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Presented by Benjamin J. Springer of the University of Utah February 18, 2009. 2007 Biennial Report: Effective Psychosocial Interventions for Youth with Behavioral and Emotional Problems.

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Presented by Benjamin J. Springer of the University of Utah February 18, 2009

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Presented by benjamin j springer of the university of utah february 18 2009

Presented by

Benjamin J. Springer

of the

University of Utah

February 18, 2009

2007 Biennial Report:EffectivePsychosocial Interventions for Youth with Behavioral and EmotionalProblems

Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with Serious Emotional Disturbance/Behavior Disorders

US Office of Education 84.325K

H325K080308


Effective interventions for youth

Effective Interventions for Youth

  • Updated review summarizing selected areas of the scientific literature on:

    • Interventions

    • Services

    • Medications

  • The Child and Adolescent Mental Health Division (CAMHD) of the Hawaii Department of Health Task Force for Empirical Basis to Services.

  • CAMHD was established to review scientific findings.

  • Goal is to broaden and update the summary of scientific information used to guide decisions about children’s care.


  • Methods

    Methods

    • Collective reports of APA Task Force on Psychological Intervention Guidelines.

    • American Academy of Child and Adolescent Psychiatry Practice Parameters

    • 322 studies were read and coded over a period of 3 years. (More than double the amount for the previous CAMHD Biennial Report).


    Levels of analysis treatment treatment families

    Levels of Analysis:Treatment & Treatment Families

    • Interventions were not defined at the level of specific manuals.

    • Majority of components with similar clinical strategies and theoretical underpinnings to qualify as “treatment families.”

    • Treatment Families were created to differentiate interventions with limited support from those with stronger support.


    Strength of evidence defined the new 5 level system

    Strength of Evidence Defined:The New 5-Level System

    • Level I: “Best Support” = APA Gold Standard of “Well-established” interventions.

    • Level II: “Good Support”: Same as Level I but doesn’t take into consideration studies involving experimental design/single subject design.

    • Level III: “Moderate Support”: Similar to Level II, refers to “treatment families” but do not use treatment manuals.

    • Level IV: “Minimal Support”: Preliminary and simply categorized as being differentiated from interventions with no scientific support whatsoever.

    • Level V: “No Support”: Treatment Family was tested and did not once outperform any control condition.


    Quality relevance the codes

    Quality & Relevance:The Codes…

    Trials

    # of studies contributing to “treatment family”

    Year

    Most recent/succesful study of an intervention

    Trainability

    Manual = High, No Manual = Low

    Compliance

    Attrition rate of treatment group

    Gender

    Age

    Mean Age of participants

    Ethnicity

    Therapist

    Training of providers

    Frequency

    Contact with child/family

    Duration

    Min/Max of time from pre-post treatment

    Format

    Group, Individual, Parents, etc.

    Setting

    Clinic? School?

    Effect Size

    SDs improved upon the mean


    Reliability

    Reliability

    • All papers, reviews, and codes were coded by INDEPENDENT RATERS using a detailed coding manual.

    • CAMHD approach is criterion-based as opposed to “consensus” based.

      -Cautionary Statement-

    • Reviews are meant to represent the state-of-the-art at the time.

    • Review is meant to be a guide in the treatment planning and inform decision-making.

    • Conservative and Reliable.


    Results of the review anxious or avoidant behavior problems

    Results of the Review:Anxious or Avoidant Behavior Problems

    • BEST SUPPORT: CBT, Exposure, Modeling, and Education

    • GOOD SUPPORT: Variations of CBT, Relaxation, CBT plus Meds, (Hypnosis was successful in 1 study), Assertiveness Training

    • MINIMAL SUPPORT: Psychodynamic Therapy, Play Therapy, Biofeedback, and Rational Emotive Therapy

    • NO SUPPORT: Attention, Client Centered Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Relationship Counseling, and Teacher Psychoeducation.


    Results attention and hyperactivity behaviors

    Results Attention and Hyperactivity Behaviors

    • BEST SUPPORT: Behavior Therapy + Meds, Self-Verbalization

    • GOOD SUPPORT: Parent Management Training, *Contingency Management*, Physical Exercise, Biofeedback, Social Skills + Meds, Relaxation, Problem Solving, Education.

    • MINIMAL SUPPORT: Parent Training and Social Skills, Social Skills(alone), Relaxation

    • NO SUPPORT: Client Centered Therapy, Self Control Training, Skill Development, PMT + Self-Verbalization


    Results autism spectrum disorders

    ResultsAutism Spectrum Disorders

    • BEST SUPPORT: Intensive Behavioral Treatment (ES = 1.27), Intensive Communication Training. (Communication Skills, Modeling, Social Skills Training, Goal Setting, Discrete Trial, Tangible Rewards, Praise, Maintenance/Relapse Prevention.)

    • “Intensive” = Daily, sometimes over the period of 5-years. Studies included ages from 2-12.

    • NO SUPPORT: Auditory Integration Training


    Results depressive or withdrawal behaviors

    ResultsDepressive or Withdrawal Behaviors

    • BEST SUPPORT: CBT, CBT + Meds

    • GOOD SUPPORT: Interpersonal Therapy, Relaxation, CBT with Parents, Client Centered Therapy, and Family Therapy

    • MINIMAL SUPPORT: Self-Control Training, Self-Modeling

    • NO SUPPORT: Attention, Counselors Care, Anger Management, Life Skills, Problem Solving


    Results delinquency and disruptive behavior

    ResultsDelinquency and Disruptive Behavior

    • BEST SUPPORT: Parent Management Training, Multisystemic Therapy, Contingency Management, Social Skills, CBT, Assertiveness Training

    • GOOD SUPPORT: Problem Solving, Communication Skills, PMT + Problem Solving, Client Centered Therapy, Anger Control, Relaxation, Functional Family Therapy, Multidimensional Treatment Foster Care, Rational Emotive Therapy, and Transactional Analysis

    • MODERATE SUPPORT: Self-Control Training, Peer Pairing, Outreach Counseling

    • MINIMAL SUPPORT: Stress Inoculation and Physical Exercise

    • NO SUPPORT: Catharsis, Collaborative Problem Sovling, Educaiton, Exposure, Family Empowerment, Family Systems Therapy, Group Therapy, Life Skills, Psychodynamic Therapy, Self-Verbalization, Skill Development.


    Results substance use

    ResultsSubstance Use

    • GOOD SUPPORT: Family Therapy, CBT, Contingency Management, Family Systems Therapy

    • NO SUPPORT: Client Centered Therapy, 12-Step Program


    Results traumatic stress

    ResultsTraumatic Stress

    • BEST SUPPORT: CBT with Parents

    • GOOD SUPPORT: CBT

    • MINIMAL SUPPORT: Psychodrama, Play Therapy

    • NO SUPPORT: Client Centered Therapy, CBT with Parents Only, EMDR


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