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 K H325K Presented by Benjamin J. Springer of the University of Utah February 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 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