A Systematic Review and Meta-Analysis of Measurement Feedback Systems in Treatment for Common Mental Health Disorders

To investigate the efects of measurement feedback systems (MFSs) in therapy on mental health outcomes through a literature review and meta-analysis. Using a three-level modeling approach, we conducted a meta-analysis of all efect sizes from randomized controlled studies of MFSs used in the treatment of common mental health disorders. Eighty-two efect sizes were extracted from the thirty-one included studies. Analyses were performed to consider the post-treatment efects of the MFS-assisted treatment compared to treatment as usual. A separate analysis was done for the subgroup “not-on-track” patients as it is theorized that MFSs will be clinically useful because they make therapists aware of patients who fail to progress. MFSs had a signifcant efect on mental health outcomes (d=0.14, 95% CI [0.082–0.206], p<.001). Further analysis found a larger efect in patients identifed as less respondent to therapy, the “not-on-track” group (d=0.29, 95% CI [0.114, 0.464], p=.003). Moderation analyses indicated that the type of outcome measurement and type of feedback system used, and whether it was used for a child and youth or adult population, infuenced efect sizes. MFSs seem to have a small positive efect on treatment outcomes. The efects seem to be larger for “not-on-track” patients, the group of patients that would usually not beneft much from treatment

Theory- and evidence based interventions for children with conduct problems : exploring applicability and underlying assumptions in real world settings

Severe child conduct problems (aggressive, disruptive, destructive, oppositional, non-compliant and antisocial behavior) are predictive of serious and violent offences, substance use problems, mental health problems and domestic violence later in life (Moffitt, 2006). Left untreated, as many as 50% to 75% of the children with severe and early conduct problems will exhibit antisocial behavior in adolescence (Nixon, 2002). However, early trajectories of conduct problems can be altered (Brestan & Eyberg, 1998; Lundahl, Risser, & Lovejoy, 2006; Nixon, 2002) and the development of interventions targeting child conduct problems has been an important area of research in the last decades (e.g. Dishion & Patterson, 2006; Webster-Stratton, Reid, & Hammond, 2004). The social interaction learning (SIL) model postulates that contextual factors (e.g. divorce, stress, SES) initiate coercive and aggressive interactions between family members and disturb parenting skills, thereby leading to an early onset path of antisocial behavior (Patterson, 1982). In other words, contextual factors are assumed to impact child adjustment indirectly through parenting practices. The present thesis has examined the applicability and underlying assumptions of theory- and evidence based prevention and treatment interventions in real world setting, namely Parent management training, the Oregon model and the community-wide model called “the Early Intervention for Children at Risk for Developing Behavioral Problems” (EICR). The principles of these interventions are derived from the SIL model. In order to study processes leading to conduct problems, Paper I examined whether the effect of interparental collaboration was mediated through maternal and paternal parenting. Two studies were carried out to investigate the applicability of interventions in real world settings. The study presented in Paper II explored whether the implementation of the EICR model in a community was related to reduced problems behaviors and better child relations in the school context. The study presented in Paper III examined gender differences in behavioral change following PMTO. The cross-sectional findings in Paper I were derived from a sample of families (N = 136) from all health regions in Norway who had been in contact with child and adolescent psychiatric services to get help with their child’s conduct problems prior to receiving PMTO. Paper II, which was based on a quasi-experimental pre-post design, consisted of a sample of school employees (N = 266) recruited from a pool of 271 employees from seven elementary schools (1st–7th grade) in a municipality near Oslo. The sample in Paper III consisted of 323 families who received PMTO, of which 239 (74%) participated in assessment sessions before (pre) and after (post) treatment. Findings from Paper I showed that maternal and paternal parenting practices fully mediated the relation between interparental collaboration and externalizing behavior. However, when the indirect effects of parenting practices were tested separately, paternal parenting functioned as a mediator, whereas maternal parenting did not, indicating that the relation between interparental collaboration, parenting and externalizing behavior was moderated by parent gender. The finding that interparental collaboration influenced child externalizing behavior indirectly through parenting practices suggests the importance of addressing interparental communication skills, teamwork and consensus during parent training interventions when parents are in a problematic relationship: Helping parents communicate and cooperate more efficiently seems to make it easier for parents to interact more positively with their children. The results from Paper II showed that the EICR model had positive short term effects (one year after initiation) in the sense that the prevalence of student problem behavior was significantly lower, and student relations were significantly better in schools located in the intervention area than in schools located in the comparison area. The positive immediate effects indicate that the implementation of the EICR model, which in fact only directly affects a small portion of the child population, can have positive impacts on the overall prevalence of child problem behavior in municipalities. Pre treatment findings from Paper III showed that girls exhibited less externalizing problem behavior according to parents and teachers, more internalizing problems according to parents, and more social competence according to teachers. Parents reported more girls to be within clinical range on externalizing behavior, while teachers reported more boys to be within clinical range. Teachers reported more comorbidity among boys than girls. At post treatment, girls had more likely changed in a positive direction according to teacher-ratings of externalizing behavior and social competence, but not according to any of the parent-reported variables. The findings from the present thesis provide support for the SIL model, thereby suggesting that it may be a beneficial strategy to offer interventions derived from the model to children with conduct problems in Norway. Despite promising findings, further research is needed to develop and refine interventions for children with severe conduct problems

Three Randomized Effectiveness Trials — One Question: Can Callous-Unemotional Traits in Children Be Altered?

Children with conduct problems and callous-unemotional (CU) traits are at risk for multiple problems. Outcome research and mediation analyses testing for mechanisms of change in CU traits have been limited. We examined whether parent training—in a short-term (Brief Parent Training; BPT) or a comprehensive format (Parent Management Training, Oregon Model; PMTO)—or child-directed social skills training (Individual Social Skills Training [ISST]) produced positive effects on CU traits. In mediation models we tested parenting practices as mechanisms of change for CU traits. We pooled data from three randomized effectiveness trials, and 551 families were included in this study. Families had children between 3 and 12 years of age and displayed emerging or present conduct problems at home, day care, or school (BPT M age = 7.28, 31.9% girls; PMTO M age = 8.56, 36.5% girls; ISST M age = 7.64, 19.7% girls). Assessments were completed preintervention, postintervention, and at follow-up (6 months following intervention). Both BPT (d = .32) and PMTO (d = .39) had positive effects on CU traits at posttest, whereas ISST did not (d = –.06). At follow-up, only PMTO produced a significant effect (d = .48) on CU traits. A significant indirect effect on CU traits emerged by positive parenting. Both parent training conditions outperformed ISST. Only PMTO maintained its effects at follow-up. The findings suggest that PMTO can reduce CU traits and that improved positive parenting is associated with positive outcomes for children’s CU traits

A Systematic Review and Meta-Analysis of Measurement Feedback Systems in Treatment for Common Mental Health Disorders

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Striving for happily ever after – supportiven interventions for youth leaving residential placement – a systematic review

Background Youth who reenter communities after forensic or residential care are overrepresented in prevalence rates for mental disorders, delinquency, incarceration, low academic achievement, and unemployment. Supportive interventions that aid youth in the reentry to their communities can be crucial for successful reintegration. In systematic reviews (SR) on this topic, only specific interventions or programs are described. Therefore, a summary of evidence about transitional interventions for various groups of reentry youth is needed. Method This overview of SRs was preregistered in PROSPERO. We searched PsycINFO, Ovid MEDLINE, Cochrane Library, Campbell Library, Web of Science, Sociological Abstracts, Criminal Justice Abstracts, Social Care Online, and Epistemonikos. SRs that fit the search criteria were evaluated using the AMSTAR checklist for methodological quality and the GRADE tool for assessing confidence in effect estimates. Results We screened 2,349 publications for eligibility. Eight SRs were included for analysis. The methodological quality of five SRs was critically low, two were of low quality, and one was of moderate quality. Recidivism was reported as the only outcome in five SRs. Detrimental outcomes were reported in five SRs. Confidence in effect estimates was low or very low for all outcomes. Ninety-five percent of primary study populations were from the United States. Conclusion We offer a rigorous appraisal of SRs on transitional interventions. The gaps of knowledge are vast regarding what works, how it works, and for whom. Development of a knowledge base should include defining the term ‘recidivism’, systematic reporting of demographics, and identifying effective common elements