CHILDREN OF DIVORCE-COPING WITH DIVORCE

(COD-COD) :

AN INTERNET-BASED PREVENTION PROGRAM

Jesse Boring, Ph.D.

Arizona State University – Prevention Research Center

ACKNOWLEDGMENTS

I am deeply indebted to the following people for their support

of the CoD-CoD program:

Irwin Sandler, Keith Crnic, Sandy Braver, John Horan, Jenn-

Yun Tien

Joanne Rzucidlo, Taylor Cody, Jessica Mueller, Silvia Baez

Joanne Pedro-Carroll, Arnold Stohlberg, Sharlene Wolchick

Matthew Berry

My Family

The study was partially funded by the ASU Graduate College

Completion Fellowship.

WHY DEVELOP AN ONLINE PROGRAM FOR

CHILDREN OF DIVORCE?

Children of divorce are at increased risk for a range of

poor developmental outcomes (Amato, 2001).

Divorce is widespread

Over 1 million children experience divorce each year (U.S. Census, 2008).

Children of divorce can be helped by prevention programs targeting developing coping skills

Children of Divorce Intervention Program

Children’s Support Group

INTERNET INTERVENTIONS

Internet-Based Program Advantages

For Users

Available at the time and place of the users choosing

Availability of specialized expertise

Reduced threat of stigma/fear of disclosure

Instant user access

For Researchers/Developers

Program fidelity

Low provision cost per user

Ability to collect usage data

Ability to revise instantly

INTERNET INTERVENTIONS

Internet intervention programs have now been used in a wide variety of capacities Depression

Anxiety

Eating Disorders

Smoking Cessation

Asthma Management

Meta-analyses indicate potential effectiveness of internet-based programs

Spek et al., 2007

Barak et al., 2008

…and also that field has long way to go

THE DARK AGES PART I: THE RESEARCH

Few trials include a randomized control group

Many studies include inadequate measures

Level of specificity at which the literature can inform

how to make a good program is very low.

Bright colors

THE DARK AGES PART II: THE PROGRAMS

Common problems for internet-based interventions.

Low recruitment rates Mailed brochures, internet recruitment

2.4 in 1000 (Clarke, et al., 2005)

High Attrition 18.6% program completion (Buller et al., 2006)

Efficacy of reminders

2.6 log-ins to 5.9 log-ins

Low satisfaction 5.9 out of 10 (Vorhees et al., 2005)

Most programs just aren’t very cool yet.

EXAMPLE COD-COD ACTIVITIES

Overview of Module Structure

Replacing Hurtful Thoughts with Hopeful Thoughts

Deciding If a Problem Is Yours To Fix

The 4 Steps of Good Communication: Step #3

Module 3 Home Practice: Talk To Your Parent

PROGRAM DESIGN INNOVATIONS OF COD-COD

Personal approach Use of humor

Module structure designed to enhance engagementHome Practice Review Program Goal Intro Video

Content Home Practice Assignment Quiz Video Game

Highly interactive (activities and dynamic content)

Creation and tracking of goal With contingent feedback on creating goal and progress

Focus on in-program skills practice.

Home Practice (with feedback on attempts)

CONTENT CREATION FOR COD-COD

The skills and information taught in CoD-CoD are

based on the available evidence-based programs

for children from disrupted families.

The Family Bereavement Project

The Children of Divorce Intervention Program

The Children’s Support Group

Research on children of divorce guided the

distillation process.

COD-COD THEORETIC MODEL

Internalizing

Symptoms

Externalizing

Symptoms

Coping Efficacy

Children’s Divorce

Appraisals

Avoidant Coping

Active Coping

Intervention

Condition

THEORY OF THE PROGRAM

Problem-solving training

Positive cognitive restructuring

Psycho-education

Active Coping

Feeling awareness

Relaxation

Distraction coping

Avoidant

Coping

Coping

Efficacy

Controllability of Stressors

Reduce wishful thinking

Peer Testimonials

Simulated Coping Practice

Divorce

Appraisals

Positive cognitive restructuring

Divorce information

Intervention

Program

Elements

Modifiable

Mediators

COD-COD TRIAL DESIGN

Recruitment

Court Records – Maricopa County

147 children ages 11-16 randomized used block

random assignment based on risk scores.

“Treatment As Usual” control

Intended to approximate best case scenario in using online

resources currently available for children of divorce.

PARTICIPANTS

147 children and adolescents

78 females and 69 males

Ages 11-16. Mean age was 13.78 (1.66).

Divorce latency mean was 1.23 years (1.08).

Divorce filing date, not divorce decree

Ethnic composition includes:*

75.2% Non-Hispanic white, 15.8% Hispanic, 3.8% Non-

Hispanic Black, 3.7%, 0.8% Native American, and 1.4%

other.

Average years of mother's education was 14.82

(2.93). *

Court Records

(25-45 months old)

n1= 818

Provided Data

Parent [n = 66 (89.19%)]

Child [n = 64 (86.49%)]

Randomized

n = 112 families

[n = 147 children]

Program Condition, [n = 74]

Control Condition, [n = 73]

Court Records

(3-16 months old)

n = 1364

Refused/Unable to Contact

n = 227

Ineligible, n = 2

Sent Invitation

Letters

Attempted

Phone Contact

n= 247

Attempted

Phone Contact

n = 763

Sent Pre-Tests

n = 18 families

[n = 24 children]

Sent Pre-Tests

n = 97 families

[n = 128 children]

Did Not Complete Pre-

Tests

n = 0

[n = 0]

Refused/Unable to Contact

n = 652

Ineligible, n = 14

Did Not Complete Pre-

Tests

n = 4

[n = 7]

Provided Data

Parent [n = 71 (97.26%)]

Child [n = 71 (97.26%)]

Pre-Test

Program Condition Control Condition

Data Collected ¹Parent Assessment: n = 116, [n = 147]

Child Assessment: n =116, [n = 146] ²

Post-Test

(1-Month)

1 One family with 2 children entered

the study through clinician referral.

2 One child did not complete the

pre-test assessment.

PROCESS DATA

89 % Home practice participation rate

92% of completers stated that the home practice was

helpful to them.

92% of program completers reported that they had

made progress toward the their program goal.

PROGRAM GOAL EXAMPLES

To not get so angry all the time.

I would like to understand how to better control my emotions

For my parents to stop putting me in the middle of their problems.

I would like to not feel so sad

To try not to hide feelings from friends and family.

PROGRAM COMPLETION RATE

Completion Rate Comparison

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Mood Gym 2009 (a)

Mood Gym 2009 (b)

BRAVE Online 2008

Project CATCH-IT 2008 (BA)

BRAVE Online 2011

Mood Gym 2006

Project CATCH-IT 2008 (MI)

CoD-CoD

NARRATIVE FEEDBACK: CHILD

“I thought this program wasn't going to help at all but I was wrong my parents divorce is so much easier to deal with now. Thank you.”

11-year old girl

“CoD-CoD changed my life by making it a little easier.”

14-year old boy

“It was great. Jesse was funny.”

13-year old boy

“It taught me to control my emotions and solve difficult problems. I can also stop myself before I say something that will most likely hurt someone else.”

14-year old girl

NARRATIVE FEEDBACK: PARENT

She is able to tell me when I am talking about something that I should only talk about with her

father. She stops me to let me know it should be between me and my ex.

-Mother of 13 year-old girl

He has expressed on numerous occasions that he feels the program continues to help him deal

with situations that arise concerning me and his dad. Thank you for including him, I see a real

change in his coping skills. I hope that the program is able to help many others to come.

-Mother of 11-year old boy

Recently, my son and I missed a flight at the airport. I was very frustrated with the way

the airlines handled the situation and it showed! My son, on the other hand, handled the

situation with uncommon maturity. I was very impressed when he told me that he was utilizing

some of the techniques that he had learned during your online program to manage the stress.

Great Job! Maybe I should have done the program with him.

-Father of 13-year old boy

I watched my son a few times as he was completing his modules. He really took time and

enjoyed the videos and information provided. It has been a positive experience, and in the short

time V. participated, he has learned positive life lessons and is applying them to his daily

activities and decisions. -Mother of 15 year-old boy

I think it made my child think a lot about ways to work though problems. She presented me with

an idea of how to resolve an argument that we had and it was a really good idea that involved

expressing feelings in a constructive manner. I was pretty impressed

-Mother of 13 year-old girl

MAIN EFFECTS

Intent-to-Treat Analysis

Reduced Total Mental Health Problems (SDQ)

d = .37

Reduced Emotional Problems (SDQ)

d = .37

ANALYSIS OF MODERATION

Variables examined as possible moderators

Baseline Variable Levels

Risk

Age

Gender

Divorce Latency

Three of the moderators examined did not significantly moderate any program effects:

child gender, child age, and divorce latency

Two of moderators examined moderated program effects on two variables:

Baseline Variable Level

Risk

GROUP X BASELINE SDQ-TOTAL

GROUP X BASELINE COPING EFFICACY

T2 SDQ-

Total

T1 SDQ-

Total

T1 SDQ-Total

x Condition

T2 Coping

Efficacy

Program

Condition

T1 Coping

Efficacy

.69***

-.16***

.73***

-.15†

T1 Coping Efficacy x

Condition -.30*

-.06

Coping Efficacy

.30*

Low T1

T2 SDQ-

Emotional

T1 SDQ-

Emotional

T2 Coping

Efficacy

Program

Condition

T1 Coping

Efficacy

Coping Efficacy

.69***

-.17***

.60***

.30*

Low T1

T1 Coping Efficacy x

Condition -.30*

-.11*

T2 BPI-

Total

T1 BPI-

Total

T1 Risk

x Condition

T2 Coping

Efficacy

Program

Condition

T1 Coping

Efficacy

-.01

.69***

-.10*

.50***

-.32†

T1 Coping Efficacy x

Condition -.30*

T1 Risk

-.22†

Coping Efficacy

.30*

Low T1

MAJOR FINDINGS

The CoD-CoD program demonstrated positive effects to reduce children’s mental health problems and to improve coping efficacy.

Program effects are strongest for children with greatest initial risk/symptomatology.

Only randomized controlled trial of an internet-based program for children and adolescents to date to use an active control condition.

First experimental trial of an internet-based program for children of divorce.

CoD-CoD’s high program completion rate suggests that program elements designed to increase engagement were effective.

POSSIBLE USES FOR COD-COD

Adjunct to counseling

Stand alone universal prevention (with support).

May be particularly appropriate with high risk children.

The program is being made available commercially

Starting July 2012

Please leave me your e-mail if you’d like a program preview.

Feel free to contact me with any questions at:

jesse.boring@familytransitions-ptw.com

FUTURE DIRECTIONS FOR PROGRAM REVISION

Add a Parent Component

Mobile Application To Support Program

Parent and Participant Testimonials

Weekly Chat Room / Moderated Forum

Further Individualization

Content (Topics, Skills, Shortening Program)

Presentation (Videos, Videogames, Narration, etc.)

Use Usage Data To Retool Program

Follow-Up Modules

EXTRA STUFF THAT MIGHT BE HANDY

Program Outline by Module

Wave 1 Demographics + Pre-Test Equivalence

PROGRAM COMPLETION

68.9% of CoD-CoD participants completed the entire

program.

Average number of modules completed = 3.83.

76.6% of the 5-module program

84.9% of BTN participants completed the entire program.

Average number of modules completed = 1.78.

89.04% of the 2-module program

CONTROL CONDITION: SITE #1

CONTROL CONDITION: SITE #2