Ch 13: Intervention: Children and Adolescents Flashcards
Who is the client in psychological services for children and adolescents?
- rarely refer themselves and there is poor agreement between parents and youth about therapy goals
- parents serve as gatekeepers to enable or disable services
How many adolescents requiring services receive them?
- only 1/3
What do alliances predict?
- parent-therapist alliance predicts child/youth participation in therapy
- youth-therapist alliance predicts symptom improvement
What are the legal issues around consent in BC?
- youth is capable of consent at 12 years old
- only one parent needs to consent (divorced or separated)
- legal consent is necessary but not sufficient because the youth has to agree to participate
What is typical of risk factors for youth?
- often don’t have control over these conditions
- treatment must still address these contexts
What did Levitt find about child psychotherapy?
- found no evidence for the efficacy of child psychotherapy
What are the four large scale meta analyses in the 80s and 90s?
- Casey and Berman found effect sizes comparable to Smith and Glass
- Weisz found d=.79 (larger for behavioural approaches)
- Kazdin found large effect sizes and that studies often used volunteer school treatment groups (recommended a research focus on characteristics that influence outcome)
- Weisz used weighted least squares to calculate d=.54 (studies with more error variance assigned less weight)
What is publication bias?
- unpublished dissertations were stronger methodologically but obtained lower effect sizes than published studies
- more evident in child studies rather then adult studies
What are well-established treatments?
- well-established treatments produce effects superior to a placebo or another treatment in at least 2 different/independent trials meeting strict methodological criteria
What are probably-efficacious treatments?
- these meet the same criteria but evidence does not come from different/independent researchers
What did Huey and Polo find?
- a number of treatments are probably efficacious for minority youth
What does exhibit 13.1 in the textbook tell us?
- most treatments are behavioural, cognitive-behavioural and interpersonal
- many involve parents learning strategies to respond to children’s behaviours
- parental psychopathology may make it difficult for parents to engage in and complete services for children
What are disruptive behaviour disorders?
- disruptive behaviour is the most common reason for child referrals
- ODD -> CD: oppositional defiant disorder often leads to conduct disorder
What are effective treatments for disruptive behaviour disorders?
- parenting programs
- multisystematic therapy (MST)
What is an evidence-based treatment for adolescent depression?
- coping with depression in adolescence (CBT)
What are coercive exchanges?
- parents unintentionally reward the child for whining or aggression, child rewards the parents for giving in to his or her complaints
What are five parenting practices?
- skill encouragement
- discipline
- parental monitoring
- problem-solving
- positive involvement
What is multisystemic therapy (MST) for?
- designed to trat serious delinquency in adolescents by intervening in an integrated way in the multiple systems in which they are involved
What theories does MST come from?
- grounded in ecological theory and behavioural approach
- behaviour is multiply determined
How does MST work?
- caregiver plays a key role in youth’s short and long-term adjustment
- MST therapists work in teams of 2-5 with small caseloads and are available 24/7
What do the MST therapists do?
- faciliate collaboration between school and family
- target any caregiver barriers to parenting capacity
- services offered in homes, schools and neighbourhoods
- emphasis on developing supportive network for family
Do EBTs work?
- standard community care for child and adolescent disorders are less effective than evidence-based psychotherapy
- better outcome than 60% of youth receiving usual care
What did a review by Lee, Harvath and Hunsley find?
- > 75% of clients followed the course of services to completion with strong improvement rates for internalizing problems an greater variability in outcomes for parenting interventions to treat disruptive behaviours
What is the use of treatment manuals associated with?
- early alliance
- use of treatment manuals does not undermine therapeutic alliance
What are modular treatment options?
- modular approach allows for tailoring of services to meet the needs of youth for whom there is no single evidence-based program
What did Chorpita and Daleiden do in relation to modular treatment options?
- reviewed 322 randomized controlled trials of treatments for youth
- identified clusters of treatment strategies shown to be efficacious
- advocated for individualizing treatments by selecting and integrating treatment modules that correspond to client’s presenting problems
What did Weisz do in relation to modular treatment?
- developed modular treatment options for depression, anxiety and conduct problems in children aged 7 to 13
- modular treatment outperformed treatment as usual and specific EBTs
What is RAD?
- reducing anxiety and depression
- weekly (12 sessions) or bootcamp (5-6 sessions)
- 8-10 adolecents age 13-18
- recruited from waitlist or offered group as supplement to individual treatment
- manualized CBT
Why does RAD have multiple facilitators?
- in case a participant gets triggered and needs to leave
What measures are used in RAD?
- screen for child anxiety related disorders (SCARED)
- patient health questionnaire (PHQ-9)
What are the core skills developed in RAD?
- behavioural activation
- exposure (principle of desensitization)
- identifying and challenging unhelpful thoughts
- improving communication and conflict resolution
- stress coping
- social connection among group members
What is Child-parent relationship therapy?
- based on play therapy work of Gary Landreth
- 10 week manualized parenting course
- teaches parents how to use play therapy skills to help young children experiencing social, emotional or behavioural problems
What is CPRT also called?
- filial play therapy
How many people are there per group for CPRT?
- 2-3 facilitators and 6-8 parents
What are the pre-screening measures for CPRT?
- interview
- parental acceptance scale
- measurement of empathy in adult-child interaction (MEACI)
What are the learning goals for CPRT?
- regain control as a parent
- help child develop self-control
- effectively discipline and limit inappropriate behaviour
- understand child’s emotional needs
- communicate more effectively with child
Why play therapy?
- helps children communicate their inner experiences
- nonpathologizing approach based on the belief that children have the internal drive to achieve
- based on respect for child and confidence in their ability to direct their own process
- work through deeper emotional fears, wounds and experiences
- range of toys: real-life, acting-out aggression and creative/expressive
What are the core skills from CPRT?
- positive involvement with child
- improved communication with child
- encouragement of skill and confidence development in child
- limit setting and discipline
