+2007 Biennial Report:Effective Psychosocial Interventions for Youth with Behavioral and

Emotional Problems

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

Presented by Benjamin J. Springer

of the University of UtahFebruary 18, 2009

+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

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

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 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…

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

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

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

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

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

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

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 GOOD SUPPORT: Family Therapy, CBT,

Contingency Management, Family Systems Therapy

NO SUPPORT: Client Centered Therapy, 12-Step Program

+Results

Traumatic Stress BEST SUPPORT: CBT with Parents

GOOD SUPPORT: CBT

MINIMAL SUPPORT: Psychodrama, Play Therapy

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