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Consultation and Videotape Therapies for Children with Conduct Problems

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Treatment integrity was ascertained. Self-Administered Videotape Therapy (VT) ... Possible adverse effects of interventions need to be ascertained and measured. ... – PowerPoint PPT presentation

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Title: 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.
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