apbs 2018-final.pptx (read-only) · equity patient- centeredness timeliness patient outcomes...

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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

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•  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

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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

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25 26

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TIER 1 IMPLEMENTATION DATA: YEARS 1-3

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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%


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%


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%


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%


PROJECT ACCESS TIER I Implementation Outcomes

Multi-Year SET Data Teaching Expectations Scores

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


PROJECT ACCESS TIER I Implementation Outcomes Multi-Year SET Data Mean Scores

SET: MEAN SCORE

TIER 1 OUTCOME DATA: YEARS 1-3

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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


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

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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

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•  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

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•  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

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•  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

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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



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

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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%

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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


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.



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

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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

apbs 2018-final.pptx (read-only) · equity patient- centeredness timeliness patient outcomes...

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