Presented by Benjamin J. Springer of the University of Utah February 18, 2009

1. Presented by Benjamin J. Springer of the University of Utah February 18, 2009 2007 Biennial Report:EffectivePsychosocial Interventions for Youth with Behavioral and EmotionalProblems Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with Serious Emotional Disturbance/Behavior Disorders US Office of Education 84.325K H325K080308

2. Effective Interventions for Youth • Updated review summarizing selected areas of the scientific literature on: • Interventions • Services • Medications • The Child and Adolescent Mental Health Division (CAMHD) of the Hawaii Department of Health Task Force for Empirical Basis to Services. • CAMHD was established to review scientific findings. • Goal is to broaden and update the summary of scientific information used to guide decisions about children’s care.

3. Methods • Collective reports of APA Task Force on Psychological Intervention Guidelines. • American Academy of Child and Adolescent Psychiatry Practice Parameters • 322 studies were read and coded over a period of 3 years. (More than double the amount for the previous CAMHD Biennial Report).

4. Levels of Analysis:Treatment & Treatment Families • Interventions were not defined at the level of specific manuals. • Majority of components with similar clinical strategies and theoretical underpinnings to qualify as “treatment families.” • Treatment Families were created to differentiate interventions with limited support from those with stronger support.

5. Strength of Evidence Defined:The New 5-Level System • Level I: “Best Support” = APA Gold Standard of “Well-established” interventions. • Level II: “Good Support”: Same as Level I but doesn’t take into consideration studies involving experimental design/single subject design. • Level III: “Moderate Support”: Similar to Level II, refers to “treatment families” but do not use treatment manuals. • Level IV: “Minimal Support”: Preliminary and simply categorized as being differentiated from interventions with no scientific support whatsoever. • Level V: “No Support”: Treatment Family was tested and did not once outperform any control condition.

6. Quality & Relevance:The Codes… Trials # of studies contributing to “treatment family” Year Most recent/succesful study of an intervention Trainability Manual = High, No Manual = Low Compliance Attrition rate of treatment group Gender Age Mean Age of participants Ethnicity Therapist Training of providers Frequency Contact with child/family Duration Min/Max of time from pre-post treatment Format Group, Individual, Parents, etc. Setting Clinic? School? Effect Size SDs improved upon the mean

7. Reliability • All papers, reviews, and codes were coded by INDEPENDENT RATERS using a detailed coding manual. • CAMHD approach is criterion-based as opposed to “consensus” based. -Cautionary Statement- • Reviews are meant to represent the state-of-the-art at the time. • Review is meant to be a guide in the treatment planning and inform decision-making. • Conservative and Reliable.

8. Results of the Review:Anxious or Avoidant Behavior Problems • BEST SUPPORT: CBT, Exposure, Modeling, and Education • GOOD SUPPORT: Variations of CBT, Relaxation, CBT plus Meds, (Hypnosis was successful in 1 study), Assertiveness Training • MINIMAL SUPPORT: Psychodynamic Therapy, Play Therapy, Biofeedback, and Rational Emotive Therapy • NO SUPPORT: Attention, Client Centered Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Relationship Counseling, and Teacher Psychoeducation.

9. Results Attention and Hyperactivity Behaviors • BEST SUPPORT: Behavior Therapy + Meds, Self-Verbalization • GOOD SUPPORT: Parent Management Training, *Contingency Management*, Physical Exercise, Biofeedback, Social Skills + Meds, Relaxation, Problem Solving, Education. • MINIMAL SUPPORT: Parent Training and Social Skills, Social Skills(alone), Relaxation • NO SUPPORT: Client Centered Therapy, Self Control Training, Skill Development, PMT + Self-Verbalization

10. ResultsAutism Spectrum Disorders • BEST SUPPORT: Intensive Behavioral Treatment (ES = 1.27), Intensive Communication Training. (Communication Skills, Modeling, Social Skills Training, Goal Setting, Discrete Trial, Tangible Rewards, Praise, Maintenance/Relapse Prevention.) • “Intensive” = Daily, sometimes over the period of 5-years. Studies included ages from 2-12. • NO SUPPORT: Auditory Integration Training

11. ResultsDepressive or Withdrawal Behaviors • BEST SUPPORT: CBT, CBT + Meds • GOOD SUPPORT: Interpersonal Therapy, Relaxation, CBT with Parents, Client Centered Therapy, and Family Therapy • MINIMAL SUPPORT: Self-Control Training, Self-Modeling • NO SUPPORT: Attention, Counselors Care, Anger Management, Life Skills, Problem Solving

12. ResultsDelinquency and Disruptive Behavior • BEST SUPPORT: Parent Management Training, Multisystemic Therapy, Contingency Management, Social Skills, CBT, Assertiveness Training • GOOD SUPPORT: Problem Solving, Communication Skills, PMT + Problem Solving, Client Centered Therapy, Anger Control, Relaxation, Functional Family Therapy, Multidimensional Treatment Foster Care, Rational Emotive Therapy, and Transactional Analysis • MODERATE SUPPORT: Self-Control Training, Peer Pairing, Outreach Counseling • MINIMAL SUPPORT: Stress Inoculation and Physical Exercise • NO SUPPORT: Catharsis, Collaborative Problem Sovling, Educaiton, Exposure, Family Empowerment, Family Systems Therapy, Group Therapy, Life Skills, Psychodynamic Therapy, Self-Verbalization, Skill Development.

13. ResultsSubstance Use • GOOD SUPPORT: Family Therapy, CBT, Contingency Management, Family Systems Therapy • NO SUPPORT: Client Centered Therapy, 12-Step Program

14. ResultsTraumatic Stress • BEST SUPPORT: CBT with Parents • GOOD SUPPORT: CBT • MINIMAL SUPPORT: Psychodrama, Play Therapy • NO SUPPORT: Client Centered Therapy, CBT with Parents Only, EMDR