Department of Psychology, George Washington University, Washington, DC, USA.
Dev Psychopathol. 2019 Dec;31(5):1777-1788. doi: 10.1017/S0954579419001044.
Tom Dishion, a pioneer in prevention science, was one of the first to recognize the importance of adapting interventions to the needs of individual families. Building towards this goal, we suggest that prevention trials be used to assess baseline target moderated mediation (BTMM), where preventive intervention effects are mediated through change in specific targets, and the resulting effect varies across baseline levels of the target. Four forms of BTMM found in recent trials are discussed including compensatory, rich-get-richer, crossover, and differential iatrogenic effects. A strategy for evaluating meaningful preventive effects is presented based on preventive thresholds for diagnostic conditions, midpoint targets and proximal risk or protective mechanisms. Methods are described for using the results from BTMM analyses of these thresholds to estimate indices of intervention risk reduction or increase as they vary over baseline target levels, and potential cut points are presented for identifying subgroups that would benefit from program adaptation because of weak or potentially iatrogenic program effects. Simulated data are used to illustrate curves for the four forms of BTMM effects and how implications for adaptation change when untreated control group outcomes also vary over baseline target levels.
汤姆·迪希恩（Tom Dishion）是预防科学的先驱之一，他是最早认识到将干预措施适应个别家庭需求的重要性的人之一。为此，我们建议利用预防试验来评估基线目标调节中介（BTMM），其中预防干预效果通过特定目标的变化来介导，并且由此产生的效果因目标的基线水平而异。讨论了最近试验中发现的四种 BTMM 形式，包括补偿性、富有者更富有、交叉和差异医源性效应。基于诊断条件、中点目标和近端风险或保护机制的预防阈值，提出了一种评估有意义的预防效果的策略。描述了如何使用这些阈值的 BTMM 分析结果来估计干预风险降低或增加的指标，因为它们因基线目标水平而异，并且提出了潜在的切点来识别因干预效果较弱或潜在医源性而需要适应计划的亚组。模拟数据用于说明这四种 BTMM 效应的曲线，以及当未治疗的对照组结果也因基线目标水平而异时，适应的影响如何变化。
