No abstract

The toddler years can be a particularly stressful time for all parents, however, parents of children with disabilities may experience additional sources of stress. Recent literature on early education for children with disabilities promotes inclusion with typical peers with increases in the availability of inclusive programs. However, little is known about early intervention inclusion programs and parental factors such as stress and adaptability. The current study expands the research for children with disabilities by investigating the associations of having a young child with an Autism Spectrum Disorder (ASD) on multiple dimensions of parental stress for mothers and fathers and how participation in an inclusive toddler program may be related to these stress levels. Results for this community sample are consistent with previous research indicating that that both mothers and fathers of children with ASD report significantly elevated levels of both child and parent related stress in comparison with parents of typically developing toddlers. Following their child's participation in the inclusion program, mothers of children with ASD report significant reductions in child-related stress but no reductions in the parent-related stress domain. No changes were seen with either child or parent domain for fathers. Lastly, a child's level of social skills was a significant predictor of child-related maternal stress for children with autism. This pattern was not seen in fathers of these children. Implications for early intervention program modifications, such as increasing family support and incorporating adjunctive parent interventions for parents with elevated levels of stress are discussed.

Objectives In the United States, more money is spent on treatment for children’s mental health problems than for any other childhood medical condition, yet little is known about usual care (UC) treatment for children. Objectives of this study were to a) characterize UC out-patient psychotherapy for children with disruptive behavior problems, and b) identify consistencies and inconsistencies between UC and common elements of evidence-based practices to inform efforts to implement evidence-based practices in UC. Methods Participants included 96 psychotherapists and 191 children ages 4–13 presenting for treatment for disruptive behavior to one of six UC clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy – Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1215 randomly selected (out of 3241 collected) videotaped treatment sessions for up to 16 months. Results Most children received a lot of treatment (mean number of sessions=22, plus other auxiliary services), and there was great variability in amount and type of care received. Therapists employed a wide array of treatment strategies directed to children and parents within and across sessions, but all strategies were delivered at low average intensity. Several strategies conceptually consistent with evidence-based practices were observed frequently (e.g., affect education, positive reinforcement); however, others were observed rarely (e.g., assigning/reviewing homework, role-playing). Conclusion UC treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and UC, thus identifying potentially potent targets for improving the effectiveness of UC.

Recently, many treatments for children with disabilities have shifted from a purely clinician-implemented model to one that focuses on a parent education component. In the current study, a repeated reversal design was employed to compare the effects of a parent education intervention that incorporates the principles outlined in the parent empowerment and ecocultural literature with a professional-driven model that does not incorporate these principles. The Parent/Clinician Partnership and Clinician-Directed models were compared on the following measures: (a) observed parent stress, (b) observed parent confidence, (c) observed child affect, and (d) child responsiveness and engagement. The results are discussed in terms of the implications for parent education programs and the relationships between clinical outcome and the type of parent education procedures implemented.

This mixed methods study examined therapist perspectives on serving children with autism spectrum disorders (ASD) in community mental health (CMH) clinics. One hundred therapists completed a survey about their experiences with this population and 17 participated in subsequent focus groups to clarify and expand survey results. Results indicate that CMH therapists serve many children with ASD for behavior or other psychiatric problems and perceive serving this population as challenging and frustrating due to their limited training. Therapists are highly motivated for comprehensive ASD training on ASD characteristics and intervention strategies. These data were used to tailor and package evidence-based intervention strategies for delivery in CMH services.

Objective This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children’s mental health services. Based on an item set informed by Stirman and colleagues’ model (2015), two factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We employed multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. Method Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% Non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. Results Analyses revealed that the two types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists’ general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. Conclusions Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components.

Research on moving evidence-based practice (EBP) intervention strategies to community service settings for children with autism spectrum disorders (ASD) is urgently needed. The current pilot study addresses this need by examining the feasibility, acceptability and preliminary outcomes of training therapists practicing in community mental health (CMH) clinics to deliver a package of EBP strategies aimed to reduce challenging behaviors in school-age children with ASD. Results indicate that CMH therapists participated in both initial and ongoing training, were able to deliver the intervention with fidelity, and perceived the intervention strategies as useful. Parents participated in almost all sessions with their children and remained in therapy when therapists delivered the intervention. Meaningful reductions in child problem behaviors occurred over 5 months providing promising support for the intervention.

The objective of this study is to examine the characteristics of outpatient mental health services delivered in community-based outpatient clinics, comparing information obtained from two different sources, therapists serving children and families, and observational coders viewing tapes of the same treatment sessions. Videotaped therapy sessions were rated by therapists and independent coders regarding goals and strategies pursued during each session. Sixty-three sessions were taped of outpatient care provided to 18 children and their caregivers by 11 therapists. Children were 4–13 years old and families were receiving services at least in part due to reported child behavior problems, confirmed by ratings from the Child Behavior Checklist and Conners Parent Rating Scale—Revised. Analyses assessed the frequency, type, and intensity of goals and strategies pursued in therapy sessions from both therapist and observational coders’ perspectives. Reliability of observer ratings and correspondence between therapist and observer reports were also examined. The reliability of observational coding of goals and strategies was moderate to good, with 76% of 39 codes having ICCs of .5 or greater. Therapists reported pursuing 2.5 times more goals and strategies per session, on average, than identified by observational coders. Correspondence between therapists and coders about the occurrence of specific goals and strategies in treatment sessions was low, with 20.5% of codes having a Kappa of .4 or higher. Substantial differences exist in what therapists and independent coders report as occurring in outpatient treatment sessions. Both perspectives suggest major differences between the content of services provided in community-based outpatient clinics and the structure of evidence-based programs, which emphasize intense pursuit of a small number of goals and strategies in each treatment session. Implications of the findings for quality improvement efforts in community-based mental health care settings are discussed.