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Alighieri C, Mouton T, Allemeersch F, Van Lierde K. "The Decision to End Speech Therapy Brought More Peace and Tranquility Into Our Family": Exploring Speech-Related Treatment Fatigue and Dropout in Parents and Children With a Cleft Palate. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-14. [PMID: 39116321 DOI: 10.1044/2024_ajslp-24-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE Treatment fatigue is a complex, multidimensional, multicausal, and subjective phenomenon that is not yet well explored and understood in the area of speech therapy. The purpose of this study was to investigate speech-related treatment fatigue and speech treatment dropout in parents and children with a cleft (lip and) palate receiving or having received speech treatment for cleft-related articulation disorders. METHOD Thirteen participants were included in this study (n = seven parents with a median age of 40 years and n = six children with a median age of 10 years). Qualitative semistructured interviews were conducted separately with parents and children to investigate their experiences with cleft speech treatment. An inductive thematic approach was used to analyze the data and construct different themes. Rigor of the data was verified by conducting an investigator triangulation and by performing member checks. RESULTS AND CONCLUSIONS The analyses of the interviews yielded three major themes of importance to the children and their parents: (a) physical symptoms of treatment fatigue, (b) psychological symptoms of treatment fatigue, and (c) from treatment fatigue to treatment dropout. Physical symptoms of treatment fatigue were mainly related to transportation burden. On a psychological level, speech treatment may potentially lead to a cognitive-emotional overload. These feelings are primarily related to the practical issue of scheduling required treatment sessions in the family agenda. The decision to discontinue speech treatment was reported to be multifactorial. In this decision-making process, data suggested that the child's perspective must be heard more.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University, Belgium
| | - Tara Mouton
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University, Belgium
| | - Fien Allemeersch
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University, Belgium
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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2
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Kaajalaakso K, Luntamo T, Korpilahti-Leino T, Ristkari T, Hinkka-Yli-Salomäki S, Sourander A. Predictors of dropout, time spent on the program and client satisfaction in an internet-based, telephone-assisted CBT anxiety program among elementary school children in a population-based sample. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02486-8. [PMID: 38849670 DOI: 10.1007/s00787-024-02486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024]
Abstract
Increasing evidence has shown that childhood anxiety can be effectively treated by Internet-based cognitive behavioral therapy (ICBT). Being able to predict why participants decide to drop out of such programs enables scarce resources to be used appropriately. The aim of this study was to report dropout predictors for a population-based ICBT intervention aimed at children with anxiety, together with the time they and their parents spent on the program and client satisfaction rates. The study focused on 234 Finnish children aged 10-13 who received an ICBT intervention, with telephone support, for anxiety symptoms, as a part of a randomized control trial. Their parents also had access to Internet-based material and participated in the weekly telephone calls with the coach. Possible drop out factors were explored and these included various family demographics, child and parent psychopathology and therapeutic alliance. Just under a fifth (23.9%) of the children dropped out of the intervention. The risk was higher if the child did not fulfill the criteria for any anxiety diagnosis or reported a poorer therapeutic alliance. Family demographics and the COVID-19 pandemic did not increase the risk. The families spent an average of 127 min on the webpage each week and an average of 32 min on the phone calls. The overall satisfaction with the program was 87% for the children and 95% for the parents. Both the children and the parents found the telephone calls helpful. These findings are important in clinical practice when assessing a family's eligibility for ICBT.
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Affiliation(s)
- Katri Kaajalaakso
- Child psychiatry, University of Turku, Turku University Hospital, Turku, Finland.
| | - Terhi Luntamo
- Child psychiatry, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Terja Ristkari
- Child psychiatry, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Andre Sourander
- Child psychiatry, University of Turku, Turku University Hospital, Turku, Finland
- INVEST Research Flagship, University of Turku, Turku, Finland
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3
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Williams P, Slonims V, Weinman J. 'Turning up and tuning in'. Factors associated with parental non-attendance and non-adherence in intervention for young children with speech, language communication needs. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:762-778. [PMID: 37824327 DOI: 10.1111/1460-6984.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non-attendance or non-adherence that are multifactorial and variable dependent on, for example, population and intervention. AIMS To identify rates of non-attendance and non-adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. METHODS Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self-efficacy), personal circumstances (socio-demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non-attendance rates were identified via local health records and non-adherence ascertained using a specific parent-reported measure within the treatment experience domain. RESULTS Participants (N = 199) were predominantly mothers, and were ethnically and socio-economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non-attendance was 25% and the main predictors of non-attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non-adherence in this cohort was 26% with parental rating of the importance of a recommendation and self-efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. CONCLUSIONS & IMPLICATIONS Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS What is already known on the subject It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge This study identified rates of parental non-attendance and non-adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non-attendance. What are the potential or actual clinical implications of this work? This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN.
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Affiliation(s)
- Penny Williams
- Children's neurosciences, Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vicky Slonims
- Children's neurosciences, Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
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4
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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5
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Phillips DA, Ginsburg GS, Ehrenreich-May J, Jensen-Doss A. Treatment Engagement in Adolescents: The Associations of Sociodemographic Characteristics, Caregiver Perceived Barriers, and Clinical Impairment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-14. [PMID: 37347999 PMCID: PMC10739653 DOI: 10.1080/15374416.2023.2222387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the associations between sociodemographic characteristics, perceived barriers to treatment, clinical impairment, and youth treatment engagement. METHOD Participants included 196 families (youth: ages 12 to 18; 64.3% cis-gender female; 23.5% Black, 60.7% White, and 12.2% Mixed/Other race; 41.3% Hispanic or Latinx ethnicity) recruited as part of a comparative effectiveness trial for adolescent anxiety and depression. Self-report measures of sociodemographic characteristics and caregiver perceived barriers were completed at intake. Youth clinical impairment was assessed at baseline via clinical interview. Measures of engagement were collected throughout treatment, including initiation status, session attendance, and termination status. Relationships were examined using analyses of variances and hierarchal linear and logistic modeling. RESULTS Perceived barriers did not differ by sociodemographic characteristics. Greater perceived stressors and obstacles predicted fewer sessions attended and a lower likelihood of successful termination. Youth of caregivers with an advanced degree and those with caregivers who were employed part time attended more sessions and were more likely to initiate and terminate treatment successfully compared to youth with caregivers of a lower education level or student or unemployed status. At higher levels of youth clinical impairment, greater perceived treatment demands and issues predicted reduced likelihood of treatment initiation. CONCLUSIONS Perceived barriers, sociodemographic characteristics, and clinical impairment were all associated with levels of engagement in the treatment process. Baseline and continued assessment of perceived and experienced barriers to treatment may promote individualized strategies for families identified as at-risk for reduced engagement.
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Affiliation(s)
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine
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6
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Escovar EL, Bocanegra ES, Craske MG, Bystritsky A, Roy-Byrne P, Sherbourne CD, Stein MB, Chavira DA. Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders. J Nerv Ment Dis 2023; 211:427-439. [PMID: 37252881 PMCID: PMC10234492 DOI: 10.1097/nmd.0000000000001533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ABSTRACT Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.
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Affiliation(s)
| | | | | | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, University of Washington at Harborview Medical Center, Seattle, Washington
| | | | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Pubic Health, University of California, San Diego, La Jolla, California
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7
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Eslinger J, Sprang G, Jodts J. Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program. Clin Child Psychol Psychiatry 2023; 28:721-733. [PMID: 35762135 DOI: 10.1177/13591045221111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.
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Affiliation(s)
- Jessica Eslinger
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Ginny Sprang
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Jenna Jodts
- Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
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de Soet R, Vermeiren RRJM, Bansema CH, van Ewijk H, Nijland L, Nooteboom LA. Drop-out and ineffective treatment in youth with severe and enduring mental health problems: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02182-z. [PMID: 36882638 DOI: 10.1007/s00787-023-02182-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Youth with severe and enduring mental health problems (SEMHP) tend to drop out of treatment or insufficiently profit from treatment in child and adolescent psychiatry (CAP). Knowledge about factors related to treatment failure in this group is scarce. Therefore, the aim of this systematic review was to thematically explore factors associated with dropout and ineffective treatment among youth with SEMHP. After including 36 studies, a descriptive thematic analysis was conducted. Themes were divided into three main categories: client, treatment, and organizational factors. The strongest evidence was found for the association between treatment failure and the following subthemes: type of treatment, engagement, transparency and communication, goodness of fit and, perspective of practitioner. However, most other themes showed limited evidence and little research has been done on organizational factors. To prevent treatment failure, attention should be paid to a good match between youth and both the treatment and the practitioner. Practitioners need to be aware of their own perceptions of youth's perspectives, and transparent communication with youth contributes to regaining their trust.
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Affiliation(s)
- R de Soet
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands.
| | - R R J M Vermeiren
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
- Youz, Parnassia Group, The Hague, The Netherlands
| | - C H Bansema
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - H van Ewijk
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L Nijland
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L A Nooteboom
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
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9
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Albaum CS, Vashi N, Bohr Y, Weiss JA. A Systematic Review of Therapeutic Process Factors in Mental Health Treatment for Autistic Youth. Clin Child Fam Psychol Rev 2023; 26:212-241. [PMID: 35999330 PMCID: PMC9879813 DOI: 10.1007/s10567-022-00409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
Understanding the role of therapeutic process factors in treatment change may prove useful for discerning why some autistic youth benefit from psychosocial interventions that target emotional and psychological aspects of mental health, while others do not. The aim of the current study was to synthesize what is currently known about therapeutic process factors in mental health treatment of emotional and psychological challenges for autistic youth, regarding how process factors have been measured in past research, and the relation between process factors and treatment outcome. A systematic review of the literature was conducted to narratively synthesize all articles published up until June 2021. Methodological quality of included studies was appraised. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. There is a limited, albeit growing, body of high-quality research evaluating the role of process factors in the treatment of mental health issues for autistic youth. Future research should continue to examine process factors in relation to treatment outcome, and validate measures to accurately capture process-related constructs in mental health treatment for this population. Greater understanding of therapy processes can lead to developing evidence-informed strategies that clinicians can implement to promote positive expectations, relationships, and engagement.
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Affiliation(s)
- Carly S Albaum
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Nisha Vashi
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Yvonne Bohr
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Becker KD, Chorpita BF. Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:284-309. [PMID: 36787342 DOI: 10.1080/15374416.2023.2169926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and "finished" bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities.
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11
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Casline EP, Ogle RR, Peris TS, Kendall PC, Piacentini J, Compton S, Keeton C, Ginsburg GS. Client-rated facilitators and barriers to long-term youth anxiety disorder recovery. J Clin Psychol 2022; 78:2164-2179. [PMID: 35687807 PMCID: PMC9561069 DOI: 10.1002/jclp.23400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.
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Affiliation(s)
| | - Robert R. Ogle
- Counseling Center, Yeshiva University, New York, NY, USA
| | - Tara S. Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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12
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Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One-session treatment compared with multisession CBT in children aged 7–16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022; 26:1-174. [DOI: 10.3310/ibct0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background
Up to 10% of children and young people have a specific phobia that can significantly affect their mental health, development and daily functioning. Cognitive–behavioural therapy-based interventions remain the dominant treatment, but limitations to their provision warrant investigation into low-intensity alternatives. One-session treatment is one such alternative that shares cognitive–behavioural therapy principles but has a shorter treatment period.
Objective
This research investigated the non-inferiority of one-session treatment to cognitive–behavioural therapy for treating specific phobias in children and young people. The acceptability and cost-effectiveness of one-session treatment were examined.
Design
A pragmatic, multicentre, non-inferiority randomised controlled trial, with embedded economic and qualitative evaluations.
Settings
There were 26 sites, including 12 NHS trusts.
Participants
Participants were aged 7–16 years and had a specific phobia defined in accordance with established international clinical criteria.
Interventions
Participants were randomised 1 : 1 to receive one-session treatment or usual-care cognitive–behavioural therapy, and were stratified according to age and phobia severity. Outcome assessors remained blind to treatment allocation.
Main outcome measures
The primary outcome measure was the Behavioural Avoidance Task at 6 months’ follow-up. Secondary outcomes included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children’s Anxiety and Depression Scale, a goal-based outcome measure, Child Health Utility 9D, EuroQol-5 Dimensions Youth version and resource usage. Treatment fidelity was assessed using the Cognitive Behaviour Therapy Scale for Children and Young People and the One-Session Treatment Rating Scale.
Results
A total of 274 participants were recruited, with 268 participants randomised to one-session treatment (n = 134) or cognitive–behavioural therapy (n = 134). A total of 197 participants contributed some data, with 149 participants in the intention-to-treat analysis and 113 in the per-protocol analysis. Mean Behavioural Avoidance Task scores at 6 months were similar across treatment groups when both intention-to-treat and per-protocol analyses were applied [cognitive–behavioural therapy: 7.1 (intention to treat), 7.4 (per protocol); one-session treatment: 7.4 (intention to treat), 7.6 (per protocol); on the standardised scale adjusted mean difference for cognitive–behavioural therapy compared with one-session treatment –0.123, 95% confidence interval –0.449 to 0.202 (intention to treat), mean difference –0.204, 95% confidence interval –0.579 to 0.171 (per protocol)]. These findings were wholly below the standardised non-inferiority limit of 0.4, which suggests that one-session treatment is non-inferior to cognitive–behavioural therapy. No between-group differences in secondary outcome measures were found. The health economics evaluation suggested that, compared with cognitive–behavioural therapy, one-session treatment marginally decreased the mean service use costs and maintained similar mean quality-adjusted life-year improvement. Nested qualitative evaluation found one-session treatment to be considered acceptable by those who received it, their parents/guardians and clinicians. No adverse events occurred as a result of phobia treatment.
Limitations
The COVID-19 pandemic meant that 48 children and young people could not complete the primary outcome measure. Service waiting times resulted in some participants not starting therapy before follow-up.
Conclusions
One-session treatment for specific phobia in UK-based child mental health treatment centres is as clinically effective as multisession cognitive–behavioural therapy and highly likely to be cost-saving. Future work could involve improving the implementation of one-session treatment through training and commissioning of improved care pathways.
Trial registration
This trial is registered as ISRCTN19883421.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Lucy Tindall
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Penny Bee
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Han-I Wang
- Centre for Health Economics, University of York, York, UK
| | - Lina Gega
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Emily Hayward
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Kiera Solaiman
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thompson Davis
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Karina Lovell
- School of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Jon Wilson
- Central Norfolk Youth Service, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Dean McMillan
- Centre for Health Economics, University of York, York, UK
| | - Amy Barr
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jennifer Lomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Parrott
- Centre for Health Economics, University of York, York, UK
| | - Catarina Teige
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rebecca Hargate
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Shehzad Ali
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - Sarah Parkinson
- COMIC Research Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, Hull York Medical School, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
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13
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Rothschild LB, Ratto AB, Kenworthy L, Hardy KK, Verbalis A, Pugliese C, Strang JF, Safer-Lichtenstein J, Anthony BJ, Anthony LG, Guter MM, Haaga DAF. Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes. J Clin Psychol 2022; 78:1388-1406. [PMID: 34997971 DOI: 10.1002/jclp.23309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. METHODS Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. RESULTS Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. CONCLUSIONS Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.
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Affiliation(s)
- Leah B Rothschild
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | | | - Bruno J Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Laura G Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Madison M Guter
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - David A F Haaga
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
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14
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Haukeland YB, Fjermestad KW, Mossige S, Vatne TM. Parent-child communication about emotions during SIBS: a joint intervention for siblings and parents of children with chronic disorders. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.1986850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Krister Westlye Fjermestad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Frambu Competence Center for Rare Disorders, Siggerud, Norway
| | - Svein Mossige
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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15
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Collyer H, Eisler I, Woolgar M. Parent and Youth Perspectives and Retention in Functional Family Therapy. FAMILY PROCESS 2021; 60:316-330. [PMID: 32951207 DOI: 10.1111/famp.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This qualitative study aimed to understand factors relating to dropout in Functional Family Therapy (FFT) through exploring the experience of families who have completed FFT and those who have dropped out from therapy. Individual interviews were undertaken with parents and adolescents from 12 families who had completed FFT therapy in England and eight families who had dropped out from therapy. Using thematic analysis, six themes were established, clustered within three domains. The patterns of responses across the accounts of families who did and did not complete FFT suggest processes that may facilitate retention in FFT. These include relational processes specific to family therapy including having a shared problem definition and a balanced therapeutic alliance. In addition, processes commonly observed across both individual- and family-based interventions were found. These include the credibility and relevance of the therapeutic work, openness in therapy, and practical barriers. Findings also suggest that establishing motivation to participate in therapy may be more important for retention in therapy than overcoming practical barriers. Barriers to retention in therapy also differ for parents and young people. These differences highlight the importance of the therapist maintaining credibility and support for parents while concurrently reducing blame toward the young person to encourage youth openness. Findings have implications for therapist actions to retain families when using the FFT model.
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Affiliation(s)
- Hannah Collyer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matt Woolgar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Soucy JN, Hadjistavropoulos HD, Karin E, Dear BF, Titov N. Brief online motivational interviewing pre-treatment intervention for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial. Internet Interv 2021; 25:100394. [PMID: 33996510 PMCID: PMC8099490 DOI: 10.1016/j.invent.2021.100394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
While the efficacy of therapist-guided internet-delivered cognitive behaviour therapy (iCBT) for anxiety and depression is well-established, a significant proportion of clients show little to no improvement with this approach. Given that motivational interviewing (MI) is found to enhance face-to-face treatment of anxiety, the current trial examined potential benefits of a brief online MI intervention prior to therapist-guided iCBT. Clients applying to transdiagnostic therapist-guided iCBT in routine care were randomly assigned to receive iCBT with (n = 231) or without (n = 249) the online MI pre-treatment. Clients rated motivation at screening and pre-iCBT and anxiety and depression at pre- and post-treatment and at 13- and 25-week follow-up after enrollment. Clients in the MI plus iCBT group made more motivational statements in their emails and were enrolled in the course for a greater number of days compared to clients who received iCBT only, but did not demonstrate higher motivation after completing the MI intervention or have higher course completion. Clients in both groups, at screening and pre-iCBT, reported high levels of motivation. No statistically significant group differences were found in the rate of primary symptom change over time, with both groups reporting large reductions in anxiety and depression pre- to post-treatment (Hedges' g range = 0.96-1.11). During follow-up, clients in the iCBT only group reported additional small reductions in anxiety, whereas clients in the MI plus iCBT group did not. The MI plus iCBT group also showed small increases in depression during follow-up, whereas improvement was sustained for the iCBT only group. It is concluded that online MI does not appear to enhance client outcomes when motivation at pre-treatment is high.
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Affiliation(s)
- Joelle N. Soucy
- Department of Psychology, University of Regina, Regina, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada,Corresponding author at: 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
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17
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Visagie L, Loxton H, Swartz L, Stallard P. Cognitive behaviour therapy-based early intervention and prevention programme for anxiety in South African children with visual impairments. Afr J Disabil 2021; 10:796. [PMID: 33604268 PMCID: PMC7876962 DOI: 10.4102/ajod.v10i0.796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. Objectives The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. Method A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9–14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1–T4). Results The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. Conclusion This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area.
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Affiliation(s)
- Lisa Visagie
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Helene Loxton
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paul Stallard
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Claverton Down, Bath, United Kingdom
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18
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Desrosiers L, Saint-Jean M, Laporte L, Lord MM. Engagement complications of adolescents with borderline personality disorder: navigating through a zone of turbulence. Borderline Personal Disord Emot Dysregul 2020; 7:18. [PMID: 32884818 PMCID: PMC7460802 DOI: 10.1186/s40479-020-00134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. METHOD A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). RESULTS Well before dropout occurs, different phenomena identified as "engagement complications" characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a "zone of turbulence" which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. CONCLUSION Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.
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Affiliation(s)
- Lyne Desrosiers
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
| | | | - Lise Laporte
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
- McGill University Health Centre, Montréal, Québec Canada
| | - Marie-Michèle Lord
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
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19
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Packard AE, Warren JS, Linford LB. Parent functioning and child psychotherapy outcomes: Predicting outcomes in usual care. J Clin Psychol 2020; 77:49-59. [PMID: 32721047 DOI: 10.1002/jclp.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/25/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was (1) to examine whether three domains of a parent's functioning-parent distress, interpersonal relationships, and social role performance-changed over the course of their child's treatment, (2) to examine how these factors as measured at intake predicted youth progress in psychotherapy, and (3) to examine whether changes in these parent factors over the course of youth psychotherapy were associated with changes in youth symptoms. METHOD Participants were 339 youth, ages 4-17 and their parents from a community outpatient treatment setting undergoing usual care. Parent and child outcomes were examined across five time points over the course of child treatment. Hierarchical linear modeling was used to examine the relationship between parent domains and youth progress in therapy. RESULTS Results suggested that parent domains significantly predicted their child's symptoms at intake as well as change in psychotherapy. In addition, parent domains improved over the course of youth treatment and the progression of these changes was related to the progression of changes in youth scores across the course of treatment. CONCLUSIONS The results of this study highlight the important relationship between youth and parent functioning in the context of treatment of youth mental health issues.
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Affiliation(s)
- Anna E Packard
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Jared S Warren
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Lauren B Linford
- Department of Psychology, Brigham Young University, Provo, Utah, USA
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20
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Drent HM, van den Hoofdakker B, de Bildt A, Buitelaar JK, Hoekstra PJ, Dietrich A. Factors related to parental pre-treatment motivation in outpatient child and adolescent mental health care. Eur Child Adolesc Psychiatry 2020; 29:947-958. [PMID: 31552498 PMCID: PMC7321896 DOI: 10.1007/s00787-019-01391-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/16/2019] [Indexed: 11/02/2022]
Abstract
The aim of this study was to investigate the relation between a variety of child, parent, family and environmental factors and pre-treatment motivation of parents of children and adolescents newly referred to a mental health care clinic in The Netherlands. Data were collected of 521 parents most involved in the upbringing of the child (443 mothers and 78 fathers; Dutch origin 97.1%) of 207 girls and 314 boys (age M = 10.2, range 1-18 years). Treatment motivation was measured by the Parent Motivation Inventory. Least absolute shrinkage and selection operator (LASSO) regression was used to investigate the prediction strength of 33 factors in 5 domains: (1) source of referral and prior use of healthcare services, (2) child characteristics, (3) characteristics of the primary parent, (4) parenting characteristics of the primary parent, and (5) family characteristics. Twenty-one factors were statistically relevant, explaining 21.3% of the deviance in pre-treatment motivation. Child characteristics, mainly type and severity of problems, contributed most to the model. Notably, internalising problems contributed more than externalising problems. Furthermore, we found relations between parental pre-treatment motivation and parents' perceived self-efficacy, parents' perceived parenting competence, financial problems and source of referral. Our findings provide insight into the multifacetedness of parental motivation prior to starting treatment and inform health professionals of specific contextual factors of interest in parents' readiness to change their behaviour and participate in treatment.
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Affiliation(s)
- Halewijn M Drent
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 A10, 9700 GZ, Groningen, The Netherlands.
| | - Barbara van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 A10, 9700 GZ, Groningen, The Netherlands
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 A10, 9700 GZ, Groningen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 A10, 9700 GZ, Groningen, The Netherlands
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21
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Fjermestad KW, Føreland Ø, Oppedal SB, Sørensen JS, Vognild YH, Gjestad R, Öst LG, Bjaastad JF, Shirk SS, Wergeland GJ. Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:229-242. [PMID: 31910051 DOI: 10.1080/15374416.2019.1683850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed. METHOD Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects. RESULTS The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance. CONCLUSION Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.
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Affiliation(s)
| | - Øyvind Føreland
- Department of Psychology, University of Oslo.,Department for Addiction Medicine, Sørlandet Regional Hospital Trust
| | - Silje B Oppedal
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Julie S Sørensen
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Ylva H Vognild
- Department of Psychology, University of Oslo.,Vinderen Adult Mental Health Services, Diakonhjemmet Hospital
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital
| | | | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre
| | | | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen
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22
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O’Keeffe S, Martin P, Target M, Midgley N. 'I Just Stopped Going': A Mixed Methods Investigation Into Types of Therapy Dropout in Adolescents With Depression. Front Psychol 2019; 10:75. [PMID: 30804827 PMCID: PMC6370696 DOI: 10.3389/fpsyg.2019.00075] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/10/2019] [Indexed: 12/17/2022] Open
Abstract
What does it mean to 'drop out' of therapy? Many definitions of 'dropout' have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client's experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether this refined categorization of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioral Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11-17 years. Thirty-two were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. Sixty-seven cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analyzed using ideal type analysis. Three types of dropout were constructed: 'dissatisfied' dropout, 'got-what-they-needed' dropout, and 'troubled' dropout. 'Dissatisfied' dropouts reported stopping therapy because they did not find it helpful. 'Got-what-they-needed' dropouts reported stopping therapy because they felt they had benefitted from therapy. 'Troubled' dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of 'dropout' cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment.
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Affiliation(s)
- Sally O’Keeffe
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Child Attachment and Psychological Therapies Research Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Peter Martin
- Child Attachment and Psychological Therapies Research Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Child Attachment and Psychological Therapies Research Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
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Rich BA, Shiffrin ND, Cummings CM, Zarger MM, Berghorst L, Alvord MK. Resilience-Based Intervention with Underserved Children: Impact on Self-Regulation in a Randomized Clinical Trial in Schools. Int J Group Psychother 2019; 69:30-53. [PMID: 38449213 DOI: 10.1080/00207284.2018.1479187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Resilience and emotion regulation are crucial for optimal psychosocial functioning in children. This study assessed whether a group-based intervention, the Resilience Builder Program (RBP), improved student report of emotion regulation when administered in elementary schools. Sixty-seven students aged 9-12 years (M = 10.50, SD =.74; 82.1% male, 98.5% ethnic/racial minority) were randomly assigned to receive the RBP intervention immediately or following a semester delay. Participants reported their emotional control using the How I Feel scale. Students who received the RBP reported a significant increase in their emotional control and a significant decrease in negative emotion compared to those students in the delayed treatment sample who had not yet received the intervention. Further, students indicated a strongly positive perception of the therapy.
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The Relationship Between Treatment Acceptability and Youth Outcome in Group CBT for Youth with ASD and Anxiety. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018. [DOI: 10.1007/s10879-018-9380-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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O'Keeffe S, Martin P, Goodyer IM, Wilkinson P, Consortium I, Midgley N. Predicting dropout in adolescents receiving therapy for depression. Psychother Res 2017; 28:708-721. [PMID: 29084488 DOI: 10.1080/10503307.2017.1393576] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Therapy dropout is a common occurrence, especially in adolescence. This study investigated whether dropout could be predicted from a range of child, family, and treatment factors in a sample of adolescents receiving therapy for depression. METHOD This study draws on data from 406 participants of the IMPACT study, a randomized controlled trial, investigating three types of therapy in the treatment of adolescent depression. Logistic regression was used to estimate the effects of predictors on the odds of dropout. RESULTS Few pre-treatment predictors of dropout were found, with the only significant predictors being older age, antisocial behaviour, and lower scores of verbal intelligence. Missed sessions and poorer therapeutic alliance early in treatment also predicted dropout. Most child and family factors investigated were not significantly associated with dropout. CONCLUSIONS There may be little about depressed adolescents' presentation prior to therapy starting that indicates their risk of dropout. However, within-treatment factors indicated that warning signs of dropout may be identifiable during the initial phase of therapy. Identifying and targeting early treatment indicators of dropout may provide possibilities for improving engagement. Clinical and methodological significance of this article: In the literature, a great deal of attention has been paid to child and family factors that predict therapy dropout, yet in this study, few pre-treatment characteristics were predictive of dropout. However, findings revealed possible warning signs of dropout in the early part of treatment, as poor therapeutic alliance and missed sessions were both found to be predictive of dropout. These findings call for therapists to be aware of such warning signs and clinical guidelines for managing cases at risk of dropout are warranted.
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Affiliation(s)
- Sally O'Keeffe
- a Research Department of Clinical, Educational and Health Psychology , University College London , London , UK.,b Child Attachment and Psychological Therapies Research Unit (ChAPTRe) , Anna Freud National Centre for Children and Families , London , UK
| | - Peter Martin
- b Child Attachment and Psychological Therapies Research Unit (ChAPTRe) , Anna Freud National Centre for Children and Families , London , UK.,c Department of Applied Health Research , University College London , London , UK
| | - Ian M Goodyer
- d Department of Psychiatry , University of Cambridge , Cambridge , UK
| | - Paul Wilkinson
- d Department of Psychiatry , University of Cambridge , Cambridge , UK
| | - Impact Consortium
- d Department of Psychiatry , University of Cambridge , Cambridge , UK
| | - Nick Midgley
- a Research Department of Clinical, Educational and Health Psychology , University College London , London , UK.,b Child Attachment and Psychological Therapies Research Unit (ChAPTRe) , Anna Freud National Centre for Children and Families , London , UK
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Salloum A, Johnco C, Lewin AB, McBride NM, Storch EA. Barriers to access and participation in community mental health treatment for anxious children. J Affect Disord 2016; 196:54-61. [PMID: 26901657 DOI: 10.1016/j.jad.2016.02.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/01/2015] [Accepted: 02/07/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders among children in the United States; yet many children do not receive treatment due to barriers to treatment access and participation. This study examined common barriers to treatment access and participation among anxious children who participated in computer-assisted cognitive behavioral therapy. Differences in barriers reported by treatment completers/non-completers were examined, as was the association with sociodemographic characteristics, anxiety severity, and impairment. The impact of barriers on treatment response was assessed, as well as the relationship with treatment expectancy and satisfaction. METHOD Barriers to access and participation, demographics, anxiety severity/impairment, treatment credibility and satisfaction were assessed among parents and children with anxiety (N=100; ages 7-13) who were enrolled in a community-based randomized clinical trial. RESULTS The most common access barrier was parents not knowing where or from whom to seek services (66%). Differences among completers and non-completers were related to stigma, confidentiality, and costs. The most common parent-reported barrier to participating was stress (32.4%) and child-reported barrier to participation was not having enough time to complete homework (22.1%). Of the sociodemographic, clinical and treatment characteristics, minority status, satisfaction, and treatment response were associated with barriers to treatment participation, although these associations varied by barriers related to treatment and external factors. LIMITATIONS Cross sectional design and lack of well-established psychometric properties for barriers measures were limitations. CONCLUSION Findings suggest that accessible, time-efficient, cost-effective service delivery methods that minimize stigma and maximize engagement when delivering evidence-based treatment for pediatric anxiety are needed.
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Affiliation(s)
- Alison Salloum
- School of Social Work, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, United States
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, United States
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, United States; Department of Health Policy and Management, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States; Department of Psychology, University of South Florida, United States; Rogers Behavioral Health - Tampa Bay, United States; All Children's Hospital - Johns Hopkins Medicine, United States
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Duong MT, Lyon AR, Ludwig K, Wasse JK, McCauley E. Student Perceptions of the Acceptability and Utility of Standardized and Idiographic Assessment in School Mental Health. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2016; 18:19-63. [PMID: 27441029 DOI: 10.1080/14623730.2015.1079429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based assessment (EBA) comprises the use of research and theory to select methods and processes that have demonstrated reliability, validity, and clinical usefulness for prescribed populations. EBA can lead to positive clinical change, and recent work has suggested that it is perceived to be useful by school mental health providers. However, virtually nothing is known about student perceptions of assessment use. Semi-structured interviews were conducted with 31 ethnically diverse middle and high school students (71% female) receiving mental health services in school-based health centers. Findings indicated that the majority of students found assessments to be useful, and perceived three primary functions of assessments: structuring the therapy session, increasing students' self-awareness, and improving communication with the provider. Barriers to acceptability were also found for a minority of respondents. Some students found the nature of standardized assessments to be confining, and others expressed that they wanted more feedback from their counselors about their responses. Idiographic assessments demonstrated especially high acceptability in this sample, with students reporting that tracking idiographic outcomes increased self-awareness, spurred problem-solving, and helped them to reach behavioral goals. Implications for school mental health service improvements are discussed.
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Affiliation(s)
- Mylien T Duong
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Kristy Ludwig
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Wergeland GJH, Fjermestad KW, Marin CE, Bjelland I, Haugland BSM, Silverman WK, Öst LG, Bjaastad JF, Oeding K, Havik OE, Heiervang ER. Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders. Behav Res Ther 2015; 76:1-12. [PMID: 26583954 DOI: 10.1016/j.brat.2015.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022]
Abstract
A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.
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Affiliation(s)
- Gro Janne H Wergeland
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
| | - Krister W Fjermestad
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Carla E Marin
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Ingvar Bjelland
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Bente Storm Mowatt Haugland
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Lars-Göran Öst
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Stockholm, Stockholm, Sweden
| | - Jon Fauskanger Bjaastad
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Kristin Oeding
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Einar R Heiervang
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Waters AM, Groth TA, Sanders M, O'Brien R, Zimmer-Gembeck MJ. Developing Partnerships in the Provision of Youth Mental Health Services and Clinical Education: A School-Based Cognitive Behavioral Intervention Targeting Anxiety Symptoms in Children. Behav Ther 2015; 46:844-55. [PMID: 26520226 DOI: 10.1016/j.beth.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
Clinical scientists are calling for strong partnerships in the provision of evidence-based treatments for child mental health problems in real-world contexts. In the present study, we describe the implementation of a cognitive-behavioral intervention (CBI) to address grade 5 children's anxiety symptoms. The CBI arose from a long-standing partnership between University and Education Department stakeholders. The partnership integrates school-based, evidence-informed treatment delivery with clinical education, and also supports a school-based psychology clinic to provide assessment and treatment services to children attending schools within the catchment area and clinical training for university graduate students. Children in the active condition (N=74) completed the CBI during regular class time, while children in the control condition (N=77) received the standard classroom curriculum. Children's anxiety and depressive symptoms, threat interpretation biases (perceived danger and coping ability), and perceptions of their social skills were assessed before and after condition. Children in the active condition reported significant improvements in self-reported anxiety symptoms, and perceptions of their social skills and coping ability, whereas no significant differences were observed for children in the control condition from pre- to post-assessment. For a subset of children assessed 12 months after the CBI (n=76), symptom improvement remained stable over time and estimates of danger and coping ability showed even greater improvement. Results demonstrate the value of strong stakeholder partnerships in innovative youth mental health services, positive child outcomes, and clinical education.
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Affiliation(s)
- Allison M Waters
- Griffith University; The Nyunga Centre for Student and Family Support.
| | | | | | - Rosanne O'Brien
- Griffith University; The Nyunga Centre for Student and Family Support
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