Chapter 13 Intervention:Children and Adolescents INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO

Topics  Who is the Client?  Does Psychotherapy work for Children and Adolescents?  Evidence-Based Practice for Children and Adolescents  Evidence-Based Treatment Examples  Efficacy of Evidence-Based Treatment

 Children rarely refer themselves for treatment – they also do not usually pay for their services  Parents/Guardians usually make the referrals  Goals for children/adolescents often do not match goals for parents/teachers  Legal issues around consent are often complex Who is the Client for Child and Adolescent Services?

 Levitt (1957, 1963) – published findings saying no clear evidence of efficacy  Subsequent meta-analyses indicated similar positive results (effect sizes) as treatment of adults  Weisz found effect sizes of.79 (and larger for behavioural approaches)  Weighted Least Squares Method: assigns less weight to studies with smaller samples or greater error Does Psychotherapy Work for Children and Adolescents?

 Evidence-Based Practice exists for many childhood disorders.  However, they are not routinely offered in standard care  Difficulty in translating clinical trials into actual care  State of Hawaii Task force developed comprehensive care based on current research  Canadian Pediatric Society (CPS) has prepared research-based position statements Evidence-Based Practice for Children and Adolescents

 Many of the current treatments with evidence for their effectiveness are cognitive behavioural, behavioural, or interpersonal in approach  Questions about appropriateness of treatment for ethnically diverse youth:  Ethnic invariance: no differences when treatment is applied to diverse sample  Ethnic disparity: differences when treatment is applied to a diverse sample Evidence-Based Practice for Children and Adolescents

 No current guidelines for children by a psychological organization (unlike adults)  Some guidelines have been published for particular disorders such as the NICE guidelines – depression (2005), conduct disorder (2006), and ADHD (2008)  There are current efforts to develop interdisciplinary evidence-based guidelines for the assessment and treatment of childhood disorders Evidence-Based Practice for Children and Adolescents

 Parent Management Training (PMT)  Based on social learning theory and importance of changing child’s environment  Often used for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)  Delivered in a structured format using a treatment manual and repeated practice  Focuses on changing coercive exchanges – parent inadvertently rewards whining or aggression  Highlights the importance of cognitive and affective variables  Trains parents to work with children in prosocial ways Evidence-Based Treatment Examples

Skill Encouragement: small steps, prompting, contingent positive reinforcement Discipline: limit setting, mild sanctions Monitoring: tracking whereabouts & activities Problem Solving: establishing clear rules, consequences, negotiations Positive Involvement: loving attention PMT Core Parenting Skills

 Multisystemic Therapy for ODD and CD  Grounded in ecological theory  Works within the context of numerous systems – family, school, community, peer, juvenile justice  Interventions developmentally appropriate  Evaluated continuously from multiple perspectives  Caregiver plays a key role in this behavioural approach Evidence-Based Treatment Examples

 Nine Principles of Multisystemic Therapy for ODD and CD: 1. Assessment is to understand the problems in their broader context. 2. Therapeutic contacts emphasize the positive and use systemic strengths as levers for change. 3. Interventions are designed to promote responsible behavior among family members. 4. Interventions are present focused and action oriented, targeting specific problems. Evidence-Based Treatment Examples

1. Interventions target sequences of behaviour within and between multiple systems. 2. Interventions are developmentally appropriate 3. Interventions require daily or weekly effort by family members. 4. Intervention effectiveness is evaluated continuously from multiple perspectives. 5. Interventions are designed to promote treatment generalization and long-term change Evidence-Based Treatment Examples

Coping with Depression in Adolescence (CWDA)  Behavioural strategies  Increasing pleasant activities  Developing problem solving skills  Assertiveness  Cognitive strategies  Positive self-talk, coping, cognitive management Evidence-Based Treatment Examples

Coping with Depression in Adolescence (CWDA)  Affect management  Relaxation  Anger management  Dealing with negative emotion  Mood monitoring  Group format - psychoeducational Evidence-Based Treatment Examples

 Growing evidence that standard community care for children and adolescents is not effective  Research needed to assess whether the efficacy studies are translatable to community settings; and how to disseminate efficacy study findings Efficacy of Evidence-Based Treatment

Development of manuals that allow flexible implementation Graduate education in evidence-based treatment Continuing education in evidence-based treatment Training Protocols: Workshops, supervision and consultation Increased research on dissemination strategies Strategies to Facilitate the Dissemination of Evidence-based Treatment ( Exhibit 13.4 )

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