept for advancing societal health. To examine whether improvements in research literacy would affect knowledge of and ethical participation in research, parents of young children received a brief educational intervention designed to enhance their understanding of child research. Results demonstrated that the intervention improved research-related knowledge and increased parents’ comfort with their research participation decisions. Moreover, enhanced understanding of child volition increased parents’ willingness to enrol their children in research. The proposed research literacy model identifies methods to enhance population knowledge and appreciation of research, strengthening links between scientific advancement and health.