Consultation and Videotape Therapies for Children with Conduct Problems

1
Consultation and Videotape Therapies for Children
with Conduct Problems

• by
• Ingrid E. Sladeczek
• C. Lisa Steinbach, Aron Blidner
• Patricia Grobe, Chantal Martel
• Staci D. Illsley Mariam Haider

McGill University Montreal, Canada
This research is supported by two grants, one
from the Social Sciences Research Council of
Canada and one from the Fonds pour la Formation
de Chercheurs et de lAide a la Recherche
2
Purpose

• To provide preliminary evaluation data for three
  indirect models of service delivery a highly
  individualized problem-solving consultation model
  (PSC) group videotape therapy with minimal
  consultation (GVT) and a self-administered
  videotape therapy program (VT). Further, to
  examine child intervention outcomes via changes
  in social skills, problem behaviors, and general
  socio-emotional functioning, and to ascertain the
  social validity of these three consultation
  approaches.

3
Research Questions

• What is the efficacy of PSC, GVT, and VT in
  ameliorating the target behaviors identified by
  parents and teachers of children with conduct
  problems?
• What is the relationship between the children's
  social skills, problem-behaviors, and general
  socio-emotional functioning and intervention
  outcomes?
• What is the social validity of PSC, GVT, and VT?

4
Background

• The development of successful relationships with
  parents, siblings and relatives, peers, and
  teachers is a fundamental accomplishment of
  childhood. However, children with conduct
  problems are at a significant disadvantage in
  doing so. Without intervention services,
  researchers (Disney, Elkins, McGue Iacono,
  1999 McMahon Estes, 1997) continue to document
  the negative outcomes for these children. These
  problems include the development of anti-social
  personality disorder (APA, 1994), depression,
  social isolation, delinquency, teenage pregnancy,
  and chronic job failure (Kann Hanna, 2000).

5
Background Continued

• Recently, one approach of working with parents
  and teachers simultaneously in an effort to help
  children with behavioral difficulties is conjoint
  behavioral consultation (CBC Sheridan
  Kratochwill, 1992 Sheridan et al., 1990).
• CBC involves an indirect form of service delivery
  in which the consultant works collaboratively
  with the parents and teachers (the consultees) to
  improve the parents' and teachers' knowledge and
  skills so that they can deal more effectively
  with the child's behavioral problems and to
  address future difficulties (Kratochwill, 1995
  Sheridan, 1993 Sheridan Kratochwill, 1992). It
  is important to provide parents and teachers with
  the skills to effectively intervene with children
  with conduct problems due to the decrease in
  resources to provide direct services to these
  students in the classroom.

6
Background Continued

• CBC (and its' variations, now referred to as
  problem-solving consultation, Kratochwill
  Stoiber, 2002) has extensive empirical evidence
  attesting to its efficacy. For example, it has
  been shown as an effective intervention modality
  for children who are socially withdrawn (e.g.,
  Wayland Sladeczek, 1996), and for children who
  exhibit externalizing behavior problems (Illsley
  Sladeczek, 1999, 2002 Robertson, 1996 Reddy
  et. al, 2000 Sladeczek, 1996).
• Furthermore, consultation has been found to be
  effective for a myriad of academic and behavior
  related problems such as social skill deficits
  (e.g., Sheridan, Kratochwill, Elliott, 1990)
  school performance in underachieving students
  (e.g., Galloway Sheridan, 1994)irrational
  fears and phobias (Sheridan Colton, 1994) and
  behavioral excesses of children diagnosed with
  attention deficit disorder (e.g., Johnson
  Tilly, 1993).

7
Background Continued

• Videotape therapy (VT) developed by
  Webster-Stratton (1989 1997) represents yet
  another effective venue of alleviating behavior
  problems of young children in home and school
  environments (Webster-Stratton, 1996, 1998). In
  fact, Webster-Stratton's videotape therapy is
  recognized by the American Psychological
  Association as meeting the criteria for a
  well-established intervention program for
  children with conduct problems (Brestan Eyberg,
  1998).

8
Background Continued

• Briefly, VT is a multicultural intervention
  program that instructs parents and teachers on
  the appropriate use of a number of behavioral
  management strategies (e.g., how to set limits,
  how to decrease inappropriate behaviors) and the
  therapy can be conducted in groups led by a
  therapist or in a self-administered format.
  Participation in both of these modalities has
  yielded significant reductions in the children's
  problematic behaviors and increases in prosocial
  behaviors (e.g., Webster-Stratton, 1989 1990
  1992 1997).

9
Design

• The study used single participant methodology
  within a repeated measures design. An A-B design
  was used where A represents a period of baseline,
  where the behavior of concern is observed prior
  to any intervention. After a steady rate of
  responding was ascertained for the baseline
  phase, the intervention (or B phase) was
  implemented. Pretest measures and posttest
  measures were also collected.

10
Participants and Selection Procedures

• Children with mild and moderate conduct problems
  (mean age 75.70 months) were randomly assigned
  to intervention conditions.
• Parents and teachers served as consultees for the
  study and were recruited via information sessions
  provided by the principal investigator and
  graduate students. The parents of the child
  participants were recruited via teacher referral.
  After teacher referral, graduate students
  informed the parents of the specifics of the
  intervention services provided by consultants.

11
Participant Screening (for all three conditions)

• Social Skills Rating System - Teacher and Parent
  Forms (Gresham Lopez, 1990).
• Child Behavior Checklist and Teacher Report Form
  (Achenbach, 1991a, 1991b).
• Conjoint Problem Identification Interview (CPII
  conducted as conjoint interviews). The goal of
  the problem identification interview was to
  obtain a tentative idea of what behaviors are of
  concern to parents and teachers, to ascertain
  possible antecedent, sequential, and consequent
  conditions, and to formulate a plan to collect
  baseline data. The interview was conducted in the
  primary language of the parent.

12
Behavioral Interviews (Sheridan, Kratochwill,
Bergan, 1993) (for all three conditions)

• The Conjoint Problem Identification Interview was
  the first behavioral interview that was also used
  as a step in the screening procedure

13
Behavioral Interviews Continued

• For the PSC condition only, the second interview
  was held - the Consultation Problem Analysis
  Interview (CPAI). The consultant and consultees-
• reviewed the baseline data
• discussed and identified the antecedents
  precipitating the target behavior
• discussed and identified the consequent
  conditions that maintained the problematic
  behavior
• discussed and identified the sequential
  conditions (e.g., situational events)
  contributing to the target behavior
• consultant and consultees developed the
  intervention plan based on a functional analysis
  of behavior.
• After the intervention, the Treatment Evaluation
  Interview (TEI) was conducted to determine the
  effectiveness of the intervention and to decide
  whether to continue, modify, or terminate
  consultation.

14
Other Intervention Components

• Problem-solving Consultation (PSC)
• A manual-based approach for delivering the
  Behavior Program for Children (Kratochwill
  Elliott, 1991) was used and included the
  following components
• Skill selection and goal setting - this section
  of the program was used to help parents and
  teachers identify social skills or behaviors
  targeted for the intervention. Focusing on one
  problem at a time, the consultant and the
  consultees formulated an intervention plan. The
  goal of the plan is to help the child develop the
  selected skill by practicing the following steps
  Tell, Show, Do, and Goal Setting and Practice.

15
Other Intervention Components Continued

• Peer Activity - Provides the child with the
  opportunity to play with a peer at least once a
  week. Eight steps for initiating peer activity
  are outlined in the manual. These include
  deciding with the consultant on the type of
  activity telling the children what behaviors are
  expected praising the children when they display
  prosocial behaviors, and providing the child with
  feedback.
• Positive Reinforcement - Positive reinforcement
  was administered on a continuous schedule and
  addtional '''special rewards' were provided for
  reaching daily and weekly goals.
• Child Management - consists of differential
  attention, instruction giving, and time out.
• Weekly telephone calls were conducted to
  ascertain the effectiveness and treatment
  integrity of the intervention, and, when needed,
  intervention plans were modified to better meet
  the needs of the participants.

16

• Consultant-led Group Videotape Therapy (CVT)
• The consultant-led groups for parents used the
  The Parent and Child Series (Webster-Stratton,
  1989) to convey the use of behavior management
  skills. The series is divided into four programs
  Play, Praise and Rewards, Effective Limit
  Setting, and Handling Misbehavior. Minimal
  consultation was provided after the group
  sessions or through the weekly telephone calls.
  Treatment integrity was ascertained.
• Self-Administered Videotape Therapy (VT)
• Participants in this condition received the same
  videotapes as the CVT participants, which were
  delivered directly to them or to their childs'
  school. Weekly telephone calls were conducted to
  ascertain treatment integrity and to answer
  questions.

17
 Results

• What is the efficacy of PSC, GVT, and VT
• in ameliorating the target behaviors
• identified by parents and teachers of
• children with conduct problems?
• Across All
  Conditions
• Home School
• Range of values of effect sizes -5.31 to -.02
  -5.15 to .04
• Percentage of effect sizes that
• were in the expected direction 100
  95
• Mean effect size
  -0.79815 -1.08485

18

• 
  PSC
• Home School
• Range of values of effect sizes -3.27 to -.04
  -1.23 to -.03
• Percentage of effect sizes that
• were in the expected direction 100
  100
• Mean effect size
  -0.95222 -0.6725
• Overall mean effect size -0.86615

19

• 
  VT
• Home School
• Range of values of effect sizes -5.31 to -.02
  -5.15 to .04
• Percentage of effect sizes that
• were in the expected direction 100
  92.86
• Mean effect size
  -0.75357 -1.21621
• Overall mean effect size -0.984893

20

• 
  GVT
• Home School
• Range of values of effect sizes -1.16 to -.1
  ---
• Percentage of effect sizes that
• were in the expected direction 100
  100
• Mean effect size
  -0.68 -1.46
• Overall mean effect size -0.875

21
Reliability Change Indices

• Home
  School
• All Conditions(N37)
• SSRS-SS 1.0759 (1.9292) 1.2755 (2.1368)
• SSRS-PB -0.5661 (1.1882)
  -0.6328 (1.3435)
• EXT-CBCL/TRF -0.9944 (2.2546) -0.1079
  (4.0500)
• PSC(N13)
• SSRS-SS 0.9515 (1.333) 0.3448
  (1.964)
• SSRS-PB -0.8987 (0.9299)
  -0.5303 (1.246)
• EXT-CBCL/TRF -0.9751 (1.778) -0.4584
  (2.109)
• VT(N17)
• SSRS-SS 0.6894 (2.255) 1.252
  (1.826)
• SSRS-PB -0.5071 (1.220)
  -0.7871 (1.204)
• EXT-CBCL/TRF -1.5250 (2.337) 0.07293
  (5.349)
• GVT(N7)
• SSRS-SS 2.4189 (1.800) 3.2460
  (2.922)
• SSRS-PB 0.0199 (1.570) -0.1178
  (2.273)
• EXT-CBCL/TRF 0.2404 (2.712) -0.1250
  (0.7774)

22
What is the relationship between the children's
social skills, problem behaviors, and general
socio-emotional functioning and intervention
outcomes?
Parent Data
CBCL-EXT
CBCL-TOT
Po SSRS-SS
Po CBCL-INT
Correlation Matrix
SSRS SS
SSRS-PB
CBCL-EXT
Po SSRS-SS
Po CBCL-EXT
Po CBCL- TOT
Effect
1.000
-.355
.381
.256
.454
.384
.066
.209
.153
.205
.125
Effect
-.355
1.000
-.437
-.308
-.511
-.406
.572
-.488
-.298
-.404
-.339
SSRS SS
.381
-.437
1.000
.700
.836
.809
-.418
.540
.414
.457
.464
SSRS-PB
.256
-.308
.700
1.000
.773
.894
-.585
.508
.502
.373
.437
CBCL-EXT
.454
-.511
.836
.773
1.000
.920
-.461
.672
.531
.543
.546
CBCL- INT
.384
-.406
.809
.894
.920
1.000
-.529
.641
.603
.553
.599
CBCL-TOT
.066
.572
-.418
-.585
-.461
-.529
1.000
-.605
-.596
-.459
-.562
Po SSRS-SS
.209
-.488
.540
.508
.672
.641
-.605
1.000
.860
.787
.866
Po SSRS-PB
.153
-.298
.414
.502
.531
.603
-.596
.860
1.000
.854
.957
Po CBCL-EXT
.205
-.404
.457
.373
.543
.553
-.459
.787
.854
1.000
.935
Po CBCL-INT
.125
-.339
.464
.437
.546
.599
-.562
.866
.957
.935
1.000
Po CBCL- TOT
23
Continued
PTIP teacher pre ES TRF and SSRS only (N14)
Correlation Matrix
Effect
SSRS-SS
SSRS-PB
TRF-EXT
TRF-INT
TRF- TOT
1.000
-.132
-.493
-.455
-.078
-.301
Effect
-.132
1.000
-.075
-.024
-.191
-.375
SSRS-SS
-.493
-.075
1.000
.679
-.053
.591
SSRS-PB
-.455
-.024
.679
1.000
-.327
.671
TRF-EXT
-.078
-.191
-.053
-.327
1.000
.330
TRF-INT
-.301
-.375
.591
.671
.330
1.000
TRF-TOT
PTIP teacher post ES TRF and SSRS only (N14)
Correlation Matrix
SSRS-SS
SSRS-PB
TRF-EXT
TRF-INT
TRF-TOT
Effect
1.000
-.231
.159
.227
.328
.378
Effect
-.231
1.000
-.516
-.478
-.676
-.618
SSRS-SS
.159
-.516
1.000
.475
.651
.493
SSRS-PB
.227
-.478
.475
1.000
.436
.897
TRF-EXT
.328
-.676
.651
.436
1.000
.724
TRF-INT
.378
-.618
.493
.897
.724
1.000
TRF-TOT
24
What is the social validity of PSC, GVT, and VT?

• PSC
• Home
  School
• Pretest BIRS A 60.833 (1.892) 60.50
  (23.334)
• Pretest BIRS E 31.50 (6.614) 27.00
  (14.142)
• Pretest BIRS TE 8.666 (2.309) 6.50
  (3.535)
• Pretest BIRS TOTAL 101.0 (9.539) 94.0
  (41.012)
•  
• Posttest BIRS A 59.25 (0.353) 75.0
  (17.397)
• Posttest BIRS E 26.0 (1.414) 24.25
  (10.996)
• Posttest BIRS TE 7.50 (0.707) 6.75
  (3.403)
• Posttest BIRS TOTAL 92.75 (1.767) 106.0
  (27.868)

25

• GVT
• Home
  School
• Pretest BIRS A -- --
• Pretest BIRS E --
  --
• Pretest BIRS TE --
  --
• Pretest BIRS TOTAL --
  --
•  
• Posttest BIRS A --
  --
• Posttest BIRS E -- --
• Posttest BIRS TE -- --
• Posttest BIRS TOTAL -- --

26

• VT
• Home
  School
• Pretest BIRS A 58.333 (12.564) 78.40
  (9.396)
• Pretest BIRS E 31.750 (11.223) 29.40
  (5.594)
• Pretest BIRS TE 9.400 (1.673) 9.50
  (1.290)
• Pretest BIRS TOTAL 107.583 (8.064) 118.25
  (18.062)
•  
• Posttest BIRS A 60.333 (6.982) 62.00
  (24.703)
• Posttest BIRS E 31.277 (7.620) 18.444
  (11.468)
• Posttest BIRS TE 9.111 (1.615)
  7.00 (3.703)
• Posttest BIRS TOTAL 100.72 (15.356) 92.666
  (31.268)

27

• All Conditions
• Home
  School
• Pretest BIRS A 59.222 (10.158) 73.285
  (15.030)
• Pretest BIRS E 31.666 (9.50)
  28.714 (7.454)
• Pretest BIRS TE 9.25 (1.908)
  8.50 (2.428)
• Pretest BIRS TOTAL 105.0 (8.674) 110.0
  (23.965)
•  
• Posttest BIRS A 60.615 (6.035) 66.785
  (22.136)
• Posttest BIRS E 30.384 (7.467) 19.714
  (10.943)
• Posttest BIRS TE 9.00 (1.683)
  6.769 (3.345)
• Posttest BIRS TOTAL 100.0 (13.964) 96.642
  (28.618)

28
Discussion

• Our preliminary findings indicate that children's
  behavior improved from baseline to treatment in
  all three conditions.
• Overall, children's social skills improved,
  problem behaviors decreased, or socio-emotional
  functioning was enhanced.
• High levels of treatment acceptability for each
  of the intervention conditions were found in both
  the home and school environments.

29
Future Research

• Longitudinal research is crucial in examining the
  possible long-term effects of PSC, GVT, and VT
  for children with conduct problems.
• More specific research is needed that helps to
  further clarify the differential effects of
  parent, teacher, and child variables and
  consultation conditions.
• Interventions made more palatable for those
  clients we know are at risk for dropping out of
  the consultation process.
• Possible adverse effects of interventions need to
  be ascertained and measured.