Design and analysis considerations for comparing dynamic treatment regimens with binary outcomes from sequential multiple assignment randomized trials

In behavioral, educational and medical practice, interventions are often personalized over time using strategies that are based on individual behaviors and characteristics and changes in symptoms, severity, or adherence that are a result of one's treatment. Such strategies that more closely mimic real practice, are known as dynamic treatment regimens (DTRs). A sequential multiple assignment randomized trial (SMART) is a multi-stage trial design that can be used to construct effective DTRs. This article reviews a simple to use ‘weighted and replicated’ estimation technique for comparing DTRs embedded in a SMART design using logistic regression for a binary, end-of-study outcome variable. Based on a Wald test that compares two embedded DTRs of interest from the ‘weighted and replicated’ regression model, a sample size calculation is presented with a corresponding user-friendly applet to aid in the process of designing a SMART. The analytic models and sample size calculations are presented for three of the more commonly used two-stage SMART designs. Simulations for the sample size calculation show the empirical power reaches expected levels. A data analysis example with corresponding code is presented in the appendix using data from a SMART developing an effective DTR in autism.     

A Leadership Training Group for at Risk Fifth & Seventh Graders: Results from A Brief Strength-Based Group Program

ABSTRACT

An increasing number of youth are exhibiting social, emotional, and behavioral problems that hinder their ability to function at grade level. Subsequently, school mental health services have not been able to address the need for services particularly among students who are minority and poor. A mixed methodology study was conducted to determine the treatment outcomes from a brief strength-based leadership training group for primarily students who are African American and poor. Pre–post scores on three scales and focus group data revealed significant positive changes in regard to internal areas of functioning and social skills, anger management skills, and school attitude. Gender and age significantly impacted outcomes.     

Self-reported Barriers to Professional Help Seeking Among College Students at Elevated Risk for Suicide

Abstract

Objectives: This study sought to describe self-reported barriers to professional help seeking among college students who are at elevated suicide risk and determine if these barriers vary by demographic and clinical characteristics. Participants: Participants were 165 non–treatment seekers recruited as part of a Web-based treatment linkage intervention for college students at elevated suicide risk (from September 2010 through December 2011). Methods: Data were collected using Web-based questionnaires. Two coders coded students’ responses to an open-ended question about reasons for not seeking professional help. Results: The most commonly reported barriers included perception that treatment is not needed (66%), lack of time (26.8%), and preference for self-management (18%). Stigma was mentioned by only 12% of students. There were notable differences based on gender, race, and severity of depression and alcohol abuse. Conclusions: Efforts aimed at reaching students at elevated risk for suicidal behavior should be particularly sensitive to these commonly described barriers.     

Exponential random graph models of preschool affiliative networks

Exponential random graph models were used to assess the relevance of reciprocity, popularity, transitivity controlling for effects based upon ego and alter sex, and sex homophily, on the formation of affiliative ties in 19 Portuguese preschool peer groups. The number of times two children were recorded as nearest neighbors in focal samples was used as an indicator of the relationship's strength. Independent parameter estimates of the different models (one for each group) were summarized, separately for the three age groups (“3-year-olds”, “4-year-olds” and “5-year-olds”) using a multi-level approach to meta-analysis. Results showed that affiliative ties between children were sex segregated, highly reciprocal, more likely to be directed to a restricted number of children and with a tendency to create transitive triads. The structural processes underlying the formation of affiliative ties were quite stable between classrooms.     

From Liberal Pluralism to Critical Multiculturalism: The Need for a Paradigm Shift in Multicultural Education for Social Work Practice in the United States

The mandate to educate students to work toward ending oppression and other forms of injustice is clear, but there has been little discussion in the multicultural literature about the kinds of knowledge that are needed to prepare students for such work. This article discusses the need for a paradigm shift from liberal pluralism to a critical approach to social work education and practice. It also outlines a set of core themes to guide multicultural curriculum development. These include (a) culture, (b) race and racism, (c) oppression, (d) multiple identities, (e) power, (f) whiteness and privilege, (g) historical context, and (h) social change. Obstacles to incorporating these ideas into the curriculum and recommendations for overcoming such obstacles are also discussed.     

The Family Outreach Model: Tools for Engaging and Working With Families in Distress

The purpose of this article is to present a family intervention model to family service providers that builds on previous research in areas of social support and family problem solving. The Family Outreach Model provides a set of strategies for engaging and working with families in five phases of family coping at different points in time in the family's life. The strategies reflect intentional choices by family service providers about both collaborative and directive styles of therapeutic alliance and highlights ways to determine which style best fits with what specific families want and need, depending on the manner of family coping that it is using. Implications for programs and public policy are presented.     

An Examination of Gender Differences in Attitudes Toward Divorce

ABSTRACT

Using the General Social Survey, this article examines the gender difference in attitudes toward divorce. Although previous studies have found that women have more tolerant attitudes toward divorce compared to men, we find that this gender difference depends on the measure. Our analysis indicates that women are more likely than men to advocate making divorce more difficult to obtain. We find a significant link between the Protestant faith and conservative attitudes toward divorce; taking into account religious factors reduced the gender difference in attitudes. Consistent with prior literature, our results indicate that different factors affect men's and women's views of divorce.