Common And Specific Ingredients Of Youth Care

EUSARF 2010Symposium Netherlands Youth InstituteSeptember 22. 2010

Tom van Yperen and Mariska van der Steege

Netherlands Youth Institute

Effects Of Youth Care

2.0 Very large effect | | .80 Large Average: .70 | (Most studies .40-.80) .50 Moderate | In practice.20 Small (new estimate: ± .40) | .00 No effect In practice | (acc. Weisz cs: ± .01)-.10 (Source a.o.: Kazdin, 1991, Kazdin & Weisz, 1998: Lipsey & Wilson, 1993, 1998; Shadish cs, 2000; Weisz cs, 1992, 1995; Van Yperen,

2005; Carr, 2009)

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Factors Accounting For Change

Factor Percentage Accounted For*

Extratherapeutic 40%

Common factors (e.g. relationship) 30%

Placebo effect (hope and expectancy)

15%

Method (specific therapy / technique)

15%

*Source: Lambert (1992)

Total effect youth care in practice: d= 0.40

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How To Improve Youth Care?

• Implement evidence-based treatments?

• Focus on the common factors?

In this session:1. Is the Lambert scheme valid? 2. Implement specific evidence-based

programs?

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Is The Lambert Scheme Valid? (1)1. Not based on quantative, statistical analyis,

but on impression of the literature

2. Outdated: published in 1992, based on Lambert, Shapiro & Bergin (1986)

3. Review based on data from adult psychotherapy (not youth care)

4. Studies show different definitions and results

Is The Lambert Scheme Valid? (2)Studies show different definitions and results

Factor

Percentage accounted for

Lambert (1992)

Wampold (2001)

Thomas (2006):

therapists

Thomas (2006): clients

Extratherapeutic 40% 22% 13%

Common factors 30% 70%

Relation 35% 29%

Placebo / hope and expectancy

15% 27% 30%

Specifiec method / technique

15% 8% 16% 28%

Unexplained 22%

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Confusion (1): The Fuzzy Concept Of ‘Common Factors’

• Fitting the treatment with the motivational stage

• Fitting the treatment with the type and severity of the problem

• Structuring the treatment

• Working with treatment integrity

• Supporting the practitioner (e.g. with good supervision)

• Monitoring the treatment, providing feedback on results

• The quality of therapist-client relationship (‘Alliance’)

Confusing: Some call this placebo (e.g. Stevens et al., 2000), others focus on relationship factor only (e.g. Thomas, 2006)

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Confusion (2): Common Factors And Specific Techniques Are Very Different Entities (Or Not)

Common factors and specific techniques are mentioned separately in Lambert’s scheme. But:

Using specific techniques may contribute to• Quality of the relation (e.g. Stams e.a. 2005)

• The structuring of the treatment (e.g. Wampold, 2001)

Specific techniques are vehickels for bringing

common factors into practice (Sprenkle & Blow, 2006; Carr, 2009)

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Do Specific Techniques Have A Unique Contribution?

Yes

1. Meta analyses show: a. In general, specific treatments do explain a (small) part of the

variance in outcome (Carr, 2009; Hoagwood, 2005; Asay & Lambert, 1999; Karver e.a., 2006).

b. In case of severe problems, specific treatments may be more important than common factors (Stevens et al, 2000)

2. Better implementation leads to better outcome (o.a. Aos, 2002;

Lowenkamp, 2004; Goggin & Gendreau 2006; Barnoski e.a., 2004).

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Do Specific Techniques Have A Unique Contribution?

Yes

1. Meta analyses show: a. In general, specific treatments do explain a (small) part of the

variance in outcome (Carr, 2009; Hoagwood, 2005; Asay & Lambert, 1999; Karver e.a., 2006).

b. In case of severe problems, specific treatments may be more important than common factors (Stevens et al, 2000)

2. Better implementation leads to better outcome (o.a. Aos, 2002;

Lowenkamp, 2004; Goggin & Gendreau 2006; Barnoski e.a., 2004).

3. Specific treatments not only specify the do’s, but also the don’ts, to eliminate negative influences on the total outcome.

Outome = Common x Specific Factors

An illustration of how to improve youth care

• IOG for multi problem families, with severe behaviour problems child

• Data 1999-2005• N of cases: 43 – 72• Response rate 50-60%• Effect size based on

– CBCL Total Problem scale– NOSI Total Parenting Stress

Source: Leijsen (2008)

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E ff e c t S iz e I O G

0 ,4 4

0 ,7 4 0 ,7 4

0 ,9 70 ,9 3

0 ,8 9

1

0 ,5 1

0 ,6 80 ,6 2

0 ,8 2 0 ,8 1 0 ,7 9

1 ,2 1

0

0 ,1

0 ,2

0 ,3

0 ,4

0 ,5

0 ,6

0 ,7

0 ,8

0 ,9

1

1 ,1

1 ,2

1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5

P r o b le m b e h a v io r P a r e n ta l S tr e s s

0 . 8 0 : L a r g e e ff e c t 0 . 2 0 - 0 . 4 9 : S m a l l e ff e c t

0 . 5 0 - 0 . 7 9 : M o d e r a t e e ff e c t < 0 . 2 0 : N e g l ig ib le e ff e c t

Improving The Outcome

Source: Leijsen (2008)

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B y c o m b in in g c o m m o n a n d s p e c ifi c fa c t o r s

0 ,4 4

0 ,7 4 0 ,7 4

0 ,9 70 ,9 3

0 ,8 9

1

0 ,5 1

0 ,6 80 ,6 2

0 ,8 2 0 ,8 1 0 ,7 9

1 ,2 1

0

0 ,1

0 ,2

0 ,3

0 ,4

0 ,5

0 ,6

0 ,7

0 ,8

0 ,9

1

1 ,1

1 ,2

1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5

P r o b le m b e h a v io r P a r e n ta l S tr e s s

0 . 8 0 : L a r g e e ff e c t 0 . 2 0 - 0 . 4 9 : S m a ll e ff e c t

0 . 5 0 - 0 . 7 9 : M o d e r a t e e ff e c t < 0 . 2 0 : N e g l ig ib le e ff e c t

Improving The Outcome

Source: Leijsen (2008)

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Enhancing The Effects Of Youth Care

Total effect youth care

in practice: d = 0.40 d = 1.20?

FactorLambert

(1992, 1986)In the year 2020

Extratherapeutic 40% 15%

Common factors (e.g. relationship)

30% 30%

Method (specific therapy / technique)

15% 40%

Placebo-effect (hope and expectancy)

15% 15%

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You are managing director of a youth care provider. How do you decide to improve your services?

What is your conclusion?

By investing mainly in common factors

(specific treatments are not that important)

By implementing specific treatments

(essential in improving youth

care)

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More information

Yperen, T.A. van, M. van der Steege, A. Addink & L. Boendermaker (2010). Algemeen en specifiek werkzame factoren in de jeugdzorg. Stand van de discussie. Utrecht: Nederlands Jeugdinstituut. (download: www.nji.nl).

Yperen, T.A. van (Red., 2010). 55 Vragen over effectiviteit. Antwoorden voor de jeugdzorg. Utrecht: Nederlands Jeugdinstituut. (Download: www.nji.nl).

Yperen, T.A. van & Steege, M. van der (In Preparation): Common and specific factors in Youth Care.