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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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slide1

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