Interventions for children and young people in the 'real-world' Flashcards
A number of factors can influence wether…?
Interventions = effective
What changes what works for whp?
Comorbidity, motivation
Moderators of treatment outcome help us understand what?
What works for whom
Do RCT’s reflect what happens in the real world? - Three factors
Parental - mental health/ conditions, timimg, availability
Child - Co - occuring cond
Therapist - Motivation and skill level
Parent ADHD
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
does parental adhd impact effectiveness of the new forest parenting programme? - ollow on study
f→ 83 families completed 8 week programme and was split into 3 groups - HIGH, MED, LOW PARENT ADHD
When parent ADHD = HIGH, did childs ADHD symptoms imporve?
NO
When parent ADHD = LOW , did childs ADHD symptoms imporve?
YES
Reasons why the improvement / lack of, may have occured?
Parents w ADHD = less likely to take on board new parental strat during the intervs = overall the intervs = less effective
SES = a factor influencing treatment outcome in parent interv e.g parental M.H = -vly affected due to …
Less access to social support systems
Research = shows at post-interv - low SES fam = benefit less overall = only when initial beh =
less severe
Wjen ppl come from LOW SES fam but behav = more severe = more benefit, why?
More motivation
After one year of intervs - what is a preedictor of treatment outcomes?
SES - regardless of severity
PARENTAL ENGAGEMENT = can affect outcome of intervention e.g…
Cognitions
Practical Constraints
Attendance
Adherence
Parental Cog will affect outcome of interv - how?
Beliefs ab interv - ‘interv will not work for me’ ‘therapist cant help me’
Practical Constrains will affect outcome of interv - how?
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
Attendance will affect outvome of interv - how?
DO parents attend all sessions?
DO they complete treatment?
DO practical constraints affecr their attendence
Aderence will affect outcome of interv - how?
is there active engagment?
hwk tasks = completed?
inconsistency = impact outcomes
Self - Directed interventions? what are they?
Can be done online, books, apps = good way to oversome issues e.g aadhereance and attendance
IN SUMMARY WHAT AFFECTS TREATMENT OUTCOMES?
Family SES
Parent m.h/cond
Parental cog
Parental constraints
Child factors that = associated w treatment outcome - 3 factors?
Comorbidity - is there more than one cond
Child Age - earlier the better
Sympt Severity - At start of treatment
Study on Comorbidity - done by ?
Lecavlier et al
What did Lecavlier et al find?
- # 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
Factors associated w cbt response for anx in children
- KUNAS ET AL - META ANALYSIS - does pre-treatment severity impact treatment outcome?
more severe the symp = associated w worse treatment response / outcome
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?
Menting et al 2013
Menting et al:
- severe group = big diff in pre and post interv score
- less severe group = not much diff between the two
why?
Due to parents = more motivated therefore likely to engage in sessions
Child age - McCart et al used meta abalytical techdo what
to identify moderators of parent interventions and CBT for young ppl w beh problems
BPT (behav paren training) = more effective as …
parents = can engage more for their child who is young
CBT = more effective for who?
older children - can benefit from this engagement
No evidenvce that earlier interv provides better outcomes for beh parenting interv in young children 2 - 11
Gardner et al
Therapist factors = important = Parent - therapist alliance. The r/s between parent and therapisr during interv = 3 factors
- Agreement on what outcomes should be
- Agreement on what therapy should involve
- +ve trusting r/s
Research studies found that good parent-therapist alliance associated w…
Improved parenting beh
Reduc in externalising child beh
Increased acceptability of interv
= if rs = non existent = detrimental to outcome
Who developed theraputic alliance scale fofr children
Shirk & Russel
What is theraputic alliance scale?
Child got to rate how they feel ab therapy
e.g - i feel the therapist = my side
- i like psending time w my therapist
If child = doesn’t like therapist what happens?
Wont engage well in intervention
child-therapist alliance in cbt for child anxiety - used indep rating of alliance btw child and therapist during CBT & Fam focused CT - how?
An indep coder watches therapy tapes & ocdes elements of child therapist rs, recorded early in treatment, mid & post
When child alliance = assessed early in treatment , associated w what =?
Reduced internalsing symp at mid treatment
Parent = reported treatment satisfac at post interv
Treatment fidelity - the extent to which the interv is delivereed sohuld be:?
- accurate
- consistent
- all components
Staff expertise and treatment setting - is interv effective when del by nurse in community settings rather than specialised nurses? - sonuga barke et al
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
IN SUMMARY what?
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
