Introduction
Method
Participants
Characteristic | Mean (SD) or % |
---|---|
Age | 11.18 (2.5) |
Gender | |
Female | 22.2% |
Male | 77.8% |
Race/ethnicity | |
Asian/Pacific Islander | 5.6% |
White | 77.8% |
Hispanic | 11.1% |
More than one reported | 5.6% |
Diagnoses | |
ADHD | 53.3% |
ODD | 33.3% |
Other behavioral diagnosis | 20.0% |
Depression NOS or Mood NOS | 33.3% |
CBCL (T) | |
Total | 71.6 (7.5) |
Externalizing | 70.4 (8.0) |
Internalizing | 64.0 (11.5) |
Conners (T) | |
ADHD | 71.3 (10.3) |
Oppositional | 73.5 (11.3) |
Total | 75.7 (9.7) |
Procedures
Enrollment and Video-Recording
Training of Coders
Measures
Demographics
Child Behavior Checklist and Conners’ Parent Rating Scale: Revised
Diagnosis and Presenting Concerns
Child Therapy Process Rating System: Overview
Goal/strategy | Child ICC | Caregiver ICC |
---|---|---|
Collect information about…’s mental health status, behavior, and/or functioning in one or more contexts (e.g., home, school, with peers); OR about family structure, such as: (a) who members of the family are and how individuals are related to one another, or (b) the strength of relationships that family members have with one another | .56 | .68 |
Collect information about…’s current psychosocial stressors
| na | .68 |
Collect information about…’s strengths and/or supports
| .30 | .58 |
Gather information about high-risk issues and/or assess for the presence or extent of high-risk issues
| .89§a
| .01§b
|
Develop and/or facilitate the development of a safety plan or crisis plan to respond to high-risk issues
| .89§a
| .01§b
|
Provide an outline or agenda of goals during the session. The agenda could have been verbal or written | .60 | .60§c
|
Review the progress of the child/family toward meeting treatment goals | na | .60§c
|
Help the child receive appropriate medications. This could occur either by connecting the child/family with an appropriate individual, or by the therapist assessing needs or prescribing him/herself (when appropriate) | .79 | |
Connect at least one individual with other informal/social supports, or strengthen relationships with other informal/social supports (e.g., friends, other parents, informal support groups, etc.) | .51§d
| .61§e
|
Connect at least one individual with other formal services or strengthen their relationships with other formal services (e.g., Head Start, social services, respite care, legal services, alcohol and drug treatment services, etc.). DO NOT COUNT MEDICATION SERVICES HERE | .51§d
| .61§e
|
Help at least one individual learn more about specific skills or abilities that the child is learning or improving | – | na |
Help at least one individual to identify and/or counteract his/her cognitive distortions (e.g., irrational beliefs and/or thoughts) | .00 | .05 |
Help at least one individual to improve his/her ability to understand and/or differentiate emotions from one another (e.g., This could involve: (a) recognizing specific emotions, (b) understanding the meaning of and verbal and nonverbal cues associated with specific emotions, etc.) | .63§f
| – |
Help at least one individual to improve his/her ability to identify his/her own signs or cues that signify specific emotions (e.g., feeling hot, muscular tension, self-denigrating thoughts, accusatory thoughts, might signify anger or sadness) | .63§f
| – |
Help at least one individual to improve his/her ability to use structured problem solving skills to handle difficult interpersonal situations (e.g., this could include skills such as: (a) recognizing and identifying the problem, (b) coming up with possible solutions, (c) evaluating possible consequences of different actions, (d) choosing an action to take, (e) rewarding oneself for problem solving, etc.) | .40 | – |
Help at least one individual to improve his/her social and/or communication skills. For example, skills might include: (a) how to listen effectively, (b) how to reflect back what another person has said, (c) how to give equal time to participants in a conversation, (d) how to meet a new person, (e) how to start a conversation, etc | .51 | – |
Help at least one individual to improve his/her ability to use relaxation skills or techniques. This could involve techniques such as: (a) meditation, (b) deep breathing strategies, (c) progressive muscle relaxation, (d) pleasant imagery, etc | .68§g
| – |
Help at least one individual to improve his/her ability to reduce own stress level. This could include: (a) relaxation or meditation skills, (b) finding time to take personal time outs, (c) taking part in more pleasant activities, (d) finding ways to anticipate and avoid stressful situations, etc | .68§g
| na |
Help at least one individual to improve his/her ability to understand another family member’s perspective and/or feelings
| .54 | .52 |
Help at least one individual to improve his/her ability to coordinate and be consistent with at least one other individual in how they interact with child (e.g., both respond to hitting in the same way). This could be caregivers with one another or caregiver(s) with teacher(s) | – | na |
Help at least one individual to improve his/her ability to: (a) assume adaptive/appropriate parental or caregiver roles and/or responsibilities, or (b) eliminate or reduce inappropriate parental or caregiver roles and/or responsibilities (e.g., acting as the child’s parent, rather than their friend) | – | na |
Help at least one individual to improve his/her ability to: (a) assume adaptive/appropriate child roles and/or responsibilities, or (b) eliminate or reduce inappropriate child roles and/or responsibilities (e.g., decrease child’s acting in a parental role or engagement in a coalition against another caregiver, etc.) | na | – |
Help at least one individual to improve his/her ability to give effective commands. This could include helping the individual to: (a) state commands succinctly, (b) not repeat commands over and over, (c) use commands that ask the child to start doing something rather than stop doing something, (d) give the child choices in commands, etc | – | .42 |
Help at least one individual to improve his/her ability to monitor or keep track of child behavior (either appropriate or inappropriate child behavior). For example, this might involve providing supervision of the child, or maintaining contact with teachers, babysitters, daycare providers, etc | – | .03 |
Help at least one individual to improve his/her ability to respond effectively to inappropriate or negative child behavior. This could involve how to: (a) ignore inappropriate behavior, (b) be consistent over time in responses to behavior, (c) select natural or logical consequences, etc |
–
| .62§h
|
Help at least one individual to improve his/her ability to use Time Out |
–
| .62§h
|
Help at least one individual to improve his/her ability to respond effectively to appropriate or good child behavior. This could involve methods such as: (a) attending to and/or praising appropriate behavior, (b) looking for approximations of good behavior to praise, etc |
–
| .79§i
|
Help at least one individual to improve his/her ability to use reward systems with child. This could involve: (a) selecting behaviors to target, (b) selecting how to reward behaviors, (c) developing a reward chart, etc |
–
| .79§i
|
Help at least one individual to experience and/or express affect (especially emotions he/she may not have been able to release). These may be in response to events or circumstances in the past, present, or future | .64 | – |
Therapist Ratings of Goals and Strategies
Intensity | Description |
---|---|
0 | Not pursued in session |
1 Pursued fleetingly | Briefest of moments |
Little or no effort to follow up on method or goal | |
One minute or less, although this is not an absolute guide | |
Coder may have uncertainty about whether or not the goal was pursued | |
Client may not know that this was a goal being pursued | |
2 Pursued minimally | More than the briefest of moments |
Some limited follow-up on the goal, but little effort to follow through on pursuit of goal | |
One to three minutes (although possibly less)—minutes are a rough guide | |
Coder is reasonably certain goal was pursued | |
Client may still not know that this was a goal being pursued | |
3 Pursued moderately | Goal was clearly pursued for several minutes |
More than minimal effort to follow through on pursuit of the goal, although not very much effort expended on pursuit of the goal | |
Two to five minutes—minutes are only a rough guide | |
Coder is certain goal was pursued | |
Unless there are very unusual circumstances, client is also likely to be clear that goal was pursued | |
4 Pursued substantially | Goal was clearly pursued for an extended period of time, either in a block or throughout the session |
Substantial attempts were made to pursue goal. This might involve efforts to acquire information of interest or to make sure that important issues were clear with the client | |
Generally five minutes or more, although it could be less—minutes are only a rough guide | |
Coder is certain goal was pursued | |
Unless there are very unusual circumstances, client is also likely to be clear that goal was pursued | |
Not quite a 5 rating because the therapist either did not spend an extended period of time on the goal (probably 8 or more minutes, although this is only a rough guide), or because the approach to pursuing the goal did not incorporate examples or specific kinds of details present in the code definition (if these are present) | |
5 Pursued intensely | Goal was clearly pursued for an extended period of time, either in a block or throughout the session |
Substantial attempts were made to pursue goal. This might involve efforts to acquire information of interest or to make sure that important issues were clear with the client | |
Generally eight minutes or more, although it could be less—minutes are only a rough guide | |
Coder is certain goal was pursued | |
Unless there are very unusual circumstances, client is also likely to be clear that goal was pursued | |
If examples or specific details are present in the code definition, the therapist’s actions should be very similar to or cover some of the details in the definition |
Observer Ratings of Goals and Strategies Pursued
Analysis
Reliability of Observer Ratings
Goals and Strategies Pursued
Results
Participants
CTPRS Reliability for Observational Coders
Total Goals and Strategies Pursued
Goal/strategy types | Intensity Threshold | |||
---|---|---|---|---|
≥1 | ≥2 | ≥3 | ≥4 | |
Child-focused | ||||
Therapist | 6.5a
| 6.1a
| 4.0a
| 1.6a
|
Observer | 3.2b
| 1.5b
| 0.7b
| 0.1b
|
Caregiver-focused | ||||
Therapist | 5.4a
| 4.8a
| 3.4a
| 1.9a
|
Observer | 1.6b
| 0.6b
| 0.2b
| 0.0b
|
Total | ||||
Therapist | 11.8a
| 10.9a
| 7.3a
| 3.5a
|
Observer | 4.8b
| 2.1b
| 1.0b
| 0.1b
|
Reports of Specific Goals and Strategies Used and Correspondence Between Rating Sources
Goal/strategy | Intensity threshold | |||||
---|---|---|---|---|---|---|
Therapist | Observer | |||||
2+ (%) | 3+ (%) | 1+ (%) | 2+ (%) | 3+ (%) | Kappa | |
Information gathering | 90 | 73 | 94 | 78 | 57 | .02 |
-MH status, behavior, functioning
| ||||||
-Family structure
| ||||||
Information gathering | 73 | 45 | 41 | 16 | 2 | .36* |
-Psychosocial stressors
| ||||||
Review progress | 60 | 32 | 18 | 0 | 0 | .01 |
Establish treatment/session goals | 50 | 24 | 32 | 8 | 0 | −.08 |
Social/communication/assertiveness skills | 43 | 31 | 20 | 8 | 4 | .39** |
Experience/express affect | 41 | 31 | 6 | 6 | 0 | .12 |
Family member perspective | 41 | 24 | 14 | 0 | 0 | −.08 |
Identifying signs/cues for emotions | 33 | 24 | 14 | 6 | 0 | .55** |
Information gathering | 28 | 18 | 8 | 2 | 0 | .40** |
-High risk issues
| ||||||
Child roles | 26 | 18 | 2 | 0 | 0 | .17* |
Problem solving skills | 24 | 14 | 33 | 18 | 8 | −.14 |
Stress reduction skills | 24 | 12 | 0 | 0 | 0 | – |
Understand/differentiate emotions | 22 | 14 | 8 | 2 | 0 | .29* |
Relaxation skills | 22 | 12 | 6 | 0 | 0 | .40** |
Cognitive distortions | 20 | 14 | 8 | 0 | 0 | −.11 |
Develop safety or crisis plan | 8 | 8 | 2 | 0 | 0 | |
Appropriate medications | 6 | 4 | 12 | 2 | 2 | .47** |
Formal supports | 6 | 2 | 8 | 2 | 2 | −.03 |
Informal supports | 0 | 0 | 0 | 0 | 0 | – |
Goal/strategy | Intensity threshold | |||||
---|---|---|---|---|---|---|
Therapist | Observer | |||||
2+ (%) | 3+ (%) | 1+ (%) | 2+ (%) | 3+ (%) | Kappa | |
Information gathering | 48 | 30 | 10 | 6 | 2 | .41** |
-Psychosocial stressors
| ||||||
Responding effectively to positive/appropriate behavior | 39 | 22 | 4 | 0 | 0 | .09 |
Review progress | 38 | 24 | 2 | 0 | 0 | .12 |
Information gathering | 38 | 21 | 33 | 18 | 8 | .28* |
-MH status, behavior, functioning
| ||||||
-Family structure
| ||||||
Family member perspective | 28 | 24 | 16 | 10 | 4 | .29* |
Respond effectively to negative/inappropriate behavior | 28 | 22 | 25 | 8 | 4 | .63** |
Establish treatment/session goals | 26 | 14 | 20 | 4 | 0 | .09 |
Learn about child skills | 26 | 14 | 0 | 0 | 0 | – |
Monitor child behavior/improve supervision | 24 | 12 | 2 | 2 | 0 | – |
Caregiver roles | 22 | 16 | 2 | 2 | 0 | .14 |
Caregiver consistency | 22 | 22 | 0 | 0 | 0 | – |
Information gathering | 22 | 22 | 6 | 2 | 0 | .30* |
-High risk issues
| ||||||
Effective commands/limit setting | 20 | 14 | 6 | 0 | 0 | .35** |
Stress reduction skills | 20 | 18 | 4 | 2 | 0 | .13 |
Reward systems | 16 | 14 | 6 | 4 | 4 | .35** |
Formal supports | 10 | 8 | 8 | 2 | 0 | .46** |
Time out | 10 | 10 | 4 | 0 | 0 | −.05 |
Cognitive distortions | 8 | 8 | 4 | 2 | 2 | .30* |
Develop/facilitate plan | 8 | 8 | 6 | 2 | 0 | .54** |
Informal supports | 8 | 4 | 2 | 0 | 0 | −.03 |