After Integrated Practices: Complementary Approaches to Improving Child Services and Outcomes

1. After Integrated Practices:Complementary Approaches to Improving Child Services and Outcomes Bruce F. Chorpita, Ph.D. Eric L. Daleiden, Ph.D. March 18, 2008 Burbank, CA

2. Agenda • Intros and acknowledgements • Background • The “Evidence Based System” • The EBT Literature • PW EBS Database • Common elements • The Clinical Dashboard • Clinical Process Modeling • Modularity • Results so far… • Discussion

3. Traditional Approach to Evidence Based Practice

8. “Dissemination as Usual” • Assumes “replacement” approach • Institutionalizes service programs • Assumes an evidence base for all problems • Assumes unlimited resources and learning capacity

9. Fixed content Fixed intensity Fixed length Single target approach Too few choices Too many choices Expiration problem More Concerns Aarons (2004); Addis & Krasnow (2000); Addis, Wade, & Hatgis (2004); Chorpita, Daleiden, & Weisz (2005); Kimhan & Chorpita (2006); Persons (1995)

10. Throw out the Bath Water:Keep the Baby • Move away from the idea that “Problem A gets Treatment B” • We decided to map the decisions made at the service system level – not just the IF-THEN of treatment selection • Goal: To build an Evidence Based System

11. Alternative:The Evidence Based System

12. Treatment Team Treatment Integrity Client Progress Supervision Selecting a program structures other decisions Service Setting Tx Program Selection Therapeutic Practices

13. Treatment Team Treatment Integrity Client Progress Supervision Selecting a program structures other decisions Multisystemic Therapy (MST) Example Service Setting Home & Community Based Tx Program Selection Therapeutic Practices MST Family Therapy, etc. 4 – 5 Members Team Supervisor Cross-Team Supervisor TAMS & SAMS Instrumental & Ultimate Outcomes

14. Treatment Team Treatment Integrity Client Progress Supervision How should we select a program? Service Setting Tx Program Selection Therapeutic Practices

15. Treatment Team Treatment Integrity Client Progress Supervision How should we select a program? General Services Research Service Setting Tx Program Selection Therapeutic Practices Evidence-Based Services Model

16. Treatment Team Treatment Integrity Client Progress Supervision How should we select a program? Causal Mechanism Research Service Setting Tx Program Selection Therapeutic Practices Case-Specific Historical Information Individualized Case Conceptualization Model

17. Treatment Team Treatment Integrity Client Progress Supervision How should we select a program? Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information Practice-Based Evidence Model

18. Treatment Team Treatment Integrity Client Progress Supervision The full system model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

19. Treatment Team Treatment Integrity Client Progress Supervision Traditional EBS Model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

20. Treatment Team Treatment Integrity Client Progress Supervision The full system model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

21. Treatment Team Treatment Integrity Client Progress Supervision Valid alternatives to deciding by program? General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

22. Common Elements Approach Stay tuned…

23. Treatment Team Treatment Integrity Client Progress Supervision The full system model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

24. A Brief Aside on Evidence Bases

25. The Phases of Evidence • Data: Discretely identifiable units • Information: Data in a context that provides it meaning • Knowledge: Information helpful to decision-making • Wisdom: Knowing when to apply our knowledge Speigler, I. (2000). Knowledge management: A new idea or a recycled concept? Communications of the Association for Information Systems, 3, 1 – 23.

26. The Phases of Evidence: Example • Data: 65 • Information: 65° F • Knowledge: It warm enough for me to wear a T-shirt. • Wisdom: I will be giving a professional talk, so the temperature outside is irrelevant to my attire.

27. Treatment Team Treatment Integrity Client Progress Supervision The full system model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information

28. General Services Research:Turning Data into Knowledge I • Meta Analysis of Children’s Treatment Research • 322 studies • 41 years • 832 study groups • 25,435 youth participants • $407 million in today’s dollars • Largest meta-analysis to date • Automated for practitioners

29. 145 protocols, 18 treatment families anxiety

30. Results: Anxiety Best Support Good Support Cognitive Behavior Therapy with Parents (2) Relaxation (2) Cognitive Behavior Therapy and Meds (1) Hypnosis (1) Assertiveness Training (1) • CBT (26) • Exposure (24) • Modeling (7) • Education (2)

31. No Support Results: Anxiety • Attention • Client Centered Therapy • EMDR • Relationship Counseling • Teacher Psychoeducation

32. 67 protocols, 18 treatment families Attention & hyperactivity

33. Results: Attention & Hyperactivity Best Support Good Support Parent Management Training (5) Contingency Management (4) Physical Exercise (3) Biofeedback (2) Social Skills and Meds (2) Relaxation and Exercise (1) Parent Management Training and Problem Solving (1) Education (1) • Self verbalization (4) • Behavior Therapy and Medication (2)

34. No Support Results: Attention & Hyperactivity • Client Centered Therapy • Self-Control Training • Skill Development • Parent Management Training and Self-Verbalization*

35. 21 protocols, 3 treatment families Autism spectrum

36. Best Support Results: Autism Spectrum • Intensive Behavioral Treatment (4) • Intensive Communication Training (3)

37. No Support Results: Autism Spectrum • Auditory Integration Training

38. 39 protocols, 15 treatment families Depression

39. Results: Depression Best Support Good Support Interpersonal Therapy (2) Relaxation (2) Cognitive Behavior Therapy with Parents (2) Client Centered Therapy (1) Family Therapy (1) • Cognitive Behavior Therapy (12) • Cognitive Behavior Therapy and Medication (2)

40. No Support Results: Depression • Attention • Counselors Care • Counselors Care plus Anger Management • Life Skills • Problem Solving • Social Skills

41. 173 protocols, 34 treatment families Disruptive behavior

42. Results: Disruptive Behavior Best Support Good Support Problem Solving (7) Communication Skills (3) Relaxation (2) Parent Management Training and Problem Solving (2) Client Centered Therapy (2) Anger Control (2) Rational Emotive Therapy (1) Multidimensional Treatment Foster Care (1) Functional Family Therapy (1) Transactional Analysis (1) • Parent Management Training (26) • Contingency Management (9) • Multisystemic Therapy (9) • Social Skills (6) • Cognitive Behavior Therapy (6) • Assertiveness Training (2)

43. Results: Disruptive Behavior • Assertiveness Training • Attention • Catharsis • Collaborative Problem Solving • Education • Exposure • Family Empowerment • Family Systems Therapy • Group Therapy (!!) • Life Skills • Project CARE (!!) • Psychodynamic • Self Verbalization • Skill Development • No Support

44. 16 protocols, 7 treatment families Traumatic Stress

45. Results: Traumatic Stress Best Support Good Support Cognitive Behavior Therapy (4) • Cognitive Behavior Therapy with Parents (5)

46. Results: Traumatic Stress • Client Centered Therapy • Cognitive Behavior Therapy with Parents Only • EMDR • No Support

47. Break

48. How do I keep track of all this information? The PW Database

49. Live Demo Possible?

50. Treatment Team Treatment Integrity Client Progress Supervision The full system model General Services Research Causal Mechanism Research Service Setting Local Aggregate Evidence Tx Program Selection Therapeutic Practices Case-Specific Historical Information