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3/27/18
1
IMPLEMENTATION STRATEGIES OF PBIS WITH MENTAL HEALTH SUPPORTS: RCT OUTCOMES Ricardo Eiraldi, PhD Children’s Hospital of Philadelphia and University of Pennsylvania
Barry McCurdy, PhD, BCBA-D Devereux Center for Effective Schools Jennifer Mautone, PhD, NCSP, ABPP Children’s Hospital of Philadelphia and University of Pennsylvania
15th INTERNATIONAL CONFERENCE ON POSITIVE BEHAVIOR SUPPORT March 28 – 31, 2018 • San Diego, CA
DISCLOSURES
Grant/Research Support • Dr. Eiraldi: NIMH, NICHD, CDC • Dr. McCurdy: NICHD, DOE
Speakers Bureau • None
Consultant • Dr. Eiraldi: McNeil Pharmaceuticals
Major Shareholder • None
AGENDA Introduction to area of research
• Project ACCESS • Implementation science
Implementation & Effectiveness Clinical Trial • Consultation vs. Consultation Plus • Tier 1 universal interventions • Tier 2 group interventions • Years 1-3
• Implementation outcomes • School outcomes • Child outcomes
MENTAL HEALTH EVIDENCE-BASED PRACTICES IN URBAN SCHOOLS
Ideal setting for transporting EBPs to “real world” • Potential for addressing services disparities • Fewer access barriers • Not effective or small effect sizes • Difficulty achieving and sustaining high fidelity
Effective programs • Consistent program implementation • Inclusion of parents, teachers, peers • Multiple modalities • Integration of program content into curriculum
Farahmand et al., 2011; Rones & Hoagwood, 2000
ADDRESSING MENTAL HEALTH SERVICES DISPARITIES FOR LOW-INCOME MINORITY CHILDREN
A Program Development Grant (Project ACCESS) Centers for Disease Control and Prevention (CDC) FOA - Elimination of Health Disparities through Translation Research Grant R18 MN000003
DISSEMINATION AND IMPLEMENTATION
EffectivenessStudies
EfficacyStudies
Dissemination and Implementation Studies
Exploration
Adoption/Preparation
Implementation
Sustainment
National Research Council and Institute of Medicine, 2009
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DEFINITION OF IMPLEMENTATION RESEARCH
Implementation research is the systematic study of how a specific set of activities and designed strategies are used to successfully integrate an evidence-based public health intervention within specific settings (e.g., primary care clinic, community center, school).
Lomas J 1993 Annals of the New York Academy of Sciences
IMPLEMENTATION RESEARCH OUTCOMES
Proctor et al 2009; 2010; *Institute of Medicine (IOM) 2001; 2006
Implementation
Outcomes Acceptability
Adoption Appropriateness
Costs Feasibility
Fidelity Penetration
Sustainability
Service
Outcomes* Efficiency
Safety Effectiveness
Equity Patient-
centeredness Timeliness
Patient Outcomes
Satisfaction
Function Health Status/
Symptoms
TARGETING SCHOOL CLIMATE AND CHILDREN'S BEHAVIORAL HEALTH IN URBAN SCHOOLS
National Institute of Child Health and Human Development (NICHD) Grant R01 HD073430
Ricardo Eiraldi, Ph.D., PI Jennifer Mautone, Ph.D., Co-I, PD Barry McCurdy, Ph.D., Co-I Muniya Khanna, Ph.D., Co-I Thomas Power, Ph.D., Co-I Abbas Jawad, Ph.D., Co-I Zuleyha Cidav, Ph.D., Health Economist
Examine differences in implementation outcomes
• Schools in the C+ condition will have higher levels of implementation fidelity for Tier 1 and Tier 2 than those in the C condition
Examine differences in school and student level outcomes
• Schools in the C+ condition will have lower levels of ODRs and better school climate than those in the C condition
• Children attending schools in the C+ condition will have better outcomes than those in the C condition
STUDY AIMS & HYPOTHESES
STUDY DESIGN AND TIMELINE
Eiraldi, McCurdy, Khanna, Mautone, et al. (2014). Implementation Science, 9:12
~75 % of Students
~20%
~5%
Primary Prevention Universal supports for all children § Clearly defined expectations § Expectations taught § Procedures to encourage behavior § Procedures for discouraging behavior § Data-based decisions
Secondary Prevention Group supports for at-risk children u Non-responders to Tier 1 § Child coping skills training for
externalizing and anxiety problems
Tertiary Prevention Individual supports for high-risk children u Non-responders to Tier 2 § Refer for individualized support
to school or community providers
Implementation of SWPBIS with Mental Health Supports
Eiraldi,McCurdy,Khanna,Mautone,etal.(2014).Implementation Science, 9:12
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SPECIFIC OUTCOMES Implementation Outcomes
Service Outcomes
13
• Content fidelity • Process fidelity • Cost & cost-effectiveness • Adequacy of support level • Sustainability
• School climate • Office discipline referrals • Attendance rate • PSSA Reading & Math • Mental health service
utilization
• Diagnostic status • Symptom severity • Impairment level • Coping skills • Academic productivity
Child Outcomes
PARTICIPATING SCHOOLS
DEMOGRAPHIC INFORMATION
Schools • 6 schools (4 K-8, 1 K-4, 1 K-5) • 4,024 Students • 17.45% English Learners (range 12%-24%) • 15.06% Receiving Special Education (range 9%-22%) • 100% Free or reduced-price lunch
Racial/Ethnic Breakdown • 54.5% Latino (range 25%-77%) • 33.17% African American (range 14%-52%) • 10.17% Other ethnic minority (range 7%-14%) • 1.8% Caucasian
SCHOOL RECRUITMENT Initial presentation to administrators Application process
• Administrator must take active leadership role • Commit to data collection and ongoing use of SWIS data • Narrative
• Describe need (data on discipline, suspensions, attendance, safety)
• Document that system is ready to support SWPBIS initiative
• Document administrative commitment
Presentation to faculty by researchers • 80% cut-off criteria
TIER 1 SUPPORTS: YEARS 1-3
17
LEADERSHIP TEAMS 6-10 members
• Administrator, teaching & support staff, parents
Responsibilities
• Develop universal support system
• Annual roll out of SWPBIS
• Attend monthly meetings
• Engage in problem-solving to refine system components
• Participate in data collection activities required by grant
Link between Tier 1 & Tier 2
• Subgroup within LT
• Review data on non-responders to Tier 1
• Referral for Tier 2
• Review data on non-responders to Tier 2
• Referral to community or school providers
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YEAR 1: TRAINING UNIVERSAL SUPPORTS 3-Day Workshop
• Didactic Sessions • Day 1:
• Context for problem behavior • History and components of PBIS • Behavioral expectations, setting-specific rules
• Day 2: • Teaching and encouraging behavior • Discouraging rule violation
• Day 3: • Data-based decision making • Team meetings • Roll out • Progress monitoring
• Product Development • Teaching matrix • Behavioral lesson plans • Recognition matrix • Flowchart for addressing problem behavior
YEAR 1: TRAINING UNIVERSAL SUPPORTS Brief Trainings Following 3-Day Workshop
• Rollout • PBIS roll out checklist and action plan
• Preparing faculty for rollout • Implementing rollout for students and families • Planning for post-rollout
• Team Implementation Checklist (TIC) • Introducing the TIC • Connecting the TIC and action planning
• Standard Meeting Agenda • Adapted from Team Initiated Problem-Solving • Standard structure for leadership team meetings • Concludes with team evaluation of meeting
• School-wide Information System (SWISS) • Trained administrator, LT data analyst, office clerk • Data entry and producing graphic displays
ANNUAL TRAINING: YEAR 2 AND AFTER
Team-initiated problem-solving (TIPS II) • Meeting foundations
• Standard meeting agenda • Team roles (facilitator, minute taker, time keeper, data analyst) • Projected minutes
• Problem-solving • Developing “precision” problem statements
• “Seventh and eighth grade students are engaging in physical aggression in the hallway between 11;30 and 12:30 for peer attention at a rate of .25 incidents per day”
• Identifying goals for change • Identifying solution actions • Implementing plans with contextual fit
School-wide Interventions Training
• 15 prevention, teaching , and reward strategies • Precorrection, modeling, peer tutoring, group contingencies, tootling
Booster Training/ New Team Member Training • Booster training sessions: PBIS Universal System, SWIS, TIPS II • Personalized 1-hour training sessions for new team members
IMPLEMENTATION: UNIVERSAL SUPPORT
Consultation
Pre-meeting phone consultation (30 min – 1 hr)
• Masters-level consultant/coach • Coach responsibilities • Facilitator responsibilities
LT agenda • Prepared in advance and forwarded to
coach • Includes section for problem-solving • Based on data analyst report
Leadership team meets following the conference call
• Minutes forwarded to consultant/coach
Consultation Plus
Pre-meeting phone consultation (30 min – 1 hr)
• Masters-level coach • Coach responsibilities • Facilitator responsibilities
LT agenda • Prepared in advance and forwarded to
coach • Includes section for problem-solving • Based on data analyst report
Coach attends leadership team meeting
• Provides prompts and makes recommendations as LT moves through agenda
• Shapes problem-solving skills Coach provides performance feedback to team after the meeting
PRE-MEETING PHONE CONSULTATION
Facilitator activities Coach activities Forwards agenda to coach
• Includes identified items to be addressed
• Includes “to-do” items from last meeting
• Includes previously defined problem in “precise” statement format
• Includes any new problems based on SWIS data
Reviews agenda Meeting logistics
• Confirms scheduled meeting
• Confirms that minutes from previous meeting are disseminated
Address questions or concerns for upcoming meeting Reminds Facilitator to forward minutes after meeting
24
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25 26
27
TIER 1 IMPLEMENTATION DATA: YEARS 1-3
28
How well are we implementing?
FIDELITY: LEADERSHIP TEAM MEETINGS
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Consultation Only Consultation Plus
Leadership Team: Meetings Held
2014-2015 2015-2016
FIDELITY: PRE-MEETING CONSULTS
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Consultation Only Consultation Plus
Pre-Meeting Calls Fidelity: Coach Steps
2013-2014 2014-2015 2015-2016
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FIDELITY: PRE-MEETING CONSULTS
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Consultation Only Consultation Plus
Pre-Meeting Calls Fidelity: Facilitator/Team Leader Steps
2013-2014 2014-2015 2015-2016
LEADERSHIP TEAM MEETING
Meeting logistics • Agenda disseminated or projected • Roles identified (recorder, time keeper, data analyst) • Majority (80%) of team present for entire meeting
Facilitator activities • Reviews status of “to-do” items • Reviews status of previously identified problems • Prompts team to stay on-task throughout meeting
Team problem solving • Data analyst defines problems in precise problem statement format • Team brainstorms and selects action solution • Team engages in self-reflection
Coach provides feedback to team • Identifies score based on fidelity measure • Identifies one area where team has performed well • Identifies one are for improvement • Provides overall summary of meeting
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Consultation Only Consultation Plus
TIPS Fidelity: Meeting Content
2013-2014 2014-2015 2015-2016
FIDELITY: LEADERSHIP TEAM MEETINGS SET: TEACHING EXPECTATIONS
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Consultation Only Consultation Plus
PROJECT ACCESS TIER I Implementation Outcomes
Multi-Year SET Data Teaching Expectations Scores
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Consultation Only Consultation Plus
PROJECT ACCESS TIER I Implementation Outcomes Multi-Year SET Data Mean Scores
SET: MEAN SCORE
TIER 1 OUTCOME DATA: YEARS 1-3
36
Given implementation, what is the impact?
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SCHOOL CLIMATE
School climate staff survey • Collaborative Responsibility Establishing School Teams
Climate Survey (CREST) • 31 items, 5-point Likert scale • Administered to ~30 staff per school • Includes teachers, para-professionals, custodial and cafeteria
workers
Psychometric properties • Factor structure
• Skill instruction • Safety • Support for staff • Staff respect for students
• Internal consistency • Cronbach Alpha = .959
SCHOOL CLIMATE
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Support for Staff
Skill Instruction
Safety Adult Respect Support for Staff
Skill Instruction
Safety Adult Respect
CREST Factor Scores: Baseline, Year 1, and Year 2
2013-2014 2014-2015 2015-2016
Consultation Plus Schools Consultation Only Schools
SCHOOL CLIMATE
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Consultation Only Consultation Plus
CREST Total Scores: Baseline, Year 1, and Year 2
2013-2014 2014-2015 2015-2016
OFFICE DISCIPLINE REFERRALS: AVERAGE ODRS PER STUDENT
40
0
0.5
1
1.5
2
2.5
C1 C2 C3 Consultation Only Schools
C+C 1 C+C 2 C+C 3 Consultation Plus Schools
Average ODRs per Student
2013-14 2014-15 2015-16
SUMMARY OF TIER 1 OUTCOMES
• Facilitators in Consultation Plus schools are less reliant on the pre-meeting conference call
• Fidelity to the protocol for leadership team meetings is similar in Consultation-Only and Consultation Plus schools
• SWPBIS fidelity, as measured with the SET, is higher for Consultation Plus schools
• School climate, as measured with the CREST, improved slightly for Consultation-Only schools
TIER 2 SUPPORTS & OUTCOMES YEARS 1-3
42
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INITIAL TRAINING Two-day workshop
• Screening / referral • Externalizing & internalizing disorders • Child group management • Behavioral and cognitive principles of behavior
change • CPP & FRIENDS treatment theory & treatment
manuals • Active learning strategies (e.g., role-play,
modeling) • Training to criterion – Knowledge of Evidence-
Based Services Questionnaire (KEBSQ) • Measuring fidelity
SUBSEQUENT SUPPORT Consultation Consultation Plus
44
• Discussion of referrals • Dealing with logistical
problems • Session preparation
• Discussion of referrals • Dealing with logistical
problems • Session preparation • Coaching elements
• Self-reflection • Goal setting • Video-based performance
feedback • Well-executed activities • Activities that need
improvement
SUPERVISION OF CONSULTANTS
Consultants • Interns, advanced graduate students, research
assistants Weekly supervision by fellows & licensed psychologists
• Performance feedback after observing and evaluating the C or C+ consultation session
• Self-reflection • Video-based performance feedback
• Examples of effective consultation • Examples of less than effective consultation
• Differentiation between conditions
IMPLEMENTER PARTICIPANTS - CPP
Relevant Experience
Racial/Ethnic Background
46
• 10 counselors/social workers
• 2 teachers • 1 dean of students • 1 climate facilitator
• Average work experience: 17 years; range: 2-38
• White - 36% • African American - 36% • Mixed Race – 28% • Latino – 50%
N = 14
IMPLEMENTER PARTICIPANTS - FRIENDS
Relevant Experience
Racial/Ethnic Background
47
• 7 counselors/social workers
• 2 teachers • 1 dean of students • 1 climate facilitator
• Average work experience: 18 years; range: 3-41
• White – 39% • African American - 46% • Mixed Race – 28% • Latino – 31%
N = 13
INCLUSION CRITERIA - CPP Grades 3-8 Screening Criteria
A score > 1SD on the Conduct Problems subscale of the Strengths and Difficulties Questionnaire (SDQ) - Teacher
Diagnostic Criteria Primary diagnosis of Oppositional Defiant Disorder, Conduct Disorder on C-DISC-IV – Parent • Included children with comorbid (secondary) conditions • Excluded children with Intellectual Disability or history of
psychotic or autistic spectrum disorders
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INCLUSION CRITERIA - FRIENDS Grades 3-8 Screening Criteria
A score > 1SD on the Emotional Problems of the Strengths and Difficulties Questionnaire (SDQ) - Teacher
Diagnostic Criteria Primary diagnosis of Generalized Anxiety Disorder, Social Phobia, or Separation Anxiety on C-DISC-IV – Parent • Included children with comorbid (secondary) conditions • Excluded children with Intellectual Disability or history of
psychotic or autistic spectrum disorders
COPING POWER PROGRAM (CPP) Cognitive-behavioral group skills training for anger management Learn coping skills
• Self-control • Perspective taking • Problem solving
Teaching strategies • Group discussions • Role playing • Coping while being taunted • Relaxation techniques
3-6 children per group Fourteen 40-minute sessions *John Lochman & Karen Wells
COPING POWER SESSIONS Session Component
1 Introduction, Group Structure, and Goal Setting 2 Emotional Awareness 3 Anger, Coping, and Self-Control 4 Overcoming Barriers to Self-Control 5 Perspective Taking Part I 6 Perspective Taking Part II 7 Social Problem Solving Part I 8 Social Problem Solving Part II 9 Social Problem Solving Part III 10 “Think Aloud” Role Plays to Review 11 Social Problem Solving with Peers in the
Community 12 Video Development and Watching Part I 13 Video Development and Watching Part II 14 Review and Termination
51
FRIENDS FOR LIFE (FRIENDS) Cognitive-behavioral group skills training for symptoms of anxiety
Education/Skills building • Anxiety is normal part of life • Recognize signs of anxiety • Change negative thoughts into positive thoughts • Learn how to relax in tough situations
Problem solving • Apply problem solving techniques in difficult situations
Practice in challenging situations • Practice coping with anxiety in difficult situations • Reward themselves for “facing fears” instead of avoiding them
5-6 children per group
40 minutes per session for 14 weeks *Paula Barrett et al.
FRIENDS FOR LIFE SESSIONS Session Component
1 Introduction, Group Structure, and Goal Setting
2 Introductions to Feelings
3 Learning to Feel Confident and Brave – “F: Feelings” and R: Remember to Relax” Steps
4 Learning to Feel Confident and Brave – “I” Step: I can do it!
5 Learning to Feel Confident and Brave – “E” Step: Exploring Solutions
6 Learning to Feel Confident and Brave – Problem Solving
7 Learning to Feel Confident and Brave – “N” Step: Now reward yourself
8 Learning to Feel Confident and Brave – “D” Step: Don’t Forget to Practice!
9 Using the FRIENDS Plan: Helping Ourselves and Others
10 Using the FRIENDS Plan: More Practice
11 Using the FRIENDS Plan: Even More Practice
12 Using the FRIENDS Plan: Even More Practice
13 Using the FRIENDS Plan: Even More Practice
14 Review and Party
53
CHILD PARTICIPANTS - CPP N = 119 children
• 74% male
Race/Ethnicity • Latino – 54% • African American – 48% • White – 35% • Multi-Racial – 10% • Other – 7%
Grade breakdown • 3rd – 26 (22%) • 4th– 37 (31%) • 5th – 38 (32%) • 6th – 15 (13%) • 7th – 1 (1%) • 8th – 2 (2%)
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CHILD PARTICIPANTS - FRIENDS N = 62 children
• 53% female Race/Ethnicity
• Latino– 50% • African American – 31% • Multi-Racial – 18% • Other – 2%
Grade breakdown • 3rd – 18 (29%) • 4th– 16 (26%) • 5th – 15 (24%) • 6th – 4 (7%) • 7th – 4 (7%) • 8th – 5 (8%)
DIAGNOSES AT BASELINE - CPP
56
Disorder Intermediate n %
Positive n %
Oppositional Defiant Disorder 60 50% 56 47% Conduct Disorder 41 35% 15 13% Attention Deficit Hyperactivity Disorder 59 50% 48 40% Panic Disorder 10 8% 1 8% Generalized Anxiety Disorder 16 13% 4 3% Post-Traumatic Stress Disorder 14 12% 6 5% Separation Anxiety Disorder 36 30% 14 12% Social Phobia Disorder 30 25% 3 3% Major Depressive Episode 31 26% 2 2% Dysthymic Disorder 5 4% 0 0%
DIAGNOSES AT BASELINE - FRIENDS
Disorder Intermediate n %
Positive n %
Oppositional Defiant Disorder 25 40% 15 24% Conduct Disorder 2 3% 5 8% Attention Deficit Hyperactivity Disorder 30 49% 15 25% Panic Disorder 14 23% 3 5% Generalized Anxiety Disorder 14 23% 8 13% Post-Traumatic Stress Disorder 9 15% 6 10% Separation Anxiety Disorder 25 40% 23 37% Social Phobia Disorder 27 44% 12 19% Major Depressive Episode 11 18% 10 16% Dysthymic Disorder 2 3% 0 0%
57
TRAINING DIFFERENTIATION - CPP Self-Reflecting Discussing
Fidelity Data
58
The coach asked the counselor to briefly discuss what went right/ wrong in the previous session and to reflect on his/her own performance.
The coach discussed the fidelity data and provided positive reinforcement for steps completed and corrective feedback.
None Some Thorough discussion review 0 1 2
None Some Thorough discussion review 0 1 2
Contamination = 3.1% (6 CPP sessions) N = 195 CPP C-condition sessions
TRAINING DIFFERENTIATION - FRIENDS
Self-Reflecting Discussing Fidelity Data
59
The coach asked the counselor to briefly discuss what went right/ wrong in the previous session and to reflect on his/her own performance.
The coach discussed the fidelity data and provided positive reinforcement for steps completed and corrective feedback.
None Some Thorough discussion review 0 1 2
None Some Thorough discussion review 0 1 2
Contamination = <1% (2 FR sessions) N = 153 FRIENDS C-condition sessions
MEASURES Fidelity to the Intervention
• Content – content manual • Process - engagement of students, use of active learning
strategies • Coding of video-recorded group treatment sessions
Child Outcomes • Diagnostic status
• Diagnostic Interview Schedule for Children, Computer Version, 4th Edition - C-DISC-IV
• Functional impairment • Clinical Global Impression – CGI and Children’s Global
Assessment Scale – CGAS • Symptoms
• Child Behavior Checklist - CBCL
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CONTENT FIDELITY - CPP
77.7%
87.1%
50
55
60
65
70
75
80
85
90
95
100
Consultation; K = 0.85
Consultation Plus; K = 0.70
61
N = 152 sessions
N = 166 sessions
t(316)=-4.039, p<.001
Eiraldi, Mautone, Khanna et al., 2018 (Beh Therapy)
CONTENT FIDELITY - FRIENDS
71%
89%
50
55
60
65
70
75
80
85
90
95
100
Consultation; K = 0.79
Consultation Plus; K = 0.84
62
N = 104 sessions
N = 79 sessions
t(181)=-4.581, p<.001
PROCESS FIDELITY - CPP
3.93 4.16
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Consultation; Icc = 0.65
Consultation Plus; Icc = 0.52
63
N = 152 sessions
N = 167 sessions
Wilcoxon (317)=-3.491, p=.007
Eiraldi, Mautone, Khanna et al., 2018 (Beh Therapy)
PROCESS FIDELITY - FRIENDS
3.07 3.31
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Consultation; Icc = 0.68
Consultation Plus; Icc = 0.77
64
N = 104 sessions
N = 79 sessions
Wilcoxon (183)=-2.855, p=.004
CHANGES IN ODD DIAGNOSTIC SEVERITY LEVEL - CPP
32% 39%
29% 28%
63%
6%
0 10 20 30 40 50 60 70 80 90
100
Lower Same Higher
Consultation, McNemar = 0.04 (1), p=1.00 Consultation Plus, McNemar = 4.45 (1), p=0.0654
65 N = 73 Eiraldi, Mautone, Khanna et al., 2018 (Beh Therapy)
CHANGES IN ANXIETY DIAGNOSTIC SEVERITY LEVEL - FRIENDS
66
21%
63%
16%
26%
64%
10%
0 10 20 30 40 50 60 70 80 90
100
Lower Same Higher
Consultation
Consultation Plus
N = 35
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CHANGES IN CLINICAL GLOBAL IMPRESSION - CPP
3.93
3.44
4.13
3.34
2
3
4
5
Pre- Post-
Seve
rity
Sco
re
Clinical Global Impression – Severity of Illness Score (CGI-S)
Consultation; t(40) = 3.281, p = .002; ES = .52
Consultation Plus; t(31) = 4.876, p = .000; ES = .86
Severity Score 1 = Normal, not at all ill 2= Borderline mentally ill 3 = Mildly ill 4 = Moderately ill 5 = Markedly ill 6 = Severely ill 7 = Among the most extremely ill
N = 73 Eiraldi, Mautone, Khanna et al., 2018 (Beh Therapy)
CHANGES IN CLINICAL GLOBAL IMPRESSION - FRIENDS
3.95
3.42 3.69
3.06
2
3
4
5
Pre- Post-
Seve
rity
Sco
re
Clinical Global Impression – Severity of Illness Score (CGI-S)
Consultation; t(18) = 2.535, p = .021; ES = .60
Consultation Plus; t(15) = 2.611, p = .020; ES = .59
Severity Score 1 = Normal, not at all ill 2= Borderline mentally ill 3 = Mildly ill 4 = Moderately ill 5 = Markedly ill 6 = Severely ill 7 = Among the most extremely ill
N = 35
CHANGES IN GLOBAL IMPAIRMENT - CPP
53.51
57.27
50.19
55
40
45
50
55
60
Pre Post
Impa
irm
ent L
evel
Clinical Global Impairment (CGAS)
Consultation; t(40) = -3.443, p = .001; ES = .54
Consultation Plus; t(31) = -4.115, p = .000; ES = .73
Impairment Level 100-91 Superior functioning 70-61 Some difficulty in a single area 60-51 Variable functioning with sporadic difficulties 50-41 Moderate degree of interference in functioning 40-31 Major impairment to functioning in several areas 10-1 Needs constant supervision
N = 73 Eiraldi, Mautone, Khanna et al., 2018 (Beh Therapy)
CHANGES IN GLOBAL IMPAIRMENT – FRIENDS
51.52
57.37 55.63
61.69
45
50
55
60
65
Pre Post
Impa
irm
ent L
evel
Clinical Global Impairment (CGAS)
Consultation; t(18) = -3.373, p = .003; ES = .86
Consultation Plus; t(15) = -3.055, p = .008; ES = .57
Impairment Level 100-91 Superior functioning 70-61 Some difficulty in a single area 60-51 Variable functioning with sporadic difficulties 50-41 Moderate degree of interference in functioning 40-31 Major impairment to functioning in several areas 10-1 Needs constant supervision
N = 35
CHANGES IN PARENT RATING SCORES - CPP
69 66
70 68
50
55
60
65
70
75
80
Pre- Post-
T-Sc
ore
CBCL Oppositional Defiant Problems
Consultation; t(40) = 2.884, p = .044 Consultation Plus; t(31) = 1.676, p = .165
N = 77
CHANGES IN PARENT RATING SCORES - FRIENDS
70 67
64
59
50
55
60
65
70
75
80
Pre- Post-
T-Sc
ore
CBCL Internalizing Problems
Consultation; t(18) = 3.221, p = .005 Consultation Plus; t(16) = 1.976, p = .066
N = 36
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SUMMARY – TIER 2 Implementation
• School-based counselors implemented manualized treatments with high fidelity
• Consultation Plus resulted in higher content and process fidelity for both CPP and FRIENDS
Effectiveness • Children in both treatments & conditions seemed to
improve • Similar improvement level between conditions in illness
severity and global impairment (CPP & FRIENDS) • Statistical trend for Consultation Plus over Consultation
for ODD • No differences between conditions for anxiety disorders • No difference between conditions on parent rating scale
(CPP & FRIENDS)
THANK YOU!
• Ricardo Eiraldi, Ph.D. [email protected] (215) 590-7759
• Barry McCurdy, Ph.D., NCSP, BCBA-D [email protected] (610) 542-3123