Ana Regina Vides de Andrade

Youth therapeutic alliance in intensive treatment settings.

Therapeutic alliance (TA), the helping relationship that develops between a client and clinician, has received little attention in child treatment studies until recently, though it is the factor found to be most predictive of clinical outcomes. Furthermore, TA is cited as one of the most important components to effective therapy according to practicing clinicians. This study examines the TA that develops between teacher/counselors and children in 2 settings, a partial hospital/day school and a wilderness camp. An important finding in this study is the lack of relationship between the teacher/counselors view of TA and the youths view. Moreover, this correlation does not improve according to how long the counselors have known or have treated the youth. The implications of this and other findings are discussed.

Dose Effect in Child Psychotherapy: Outcomes Associated With Negligible Treatment

OBJECTIVE To compare the outcomes of children who received negligible amounts of outpatient treatment to children receiving more treatment. METHOD A random regression longitudinal model was used to analyze outcomes of children (aged 5-17 years) from the Fort Bragg Evaluation Project. RESULTS In examining several outcomes, the results show no statistically significant dose effect. CONCLUSIONS Children receiving substantial amounts of treatment showed no better mental health outcomes than those receiving negligible amounts of treatment. The results do not support the existence of a dose effect consistent enough to guide clinicians, administrators, or policymakers.

Evaluation of a Congressionally Mandated Wraparound Demonstration.

In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the cost-effectiveness of the demonstration. The results showed that children in the Wraparound Group received more wraparound services than those in the treatment as usual (TAU) Comparison Group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Multiple methods were used to investigate the impact of wraparound. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Several possible explanations of these results are provided.

Two low-cost measures of child and adolescent functioning for services research

The Parent and Youth Vanderbilt Functioning Indexes (VFI-P and VFI-Y) are functioning problem indexes for children and adolescents. These are specialized assessment tools distinct from the lengthy procedures used by clinicians to assess functioning. The VFIs low cost permits adequate sample sizes in outcome evaluations of large numbers of children. They collect information on child behavior from two important sources, parents and youths. They are inexpensive to administer, require no clinicians or trained raters and produce predictive validities better than interview-based measures of functioning and popular checklist measures of pathology and competence, especially for measuring serious impairment. Each VFI was developed by; (a) selecting face-valid functioning problems; (b) eliminating all problems not adding significant predictive validity; (c) evaluating the reliability and validity of the index; and (d) comparing the VFIs validity with other popular assessments of child functioning.

The relationship between change in therapeutic alliance ratings and improvement in youth symptom severity: Whose ratings matter the most?

This paper presents the psychometric evaluation of brief measures of therapeutic alliance (TA) for youths, clinicians and caregivers and a longitudinal analysis of relationships between changes in TA and changes in youth symptom and functioning severity. Psychometric analyses using methods from Classical Test Theory, Item Response Theory, and Factor Analysis indicate that the measures of TA used in this study offer something new for both practice and research. The measures have variability, sensitivity to change over time, brevity and can be used with multiple parties through parallel forms. The longitudinal analyses, employing hierarchical linear modeling with time-varying covariates, found that TA ratings of the clinician correlated with symptom improvement as rated by the clinician, caregiver and youth. Additional analyses showed that decreases in clinician-rated youth TA was most important in predicting a lower rate of youth improvement. Implications for future research and clinical practice are discussed.

Exploring the black box: measuring youth treatment process and progress in usual care.

The session report form (SRF) is a 25-item self-report measure scheduled to be completed by clinicians at the end of each session. This study addresses the utility of the SRF for describing session content by exploring patterns of self-reported behavior of 235 clinicians in 7,058 sessions with 600 clients. Results indicate that the SRF has a distinct subscale of treatment process and provides an adequate range of topics related to session content while also discriminating between client and clinician influences on patterns of topics addressed. The SRF is a promising measure meeting a significant need in describing session content in usual care.

Measurement Quality of the Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7)

This study examined the measurement quality of an abbreviated version of the Caregiver Strain Questionnaire. The CGSQ-Short Form 7 (CGSQ-SF7) is practical for routine assessment of objective and subjective internalized caregiver strain. The subjective externalized subscale is not included in the CGSQ-SF7. Findings indicate that the reliability and validity of the shortened objective and subjective internalized subscales are comparable to the original. Examination of construct validity suggested that caregiver, youth, and clinician ratings of child clinical severity were related to objective caregiver strain. However, youth and clinician ratings of child clinical severity were not related to subjective internalized caregiver strain.

The Peabody Treatment Progress Battery: History and Methods for Developing a Comprehensive Measurement Battery for Youth Mental Health

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

Feedback mechanisms of change: How problem alerts reported by youth clients and their caregivers impact clinician-reported session content.

Abstract Objective. This study explored how clinician-reported content addressed in treatment sessions was predicted by clinician feedback group and multi-informant cumulative problem alerts that appeared in computerized feedback reports for 299 clients aged 11–18 years receiving home-based community mental health treatment. Method. Measures included a clinician report of content addressed in sessions and additional measures of treatment progress and process (e.g., therapeutic alliance) completed by clinicians, clients, and their caregivers. Item responses in the top 25th percentile in severity from these measures appeared as “problem alerts” on corresponding computerized feedback reports. Clinicians randomized to the feedback group received feedback weekly while the control group did not. Analyses were conducted using the Cox proportional hazards regression for recurrent events. Results. For all content domains, the results of the survival analyses indicated a robust effect of the feedback group on addressing specific content in sessions, with feedback associated with shorter duration to first occurrence and increased likelihood of addressing or focusing on a topic compared to the non-feedback group. Conclusion. There appears to be an important relationship between feedback and cumulative problem alerts reported by multiple informants as they influence session content.

Comparative Effectiveness of After-School Programs to Increase Physical Activity

Background. We conducted a comparative effectiveness analysis to evaluate the difference in the amount of physical activity children engaged in when enrolled in a physical activity-enhanced after-school program based in a community recreation center versus a standard school-based after-school program. Methods. The study was a natural experiment with 54 elementary school children attending the community ASP and 37 attending the school-based ASP. Accelerometry was used to measure physical activity. Data were collected at baseline, 6 weeks, and 12 weeks, with 91% retention. Results. At baseline, 43% of the multiethnic sample was overweight/obese, and the mean age was 7.9 years (SD = 1.7). Linear latent growth models suggested that the average difference between the two groups of children at Week 12 was 14.7 percentage points in moderate-vigorous physical activity (P < .001). Cost analysis suggested that children attending traditional school-based ASPs—at an average cost of