Interventions for children and young people in the 'real-world'

Question 1

A number of factors can influence wether…?

Answer 1

Interventions = effective

Question 2

What changes what works for whp?

Answer 2

Comorbidity, motivation

Question 3

Moderators of treatment outcome help us understand what?

Answer 3

What works for whom

Question 4

Do RCT’s reflect what happens in the real world? - Three factors

Answer 4

Parental - mental health/ conditions, timimg, availability
Child - Co - occuring cond
Therapist - Motivation and skill level

Question 5

Parent ADHD

Answer 5

ADHD = genetic basis = parents of children w ADHD will give ADHD trails = strong genetic link

SO

Parent ADHD affects outcomes from Parent Interv in ADHD = More difficulty implementing some strategies within these interventions to support their children e.g. structuring of a token econ

Question 6

does parental adhd impact effectiveness of the new forest parenting programme? - ollow on study

Answer 6

f→ 83 families completed 8 week programme and was split into 3 groups - HIGH, MED, LOW PARENT ADHD

Question 7

When parent ADHD = HIGH, did childs ADHD symptoms imporve?

Answer 7

NO

Question 8

When parent ADHD = LOW , did childs ADHD symptoms imporve?

Answer 8

YES

Question 9

Reasons why the improvement / lack of, may have occured?

Answer 9

Parents w ADHD = less likely to take on board new parental strat during the intervs = overall the intervs = less effective

Question 10

SES = a factor influencing treatment outcome in parent interv e.g parental M.H = -vly affected due to …

Answer 10

Less access to social support systems

Question 11

Research = shows at post-interv - low SES fam = benefit less overall = only when initial beh =

Answer 11

less severe

Question 12

Wjen ppl come from LOW SES fam but behav = more severe = more benefit, why?

Answer 12

More motivation

Question 13

After one year of intervs - what is a preedictor of treatment outcomes?

Answer 13

SES - regardless of severity

Question 14

PARENTAL ENGAGEMENT = can affect outcome of intervention e.g…

Answer 14

Cognitions
Practical Constraints
Attendance
Adherence

Question 15

Parental Cog will affect outcome of interv - how?

Answer 15

Beliefs ab interv - ‘interv will not work for me’ ‘therapist cant help me’

Question 16

Practical Constrains will affect outcome of interv - how?

Answer 16

Can parents engage in the first place? or is it child only?
Work commitments - can they get out of work?
Transport / are they able to provide childcare

Question 17

Attendance will affect outvome of interv - how?

Answer 17

DO parents attend all sessions?
DO they complete treatment?
DO practical constraints affecr their attendence

Question 18

Aderence will affect outcome of interv - how?

Answer 18

is there active engagment?
hwk tasks = completed?
inconsistency = impact outcomes

Question 19

Self - Directed interventions? what are they?

Answer 19

Can be done online, books, apps = good way to oversome issues e.g aadhereance and attendance

Question 20

IN SUMMARY WHAT AFFECTS TREATMENT OUTCOMES?

Answer 20

Family SES
Parent m.h/cond
Parental cog
Parental constraints

Question 21

Child factors that = associated w treatment outcome - 3 factors?

Answer 21

Comorbidity - is there more than one cond
Child Age - earlier the better
Sympt Severity - At start of treatment

Question 22

Study on Comorbidity - done by ?

Answer 22

Lecavlier et al

Question 23

What did Lecavlier et al find?

Answer 23

• # looked at parent intervention for disruptive behaviour in young children with autism compared to a psycho-education control group
• explored which child variables including IQ, severity of autism, adhd, odd, and anxiety influenced treatment outcomes for parent intervention
• children with lower adhd scores and lower anxiety scores more likely to benefit from parent intervention

Question 24

Factors associated w cbt response for anx in children
- KUNAS ET AL - META ANALYSIS - does pre-treatment severity impact treatment outcome?

Answer 24

more severe the symp = associated w worse treatment response / outcome

Question 25

Severity of prob at the start of treatment? - for disrup beh - better effect sizes = associated w more severe child beh at pre-intervention says who?

Answer 25

Menting et al 2013

Question 26

Menting et al: - severe group = big diff in pre and post interv score - less severe group = not much diff between the two why?

Answer 26

Due to parents = more motivated therefore likely to engage in sessions

Question 27

Child age - McCart et al used meta abalytical techdo what

Answer 27

to identify moderators of parent interventions and CBT for young ppl w beh problems

Question 28

BPT (behav paren training) = more effective as ...

Answer 28

parents = can engage more for their child who is young

Question 29

CBT = more effective for who?

Answer 29

older children - can benefit from this engagement

Question 30

No evidenvce that earlier interv provides better outcomes for beh parenting interv in young children 2 - 11

Answer 30

Gardner et al

Question 31

Therapist factors = important = Parent - therapist alliance. The r/s between parent and therapisr during interv = 3 factors

Answer 31

1. Agreement on what outcomes should be 2. Agreement on what therapy should involve 3. +ve trusting r/s

Question 32

Research studies found that good parent-therapist alliance associated w...

Answer 32

Improved parenting beh Reduc in externalising child beh Increased acceptability of interv = if rs = non existent = detrimental to outcome

Question 33

Who developed theraputic alliance scale fofr children

Answer 33

Shirk & Russel

Question 34

What is theraputic alliance scale?

Answer 34

Child got to rate how they feel ab therapy e.g - i feel the therapist = my side - i like psending time w my therapist

Question 35

If child = doesn't like therapist what happens?

Answer 35

Wont engage well in intervention

Question 36

child-therapist alliance in cbt for child anxiety - used indep rating of alliance btw child and therapist during CBT & Fam focused CT - how?

Answer 36

An indep coder watches therapy tapes & ocdes elements of child therapist rs, recorded early in treatment, mid & post

Question 37

When child alliance = assessed early in treatment , associated w what =?

Answer 37

Reduced internalsing symp at mid treatment Parent = reported treatment satisfac at post interv

Question 38

Treatment fidelity - the extent to which the interv is delivereed sohuld be:?

Answer 38

1. accurate 2. consistent 3. all components

Question 39

Staff expertise and treatment setting - is interv effective when del by nurse in community settings rather than specialised nurses? - sonuga barke et al

Answer 39

health visitors delivered N.F.P.P on their caseload --> nfpp wasnt associated w reduc in adhd symp or improvements in maternal well being - nfpp = worked better w experienced nurses

Question 40

IN SUMMARY what?

Answer 40

Number of factors = can affect treatment outcomes of interv Not all interv = for everyine Identifying factors associtaed w treatment effectivness = can help inform dev of better interv