The Effectiveness of Forensic Outpatient Systemic Therapy: a Multiple Case Experimental Design

Recruiting

• Conditions: Antisocial Behavior; Conduct Disorder; Aggression; Behavioral Disorder
• Interventions: Behavioral: FAST

• Registration Number: NCT06032520
• Lead Sponsor: Utrecht University

Brief Summary

The purpose of this study is to investigate the effectiveness and mediators of Forensic Outpatient Systemic Therapy (FAST).

Detailed Description

Forensic Outpatient Systemic Therapy (in Dutch: Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles showing severe antisocial behavior, including aggression, (domestic) violence, and delinquent behavior. FAST has a flexible intensity and length, addresses individual and systemic risk and protective factors, and is responsive to the abilities of the client (system), intervention characteristics all considered crucial for effective treatment. The current study will investigate whether FAST is effective in reducing aggression of the juvenile, in reaching client formulated subgoals, and in improving family functioning (i.e., reducing juvenile-caregiver conflict and increasing caregiver responsiveness). In addition, processes of change will be examined, as well as mediation by reaching client formulated subgoals and improved family functioning. A Multiple Case Experimental Design (MCED) with an ABC design will be performed (A = baseline, B = intervention, and C = follow-up). Juveniles with primary aggression and/or anger problems (N = 15) and their caregiver(s) will be recruited.

Study Timeline

• Study Start: 2023-08-25
• Study First Submitted: 2023-08-28
• Study First Submitted QC: 2023-09-04
• Study First Posted: 2023-09-13
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-06
• Last Update Posted: 2024-12-12
• Primary Completion: 2025-08
• Study Completion: 2025-08

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 15

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Forensic Outpatient Systemic Therapy (FAST)	FAST	FAST is a promising treatment for juveniles showing severe antisocial behavior, including aggression, (domestic) violence, and delinquent behavior. FAST has a flexible intensity and length, addresses individual and systemic risk and protective factors, and is responsive to the abilities of the client (system), intervention characteristics all considered crucial for effective treatment.

Primary Outcome Measures

Name	Time	Method
Change in Juvenile-Caregiver Conflict assessed by the Network of Relationship Inventory (NRI)	T1 (baseline); twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; T2 (post-intervention) up to 9 months; weekly during phase C, 6 weeks	The NRI is a self-reported instrument for juveniles and caregivers. The NRI contains six items with possible scores ranging from 1 (not at all) to 100 (the most).
Change in Additional Criminogenic Needs assessed by individualized items	Twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; weekly during phase C, 6 weeks	If severe truancy, substance use, contact with deviant peers, or delinquent behavior are reported at T1 but not prioritized in the top three goals, single items will be administered on these problems as well.
Change in Aggression assessed by the Aggressive Behavior scale of the Child Behavior Checklist (CBCL)	Twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; weekly during phase C, 6 weeks	The CBCL is a caregiver-reported instrument. The Aggressive Behavior scale contains 19 items assessing aggression. Possible scores range from 1 (never) to 100 (always).
Change in Client Formulated Subgoals assessed by the FAST Goal list	Twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; weekly during phase C, 6 weeks	The FAST Goal list is a self-report instrument for juveniles and caregivers. It contains 21 items with possible scores ranging from 0 (not true at all) to 100 (definitely true). The FAST Goal lists are used in an idiographic and client-guided approach. The first questionnaire in phase A contains the entire FAST Goal list and a follow-up question asks participants to prioritize their top three FAST goals. In the subsequent measurements, only the items measuring the three prioritized goals are administered. Added to these three items, a fourth item measures whether prioritization or goals have changed. If so, the participant is asked to state their new prioritization or goals, and the questions about the new goals are added in the subsequent measurements.
Change in Aggression assessed by the Aggressive Behavior scale of the Youth Self Report (YSR)	Twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; weekly during phase C, 6 weeks	The YSR is a self-reported instrument. The Aggressive Behavior scale contains 19 items assessing aggression. Possible scores range from 1 (never) to 100 (always).
Change in Caregiver Responsiveness assessed by the the Responsiveness Scale of the Nijmeegse Parenting Questionnaire (NPQ)	T1 (baseline); twice a week during phase A, up to 5 weeks; every other week during phase B, up to 8 months; T2 (post-intervention) up to 9 months; weekly during phase C, 6 weeks	The NPQ is a self-reported instrument for juveniles and caregivers. The the Responsiveness Scale contains eight items with possible scores ranging from 1 (completely disagree) to 100 (completely agree).

Secondary Outcome Measures

Name	Time	Method
Therapist-Client Alliance assessed by the Relationship with Interventionist	T2 (post-intervention) up to 9 months from baseline	The Relationship with Interventionist is a juvenile and caregiver self-reported instrument and contains 12 items. Possible scores range from 1 (completely disagree) to 6 (completely agree).
Change in Externalizing Behavior assessed with the Child Behavior Checklist (CBCL)	T1 (baseline); T2 (post-intervention) up to 9 months	The CBCL is a caregiver-reported instrument. The Externalizing scale contains 36 items assessing aggression and delinquency. Possible scores range from 0 (never) to 2 (often).
Percentage of Participants with Out of Home Placement assessed using File Analysis	T1 (baseline); T2 (post-intervention) up to 9 months	A participant is viewed as being placed out of home when they do not reside with their primary family, either temporarily or permanently, and either voluntarily or involuntarily. Out of home placement is registered by therapists during treatment as part of the standard FAST procedure.
Change in Delinquency assessed with the Self-Report Delinquent Behavior (SDB)	T1 (baseline); T2 (post-intervention) up to 9 months	The SDB is a self-reported instrument, assessing how many times the juvenile has done certain (rule-breaking) things in the past year. The SDB contains 30 items.
Change in Caregiver-Adolescent Relationship Quality assessed by the Nijmeegse Parenting Stress Index (NPSI)	T1 (baseline); T2 (post-intervention) up to 9 months	The NPSI is a caregiver self-reported instrument and contains nine items. Possible scores range from 1 (not applicable at all) to 6 (completely applicable).
Change in Externalizing Behavior assessed by the Youth Self Report (YSR)	T1 (baseline); T2 (post-intervention) up to 9 months	The YSR is a self-reported instrument. The Externalizing scale contains 30 items assessing aggression and delinquency. Possible scores range from 0 (never) to 2 (often).
Change in Social Support assessed by the Parental Support Questionnaire (PSQ)	T1 (baseline); T2 (post-intervention) up to 9 months	The PSQ is a caregiver self-reported instrument and contains 15 items. Possible scores range from 0 (no) to 1 (yes), and 1 (unsatisfied) to 5 (satisfied).
Change in Psychological Control assessed by the Psychological Control Scale Youth Self-Report (PCS-YSR)	T1 (baseline); T2 (post-intervention) up to 9 months	The PCS-YSR is a self-reported instrument and contains eight items. Possible scores range from 1 (not applicable at all) to 5 (completely applicable).
Change in Personality assessed by the Inventory of Callous-Unemotional Traits (ICU)	T1 (baseline)	The ICU is reported by juveniles and caregivers and contains 24 items. Possible scores range from 1 (completely untrue) to 4 (always true).
Change in Substance Use assessed with the Peilstation Middelengebruik	T1 (baseline); T2 (post-intervention) up to 9 months	Peilstation Middelengebruik is a self-reported instrument. It contains five items assessing frequency and intensity of substance use.
Change in Cognitive Distortions assessed by the Brief Irrational Thoughts Inventory (BITI)	T1 (baseline); T2 (post-intervention) up to 9 months	The BITI is a self-reported instrument and is filled in by juveniles as part of the standard FAST procedure. The BITI contains 18 items with possible scores range from 1 (completely disagree) to 6 (completely agree).
Demographics assessed by a Demographic Information Questionnaire	T1 (baseline)	The Demographic information questionnaire contains items about gender, age, and occupation. The questionnaire contains nine items for juveniles, 19 for caregivers, and eight for therapists.
Primary Diagnosis assessed by Therapist File Search	T1 (baseline)	The therapist file contains the primary diagnosis of the juvenile.
Change in Substance Use assessed with the FAST Goal list	T1 (baseline); T2 (post-intervention) up to 9 months	The FAST Goals List is filled in by juveniles, caregivers, and therapists as part of the standard FAST procedure, and assess the achievement of FAST goals in the past two months. The list includes 1 item on change in substance use. Possible scores range from 1 (not true at all) to 10 (absolutely true).
Change in Contact with Deviant Peers assessed with the Basic Peer Questionnaire (BPQ)	T1 (baseline); T2 (post-intervention) up to 9 months	The BPQ is a self-reported instrument with 13 items. Possible scores differ per question, for instance measuring amount of friends, or 0 (never) to 4 (5 times or more).
Change in Caregiver-Adolescent Relationship Quality assessed by the Inventory of Parent and Peer Attachment (IPPA)	T1 (baseline); T2 (post-intervention) up to 9 months	The IPPA is a juvenile self-reported instrument and contains 12 items per caregiver. Possible scores range from; 1 (almost never) to 4 (almost always).
Change in Caregiver Consistency assessed by the Consistency Scale of the Parenting Dimensions Inventory (PDI)	T1 (baseline); T2 (post-intervention) up to 9 months	The PDI is a juvenile and caregiver self-reported instrument. The Consistency scale contains eight items. Possible scores range from 1 (completely disagree) to 6 (completely agree).
Change in Discipline Practices assessed by the Parenting Dimensions Inventory (PDI)	T1 (baseline); T2 (post-intervention) up to 9 months	The PDI is a juvenile and caregiver self-reported instrument and contains three hypothetical situations with six items each. Possible scores range from 1 (very improbable) to 6 (very probable).
Treatment Intensity assessed by Therapist File Search	T2 (post-intervention) up to 9 months from baseline	Treatment intensity will be calculated based on the registered direct treatment time by therapists in their appointment agendas. Treatment intensity will be measured in average hours of direct treatment time per week.
Change in Treatment Motivation assessed by the Treatment Motivation Scales for Forensic Outpatient Treatment (TMS-F)	T1 (baseline); T2 (post-intervention) up to 9 months	The TMS-F is reported on by juveniles and caregivers and contains 16 items. Possible scores range from 1 (completely disagree) to 5 (completely agree).
Percentage of Participants with Out of Home Placement assessed using an Out of Home Placement Questionnaire	T2 (post-intervention) up to 9 months	A participant is viewed as being placed out of home when they do not reside with their primary family, either temporarily or permanently, and either voluntarily or involuntarily. Out of home placement will be assessed using a questionnaire measuring living situation, which is filled in by juveniles and caregivers. The questionnaire contains one item assessing where the juvenile lives most days of the week.
Change in Recidivism Risk assessed with the RAF GGZ Youth	T1 (baseline); T2 (post-intervention) up to 9 months	The RAF GGZ Youth is an extensive risk assessment instrument and includes items measuring recidivism risk. The RAF GGZ Youth is filled in by the therapist as part of the standard FAST procedure. Possible scores range from 1 (low) to 5 (high).
Change in Substance Use assessed with the RAF GGZ Youth	T1 (baseline); T2 (post-intervention) up to 9 months	The RAF GGZ Youth is an extensive risk assessment instrument and includes items measuring substance use. The RAF GGZ Youth is filled in by the therapist as part of the standard FAST procedure.
Change in Behavioral Control assessed by the Parenting Practices	T1 (baseline); T2 (post-intervention) up to 9 months	The Parent Practices is a juvenile and caregiver self-reported instrument and contains six items. Possible scores range from 1 (never) to 5 (always).
Change in Parental Monitoring assessed by the Parental Monitoring Scale	T1 (baseline); T2 (post-intervention) up to 9 months	The Parental Monitoring Scale is reported on by juveniles. It contains five items and one additional item measuring parental knowledge about school grades. Possible scores range from 1 (nothing) to 4 (everything).
Change in Personality assessed by the Narcissism and Impulse Control scales of the Antisocial Process Screening Device (APSD)	T1 (baseline)	The APSD is reported by juveniles and caregivers. The scales contain 12 items for juveniles and 16 items for caregivers. Possible scores range from 1 (completely true) to 4 (always true).
Treatment Completion assessed by Therapist File Search	T2 (post-intervention) up to 9 months from baseline	Treatment completion will be assessed by coding whether FAST completion was registered as positive or negative.
Change in Caregiver Competence assessed by the Nijmeegse Parenting Stress Index (NPSI)	T1 (baseline); T2 (post-intervention) up to 9 months	The NPSI is a caregiver self-reported instrument and contains 15 items. Possible scores range from 1 (completely disagree) to 6 (completely agree).
Caregiver Psychopathology assessed by the RAF GGZ Youth	T1 (baseline)	The RAF GGZ Youth is an extensive risk assessment instrument and includes items measuring caregiver psychopathology. The RAF GGZ Youth is filled in by the therapist as part of the standard FAST procedure. Possible scores range from 0 (problems not present) to 2 (problems definitely present).
Treatment Integrity assessed by the FAST Evaluation Forms	T2 (post-intervention) up to 9 months from baseline	The FAST evaluation forms are filled in by juveniles, caregivers, and therapists as part of the standard FAST procedure. Possible scores range from 0 (no) to 1 (yes), and 1 (very bad, never) to 10 (very good, always).
Treatment Duration assessed by Therapist File Search	T2 (post-intervention) up to 9 months from baseline	Treatment duration will be calculated based on the registered direct treatment time by therapists in their appointment agendas. Treatment duration will be measured in weeks.
Treatment Expectancies assessed by the Parent Expectancies for Therapy Scale (PETS)	T1 (baseline)	The PETS is a caregiver self-reported instrument and contains seven items. Possible scores range from 1 (completely disagree) to 5 (completely agree).
Treatment Cooperation assessed by the Cooperation Scale	T2 (post-intervention) up to 9 months from baseline	The Cooperation Scale is reported on by juveniles, caregivers, and therapists and contains five items. Possible scores range from 1 (completely disagree) to 6 (completely agree).

Trial Locations

Locations (2)

de Waag; 🇳🇱 Utrecht, Netherlands

Utrecht University; 🇳🇱 Utrecht, Netherlands