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Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B): study protocol for a randomized controlled trial.

Fonagy P, Butler S, Baruch G, Byford S, Seto MC, Wason J, Wells C, Greisbach J, Ellison R, Simes E - Trials (2015)

Bottom Line: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed.Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour.Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs.

View Article: PubMed Central - PubMed

Affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. p.fonagy@ucl.ac.uk.

ABSTRACT

Background: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour.

Methods/design: Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis.

Discussion: The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial.

Trial registration: ISRCTN28441235 (registered 25 January 2012).

No MeSH data available.


Related in: MedlinePlus

CONSORT flow diagram of progress through the phases of recruitment and treatment in the STEPS-B trial of multisystemic therapy for youth with problem sexual behaviour
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Fig1: CONSORT flow diagram of progress through the phases of recruitment and treatment in the STEPS-B trial of multisystemic therapy for youth with problem sexual behaviour

Mentions: Effect size has been estimated on the basis of the available data from a recent MST intervention study of sexual offenders in the United States [46]. As only summary statistics were available, 95 % confidence intervals for effect size were used and the lower limit chosen in a conservative approach. On the basis of the number of participants in the two groups who moved from offender to non-offender status during the follow-up period, the highly significant effect of treatment (P < 0.001, Fisher’s exact test) is 0.32 to 0.49 (Cramer, a medium to large effect). In the current study, non-offender status is defined as no arrest leading to conviction over the follow-up period, based on police computer records. We expect to achieve the lower end of the effect size range, given that the trial is mounted independently (although under the supervision) of the development team and involves the transportation of the clinical methodology across national boundaries, healthcare systems and cultures. A sample size estimate to give 80 % power based on the lower estimated effect size of 0.32 suggests 56 participants in a two-group design. Figure 1 shows the expected flow of participants from recruitment through to the end of the study.Fig. 1


Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B): study protocol for a randomized controlled trial.

Fonagy P, Butler S, Baruch G, Byford S, Seto MC, Wason J, Wells C, Greisbach J, Ellison R, Simes E - Trials (2015)

CONSORT flow diagram of progress through the phases of recruitment and treatment in the STEPS-B trial of multisystemic therapy for youth with problem sexual behaviour
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4631080&req=5

Fig1: CONSORT flow diagram of progress through the phases of recruitment and treatment in the STEPS-B trial of multisystemic therapy for youth with problem sexual behaviour
Mentions: Effect size has been estimated on the basis of the available data from a recent MST intervention study of sexual offenders in the United States [46]. As only summary statistics were available, 95 % confidence intervals for effect size were used and the lower limit chosen in a conservative approach. On the basis of the number of participants in the two groups who moved from offender to non-offender status during the follow-up period, the highly significant effect of treatment (P < 0.001, Fisher’s exact test) is 0.32 to 0.49 (Cramer, a medium to large effect). In the current study, non-offender status is defined as no arrest leading to conviction over the follow-up period, based on police computer records. We expect to achieve the lower end of the effect size range, given that the trial is mounted independently (although under the supervision) of the development team and involves the transportation of the clinical methodology across national boundaries, healthcare systems and cultures. A sample size estimate to give 80 % power based on the lower estimated effect size of 0.32 suggests 56 participants in a two-group design. Figure 1 shows the expected flow of participants from recruitment through to the end of the study.Fig. 1

Bottom Line: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed.Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour.Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs.

View Article: PubMed Central - PubMed

Affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. p.fonagy@ucl.ac.uk.

ABSTRACT

Background: Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour.

Methods/design: Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis.

Discussion: The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial.

Trial registration: ISRCTN28441235 (registered 25 January 2012).

No MeSH data available.


Related in: MedlinePlus