Evidence-based Treatment For Children Research Articles

8.L. Workshop: The children and parents in focus: Challenges in evaluating a public health approach to parenting

Abstract Parenting programs have strong evidence in promoting positive changes in both parents and children and are considered as evidence-based treatments for children with externalising problems such as conduct problems and ADHD. It is expected that a public health approach to parenting - i.e., the availability of parenting programs to all parents regardless of their risk status - will reduce the number of children with externalising problems at the population level. However, the evidence on the effectiveness of this approach is inconclusive. This is largely due to difficulties in conducting the needed large population trials of universal parenting programs. The objective of the workshop is to facilitate a discussion on planning and conducting research projects to successfully evaluate the effectiveness of psychological interventions such as parenting programs when they are offered universally to everyone. We will describe three main challenges in evaluating a public health approach to parenting: difficulties in collecting data from the whole population (and not only those exposed to the intervention), lack of validated instruments to measure population-level impact, and low program exposure. To illustrate our points, we use a population-based cluster randomised controlled trial as an example. The aim of the project - Children and Parents in Focus - was to test the effectiveness of a universally offered parenting program in addressing emotional and behavioural problems in preschool children. The project was carried out for four years in a municipality with 200 000 inhabitants in Sweden. Data were collected from mothers, fathers and teachers of over 7 000 children aged 3 to 5 years. The workshop will include a brief introduction and three presentations. In the first presentation, we focus on recruitment of parents into the study. We discuss the rational for recruiting parents of all children aged 3-5 into the study through child health centres and the steps that we took to increase the number of parents who participated in the study. In the second presentation, we describe the primary outcome measure in the study i.e., the Strengths and Difficulties Questionnaires (SDQ) collected from fathers, mothers and preschool teachers. We discuss how we validated the SDQ for all the three informants and developed a guideline for using the SDQ during routine health check-ups. In the third presentation, we explain our challenges in recruiting parents to the intervention, particularly the restrictions imposed on us by the trial design and describe how we addressed low program participation. After each presentation, the participants will be invited to share their experiences, thoughts and ideas. Their comments will be first collected through a digital interactive platform and then discussed in the room. Key messages Successful evaluation of a public health interventions at the population-level requires ample attention to the recruitment of participants into research and intervention. Program uptake can be increased using simple low cost direct-to-consumer marketing strategies; however, it does take time to build demand for the program.

Power Fun: A Therapeutic Summer Camp Enabling Children With Severe Disabilities to Learn Powered Mobility (PM) Skills

Abstract Date Presented 03/27/20 Power Fun, a therapeutic powered mobility (PM) summer camp, provides a pragmatic solution to promote independent mobility for children with severe cerebral palsy. This poster presents the protocol of Power Fun and the results of a repeated-measure mixed-method validation study (N = 24). Results showed significant improvement in PM skills, attainment of most functional goals, and social changes after participation, making it an evidence-based intervention for children with multiple, severe disabilities. Primary Author and Speaker: Lori Rosenberg Additional Authors and Speakers: Yafit Gilboa Contributing Authors: Adina Maeir

From doubt to trust: Swedish mothers' and counsellors' experience testing a parenting programme for mothers exposed to intimate partner violence whose children have developed behavioural problems.

Many countries seek evidence-based interventions for children who have been exposed to domestic violence, and they frequently turn to interventions developed in the US and disseminated to Europe as a solution. Societal and cultural differences may, however, pose barriers to successful implementation. Project Support (PS), piloted in this study through social services agencies in Sweden, has shown positive effects in the US for families with children who have been exposed to intimate partner violence (IPV). The aim of this study was to investigate counselors’ and caregivers’ experiences when giving/receiving PS in Sweden.The study was based on interviews conducted with 11 mothers and 13 counselors with experience in the programme. A thematic analysis showed three themes (Initial doubts, Confidence from positive change, and Flexibility- challenge for the organization) and the study adds information about obstacles for implementation of PS in Sweden. Cultural and organizational differences between Sweden and the US in practice and child-rearing attitudes are highlighted, as well as the importance of making adjustments while maintaining treatment fidelity, and promoting the dissemination of the approach.

Ethics of randomized trials in pediatric surgery.

To provide the best evidence-based treatment for children, and timely evaluation of innovations, the role of the pediatric surgeon's participation in randomized controlled trials (RCTs) and prospective comparative studies is required. The ethical considerations of pediatric surgical RCTs pose unique practical difficulties in the design and performance of clinical trials in children. There are several ethical issues unique to pediatric surgical RCTs: diseases with low volume, an inability to conduct Phase 1 and 2 trials, parental emotional involvement, difficulty with recruitment in surgical trials, volume, and modified study design, issues with permission vs. assent and investigator bias. This article reviews the ethical aspects unique to pediatric surgical RCTs and prospective comparative studies.Level of evidence: Level 3.

An intensive form of trauma focused cognitive behaviour therapy in an acute adolescent inpatient unit: An uncontrolled open trial.

Post-traumatic stress disorder (PTSD) rates among hospitalised adolescents are between 21% and 32%, and there is a lack of evidence-based interventions for this population. Trauma-focused cognitive behaviour therapy (TF-CBT) is an evidence-based intervention for children and adolescents with PTSD; however, it has not been implemented in an acute adolescent inpatient unit. This study examines the implementation of an intensive form of TF-CBT in an adolescent inpatient unit. An uncontrolled open trail study was conducted where 15 adolescents diagnosed with PTSD were treated with an intensive form of TF-CBT. Measures used were the University of California, Los Angeles' (UCLA) PTSD Reaction Index for Diagnostic and Statistical Manual of Mental Disorders (4th ed., Adolescent Version; DSM-IV-Adolescent Version), the National Stressful Events Survey PTSD Short Scale (NSESSS) and the Children's Global Assessment Scale (CGAS). Adolescents received an average of nine sessions of TF-CBT over a period of 28 days. The average NSESSS on admission was 23.73 and 8.27 at discharge; the CGAS average on admission was 19 and on discharge was 48.7; both were statistically significant changes. Preliminary findings support the use of an intensive form of TF-CBT to treat adolescents with PTSD admitted to acute adolescent inpatient units indicating the need for further research in this area.

Fidelity and sustainability in evidence-based treatments for children: An investigation of implementation determinants

ABSTRACTIn order to improve access to and utilization of high-quality children’s mental health services, there have been considerable efforts to disseminate evidence-based treatments (EBTs) into community-based settings. However, these efforts have not always led to successful use of interventions overtime, and further understanding of how organizational and individual factors may serve as barriers to the implementation process is needed. To help measure implementation and sustainability success in a sample of 118 community-based mental health providers, a 70-item electronic survey was developed to query participant’s experiences with EBT implementation post-training. Results of hierarchical regression analysis suggest that more positive attitudes toward evidence-based practices, the provision of agency incentives, and more intensive training of the intervention increase the likelihood of EBT sustainability, while more positive attitudes toward evidence-based practice and more intensive training increase the likelihood that strategies to help promote protocol fidelity are used. Results contribute to the growing implementation literature in mental health. Post-training consultation may help increase a provider’s ability to manage organizational barriers inherent to providing EBTs within community-based settings. Provision of agency incentives, such as praise and financial compensation, as well as helping promote trainee’s positive attitudes toward EBTs, may also help increase likelihood of implementation success.

An investigation of predictors of attendance for fathers in behavioral parent training programs for children with ADHD

Behavioral parent training programs are evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD), yet attendance in such programs is variable. Relative to mothers of children with ADHD, far less is known about fathers and what predicts their attendance in treatment. The current study aimed to explore predictors of father (N = 171) attendance using data from four studies that tested the efficacy of behavioral parent training programs aimed specifically at fathers. A hierarchical regression was performed to test four potential predictors of attendance, including father race/ethnicity, father education level, child medication status, and father ratings of the child’s oppositional defiant disorder symptoms. Father education level was determined to be a significant predictor of attendance, whereas father race/ethnicity, child medication status, and father ratings of the child’s ODD behavior were not. The results suggest that future parent training interventions may need to be adapted to improve attendance from fathers of lower education levels.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Characterizing Shared and Unique Implementation Influences in Two Community Services Systems for Autism: Applying the EPIS Framework to Two Large-Scale Autism Intervention Community Effectiveness Trials.

The purpose of this study was to examine common and unique factors influencing implementation process for two evidence-based interventions for children with autism spectrum disorder (ASD) in mental health and education service contexts. This study prospectively collected qualitative data from intervention developers and research staff on the implementation process within the context of two separate ASD intervention effectiveness trials. Results reveal common and unique factors influencing implementation in both study contexts. Implementation leadership and provider attitudes and motivation emerge as key influences on implementation across systems. These findings provide promising targets for modular implementation interventions that can be leveraged within growing, large-scale translation efforts in usual care.

Advancing implementation frameworks with a mixed methods case study in child behavioral health.

Despite a growing policy push for the provision of services based on evidence, evidence-based treatments for children and youth with mental health challenges have poor uptake, yielding limited benefit. With a view to improving implementation in child behavioral health, we investigated a complementary implementation approach informed by three implementation frameworks in the context of implementing motivational interviewing in four child and youth behavioral health agencies: the Active Implementation Frameworks (AIF) (process), the Consolidated Framework for Implementation Research (factors), and the Implementation Outcomes Framework (evaluation). The study design was mixed methods with embedded interrupted time series and motivational interviewing (MI) fidelity was the primary outcome. Focus groups and field notes informed perspectives on the implementation approach, and a questionnaire explored the salience of Consolidated Framework for Implementation Research (CFIR) factors. Findings validate the process guidance provided by the AIF and highlight CIFR factors related to implementation success. Novel CFIR factors, not elsewhere reported in the literature, are identified that could potentially extend the framework if validated in future research. Introducing fidelity measurement in practice proved challenging and was not sustained beyond the study. A complementary implementation approach was successful in implementing MI in child behavioral health agencies. In contrast with the typical train and hope approach to implementation, practice change did not occur immediately post-training but emerged over a 7 month period of consultation and practice following a discrete interactive training period. The saliency of CFIR constructs aligned with findings from studies conducted in other contexts, demonstrating external validity and highlighting common factors that can focus planning and measurement.

Early results from a combined low-intensive psychoeducational intervention for preschoolers with autism spectrum disorder

Purpose: Early and Intensive Behavioral Treatments are considered to be evidence-based interventions for children with Autism Spectrum Disorder (ASD). Nevertheless, children with ASD might not always have the opportunity to benefit from intensive treatment; new, more accessible and alternative treatment options need to be tested. The aim of this study was to evaluate the effectiveness of the Combined Low-intensive Psychoeducational Intervention (CLI-PEI) delivered to preschoolers with ASD at the end of the pre-primary school day.Methods: A quasi-experimental design study, namely a pretest–posttest alternative-treatment comparison groups design, was used. Treatment sessions were carried out over a period of 12 months. Forty-three individuals with autism were included in the study: 24 received the CLI-PEI and 19 were administered the Treatment As Usual. A pre- and posttreatment assessment was carried out using the Psychoeducational Profile-Third edition and the Vineland Adaptive Behavior Scale.Results: The children who received the CLI-PEI showed better gains in both developmental and maladaptive behaviors; furthermore, increased skills were found in all adaptive domains.Conclusions: The CLI-PEI might seems to be a viable treatment option for children with ASD, when intensive behavioral treatments are not accessible.Implication for rehabilitationChildren with ASD might not always have the opportunity to benefit from intensive treatment.The identification of more accessible, less intensive and less expensive evidence-based psychoeducational interventions might represent an appealing challenge for rehabilitation therapists.Less intensive and less expensive evidence-based interventions might also represent a viable option for children and their families, especially in communities with limited resources for autism.A pragmatic approach including components from evidence-based treatments might guarantee flexibility and the possibility to implement an intervention well-tailored to the specific child needs.CLI-PEI for preschoolers with ASD seems to be a promising pragmatic approach, promoting improvements in developmental, adaptive and maladaptive domains.

Responsiveness of the ACTIVLIM-CP questionnaire: measuring global activity performance in children with cerebral palsy.

To investigate the responsiveness of the ACTIVLIM-CP questionnaire after two evidence-based interventions for children with cerebral palsy (CP). Seventy-five children with CP either participated in an intensive motor-skill learning intervention (hand-arm bimanual intensive therapy including lower extremities [HABIT-ILE], n=47) or received botulinum neurotoxin-A (BoNT-A) injection(s) into lower extremities combined with conventional physical therapy (n=28). All children were assessed three times: at baseline (T0 ; before HABIT-ILE/the day of BoNT-A injection), at T1 (last day of HABIT-ILE/6wks after BoNT-A injection), and at follow-up (T2 ; 3-4mo after the beginning of intervention). Parents completed ACTIVLIM-CP and three other activity questionnaires. Responsiveness was analysed using group (based on intervention), subgroup (based on gross motor function level), and individual approaches. For the HABIT-ILE group, significant improvements in ACTIVLIM-CP were observed for the T0 -T1 period (p<0.001) but not for the T1 -T2 period. No significant changes were found in the BoNT-A group during assessments (p=0.84). In the subgroup analysis for the HABIT-ILE group (T0 -T1 ), greater changes were demonstrated for children in Gross Motor Function Classification System levels III and IV (p<0.001, effect size=1.36). The individual approach was congruent with the group approach. ACTIVLIM-CP demonstrated high responsiveness after HABIT-ILE, showing that this scale may be used to investigate global activity performance in clinical trials focusing on improving daily life activities. Good responsiveness of ACTIVLIM-CP questionnaire during intensive motor-skill learning intervention. Higher responsiveness for children in Gross Motor Function Classification System (GMFCS) levels III and IV versus I and II after intensive intervention. ACTIVLIM-CP is useful to identify children improving their performance after botulinum neurotoxin-A injection.

Social Work Training in the Use of Evidence-Based Treatments for Children: What Works?

ABSTRACTDespite the benefits of evidence-based treatments (EBTs) for client outcomes, social service systems have struggled to disseminate EBTs. Effective graduate-level training in EBTs is critical to increase use, given the strong effect of initial training on future practices. This study examined outcomes of a graduate-level training program in EBTs. Questionnaires while in the program and postgraduation were administered to 66 students. Regression analyses indicated an increase in postgraduation use occurred after the program incorporated strategies to support the use of specific EBTs. Consistent with the implementation literature, initial planning with field sites, behavioral rehearsal of specific practice skills, focusing on initiation of EBTs, and targeted support for use of specific practices appear to support graduates’ uptake of EBTs in mental health settings.

Supporting Children with Autism Using an Evidence-Based Approach

In the state of Missouri, autism is a growing phenomenon affecting a significant minority of young children. For example, according to the latest research, it is estimated that 1 in every 70 children (1 in 43 boys and 1 in 200 girls) are affected by autism. These figures are similar to the average estimate of children identified with autism (1 in 68) in all areas of the United States. Consequently, there is a growing need to support this heterogeneous population of children through early intervention underpinned by empirical evidence. The Early Start Denver Model (ESDM) is one of several evidence-based interventions for children with autism, ages 12 to 48 months. The purpose of this commentary article is twofold. First, the paper provides a brief but informative overview of ESDM research. Second, the paper discusses the ESDM program in the context of St. Louis Arc, a non-profit agency supporting individuals with intellectual and developmental disabilities and their families to lead better lives. The intended audience for this paper includes parents of children with or at risk for autism, Board Certified Behavior Analysts (BCBAs), occupational and speech therapists, general and special education teachers, and non-profit organizations providing clinical and community outreach programs for children with or at risk of autism.

Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder

The purpose of this research was to update the series of articles on evidence-based treatment for children and adolescents with attention deficit/hyperactivity disorder that have appeared in this journal (Evans, Owens & Bunford, 2014; Pelham & Fabiano, 2008; Pelham, Wheeler, & Chronis, 1998). We completed a systematic review of the literature published between 2012 and 2016 to establish levels of evidence for psychosocial treatments for these youth. We identified articles using criteria established by the Society of Clinical Child and Adolescent Psychology using keyword searches of abstracts and titles. Articles were classified according to a modified version of the Division 12 task force guidelines that was used in other reviews in this series. The results revealed that findings are becoming increasingly nuanced with variations in levels of evidence related to ages of the children and characteristics of the specific treatment. In addition, we focused our critique on generalization of treatment effects across settings and time and on sample diversity (with regard to ethnicity and levels of parent education) in relation to the population. Children of parents with higher levels of education than average appear to be overrepresented in the literature. Implications for future treatment development and evaluation and for dissemination research are discussed.

The Treatment of Childhood Disruptive Behavior Disorders in Ambulatory Mental Health Centers

Over the years, evidence-based treatments for children with disruptive behavior disorders (DBDs; e.g., conduct disorder, oppositional defiant disorder) have been developed, however, there is not much information about the treatment children receive in usual mental healthcare settings. This study examined the common treatment provided in US ambulatory mental health clinics to children aged 3 to 9 years who are diagnosed with DBDs. An online survey was filled by appropriate respondents from 145 ambulatory mental health centers across 33 states within the US. The most common treatment provided for childhood DBDs was a combination of child therapy (CT) and parent training (PT) (n = 81, 56%), followed by family therapy (n = 42, 29%), CT (n = 17, 12%), and PT (n = 5, 3%). Behavioral and cognitive principles were reported as the most common treatment orientations across all types of treatment (n = 116/145, 80%). The mean number of sessions administered was 31.38 ± 22.72, and PT as a standalone treatment required approximately a third of sessions (10.6 ± 1.34). In treatments combining CT and PT, the utilization of specific parenting programs was associated with fewer administered sessions. Results suggest that the importance of parental involvement in treating DBDs is acknowledged in routine practice. However, more studies are needed to determine why certain types and orientations of treatments are favored over others.

Using behavioral skills training to teach high school students to implement discrete trial training.

Discrete trial training (DTT) is widely recognized as an evidence-based intervention for children with autism spectrum disorder (ASD; National Autism Center, 2010), but it is not typically provided to students with ASD in school settings (Stahmer et al., 2015), presumably due to personnel resource l

Furthering the Evidence and Clinical Practice of Constraint-Induced Movement Therapy: Effects of Multiple Treatment Epochs

Abstract Date Presented 4/1/2017 Constraint-induced movement therapy (CIMT) is a well-known, evidence-based treatment for children with cerebral palsy with high levels of demonstrated efficacy. The aim of this study is to provide initial evidence regarding the efficacy of multiple treatment epochs of CIMT. Primary Author and Speaker: Mary Rebekah Trucks Additional Authors and Speakers: Dory Wallace

Transactional relations between caregiving stress, executive functioning, and problem behavior from early childhood to early adolescence.

Developmental psychopathologists face the difficult task of identifying the environmental conditions that may contribute to early childhood behavior problems. Highly stressed caregivers can exacerbate behavior problems, while children with behavior problems may make parenting more difficult and increase caregiver stress. Unknown is: (a) how these transactions originate, (b) whether they persist over time to contribute to the development of problem behavior and (c) what role resilience factors, such as child executive functioning, may play in mitigating the development of problem behavior. In the present study, transactional relations between caregiving stress, executive functioning, and behavior problems were examined in a sample of 1,388 children with prenatal drug exposures at three developmental time points: early childhood (birth to age 5), middle childhood (ages 6 to 9), and early adolescence (ages 10 to 13). Transactional relations differed between caregiving stress and internalizing versus externalizing behavior. Targeting executive functioning in evidence-based interventions for children with prenatal substance exposure who present with internalizing problems and treating caregiving psychopathology, depression, and parenting stress in early childhood may be particularly important for children presenting with internalizing behavior.

Putting children first: An opportunity for Canada's new government.

For more than 50 years, the importance of studying new medicines in childhood has been widely recognized. Nonetheless, Health Canada has eschewed policies requiring such evaluation, despite effective reforms elsewhere. In 2012, the Council of Canadian Academies convened an expert panel to assess Canada's research base for labelling of pediatric therapies. The September 2014 report has not yet resulted in action, but it deserves consideration by the new government with timely recognition of the high priority that evidence-based treatment of children deserves.