Fleming Theresa M, Gillham Bridgette, Bavin Lynda M, Stasiak Karolina, Lewycka Sonia, Moore Julie, Shepherd Matthew, Merry Sally Nicola
The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand.
Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
Internet Interv. 2019 Oct 20;18:100287. doi: 10.1016/j.invent.2019.100287. eCollection 2019 Dec.
Youth offenders have high rates of unmet mental health needs, including elevated rates of subclinical or clinical depression. Computerized cognitive behavioral therapy (cCBT) has been shown to be effective for depression, and cognitive behavioral therapy (CBT) is among the most effective psychological treatments for offence related behaviours. We planned to evaluate the impact of SPARX-R 1.0 (the first iteration of a revised version of SPARX cCBT) for adolescents in a community day program (Mentoring Youth New Directions or MYND) for male recidivist youth aged between 14 and 17 years. Recruitment and retention in the trial were lower than anticipated. In this brief report we present main findings and discuss implications.
We developed a stepwise cohort design to investigate the acceptability and effectiveness of SPARX-R in a complex, real-world setting. Participants were allocated to the MYND program only (treatment as usual), or MYND with the addition of SPARX-R. All adolescents referred to MYND within a specified period were assigned to one of four social workers, as per usual practice. Each social worker was randomized to begin SPARX-R with consenting new clients from one of four time points. Assessments were completed within the first two weeks of commencing the MYND program and then at 10 and 20 weeks after commencement. We solicited brief feedback on SPARX-R from young people and staff who used it.
Of 64 eligible youth who began MYND during the trial period, 51 consented but 25 stopped attending MYND despite court orders or because their court orders were changed. Nineteen participants were randomized to SPARX-R but only two completed two or more levels of the 7-level program, so it was not possible to evaluate the impact as planned. The four participants who provided feedback were indifferent or negative about SPARX-R. Staff advised that technical difficulties (such as loading or saving problems) were off putting and that SPARX-R was slow and not appealing to their clients.
Computerized CBT was not successfully implemented in this group, highlighting challenges in retention in this non-residential justice program. The findings also indicate that computerized therapies of proven acceptability and effectiveness in one setting may be unappealing in another. Implementation and equity efforts need to consider and test the specialist needs of diverse groups.
青少年罪犯未得到满足的心理健康需求比例很高，包括亚临床或临床抑郁症的发病率升高。计算机化认知行为疗法（cCBT）已被证明对抑郁症有效，而认知行为疗法（CBT）是治疗与犯罪相关行为最有效的心理治疗方法之一。我们计划评估SPARX-R 1.0（SPARX cCBT修订版的第一个版本）对14至17岁男性累犯青少年社区日间项目（指导青年新方向或MYND）中的青少年的影响。试验中的招募和留存率低于预期。在这份简短的报告中，我们展示主要研究结果并讨论其意义。
我们设计了一个逐步队列设计，以调查SPARX-R在复杂的现实环境中的可接受性和有效性。参与者被分配到仅参加MYND项目（照常治疗），或参加添加了SPARX-R的MYND项目。按照惯例，在特定时期内转介到MYND的所有青少年都被分配给四名社会工作者之一。每位社会工作者被随机安排从四个时间点之一开始对同意参与的新客户使用SPARX-R。评估在MYND项目开始的前两周内完成，然后在开始后的第10周和第20周进行。我们征求了使用过SPARX-R的年轻人和工作人员的简短反馈。
在试验期间开始参加MYND的64名符合条件的青少年中，51人同意参与，但25人尽管有法庭命令仍停止参加MYND，或者因为他们的法庭命令被更改。19名参与者被随机分配到SPARX-R组，但只有两人完成了7级项目中的两个或更多级别，因此无法按计划评估其影响。提供反馈的四名参与者对SPARX-R持冷漠或负面态度。工作人员表示，技术问题（如加载或保存问题）令人反感，而且SPARX-R速度慢，对他们的客户没有吸引力。
计算机化CBT在该群体中未成功实施，凸显了这个非寄宿制司法项目在留存方面的挑战。研究结果还表明，在一种环境中已证明具有可接受性和有效性的计算机化疗法在另一种环境中可能并不吸引人。实施和公平性工作需要考虑并测试不同群体的特殊需求。
