Lauren Brookman-Frazee

Stress Levels and Adaptability in Parents of Toddlers with and without Autism Spectrum Disorders

The toddler years can be a particularly stressful time for all parents, however, parents of children with disabilities may experience additional sources of stress. Recent literature on early education for children with disabilities promotes inclusion with typical peers with increases in the availability of inclusive programs. However, little is known about early intervention inclusion programs and parental factors such as stress and adaptability. The current study expands the research for children with disabilities by investigating the associations of having a young child with an Autism Spectrum Disorder (ASD) on multiple dimensions of parental stress for mothers and fathers and how participation in an inclusive toddler program may be related to these stress levels. Results for this community sample are consistent with previous research indicating that that both mothers and fathers of children with ASD report significantly elevated levels of both child and parent related stress in comparison with parents of typically developing toddlers. Following their childs participation in the inclusion program, mothers of children with ASD report significant reductions in child-related stress but no reductions in the parent-related stress domain. No changes were seen with either child or parent domain for fathers. Lastly, a childs level of social skills was a significant predictor of child-related maternal stress for children with autism. This pattern was not seen in fathers of these children. Implications for early intervention program modifications, such as increasing family support and incorporating adjunctive parent interventions for parents with elevated levels of stress are discussed.

Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices

OBJECTIVES In the United States, more money is spent on treatment for childrens mental health problems than for any other childhood medical condition, yet little is known about usual care treatment for children. Objectives of this study were to characterize usual care outpatient psychotherapy for children with disruptive behavior problems and to identify consistencies and inconsistencies between usual care and common elements of evidence-based practices in order to inform efforts to implement evidence-based practices in usual care. METHODS Participants included 96 psychotherapists and 191 children aged four to 13 who were presenting for treatment for disruptive behavior to one of six usual care clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1,215 randomly selected (out of 3,241 collected) videotaped treatment sessions; treatment sessions were recorded for up to 16 months. RESULTS Most children received a large amount of treatment (mean number of sessions=22, plus children received other auxiliary services), and there was great variability in the amount and type of care received. Therapists employed a wide array of treatment strategies directed toward children and parents within and across sessions, but on average all strategies were delivered at a low intensity. Several strategies that were conceptually consistent with evidence-based practices were observed frequently (for example, affect education and using positive reinforcement); however, others were observed rarely (for example, assigning or reviewing homework and role-playing). CONCLUSIONS Usual care treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and usual care, thus identifying potentially potent targets for improving the effectiveness of usual care.

Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action

There is urgent need for improvement in community-based mental health care for children and families. Multiple studies have documented serious limitations in the effectiveness of “usual care.” Fortunately, many empirically-supported strategies to improve care have been developed, and thus there is now a great deal of knowledge available to address this significant public health problem. The goal of this selective review is to highlight and synthesize that empirically-supported knowledge to stimulate and facilitate the needed translation of knowledge into action. The review provides a sound foundation for constructing improved services by consolidating descriptive data on the status quo in children’s mental health care, as well as evidence for an array of promising strategies to improve (a) Service access and engagement; (b) Delivery of evidence-based practices; and (c) Outcome accountability. A multi-level framework is used to highlight recommended care improvement targets.

Factors Associated with Use of Evidence-Based Practice Strategies in Usual Care Youth Psychotherapy

The purpose of this study was to gain an understanding of how therapists providing usual care (UC) psychotherapy are using elements of treatment common to evidence-based practices (EBPs) for children with disruptive behavior disorders (DBPs) and to identify client and therapist characteristics that may be associated with EBP strategies directed toward children and those directed to their caregivers. Results indicate that certain child, family, and therapist characteristics are associated with use of EBP strategies; however, much of the variability in practice was not explained by the variables examined. These findings highlight the complexity of UC psychotherapy and provide directions for future research on implementation of EBPs in UC.

Characterizing Community-Based Mental Health Services for Children with Autism Spectrum Disorders and Disruptive Behavior Problems

This study describes the characteristics of children with autism spectrum disorders (ASD) with disruptive behavior problems served in community-based mental health clinics, characterizes psychotherapy process and outcome, and examines differences between children with ASD and a non-ASD comparison group. Results indicate that children with ASD served in this setting are high functioning and diagnostically complex. Certain research-based behavioral and cognitive behavioral psychotherapeutic strategies were observed frequently, while parent training strategies and active teaching strategies were observed less frequently. The intensity or thoroughness with which strategies were pursued was relatively low. Outcome analyses indicate improvement in child symptoms and family functioning. Treatment delivery and outcome were similar for children with and without ASD. These findings represent the first detailed observational data characterizing community-based mental health services for children with ASD.

Methodological Challenges of Characterizing Usual Care Psychotherapeutic Practice

There is minimal existing research providing detailed, reliable data characterizing usual community-based psychotherapy practice, and, thus, limited established methods for such research. This article identifies methodological challenges of usual care descriptive research, including, (a) general design considerations, (b) measurement, (c) data analytic, and (d) ethical challenges. Case examples drawn from studies reported in this special issue are used to illustrate the implications, strengths, and weaknesses of different methodological decisions. Central themes include achieving an acceptable balance of scientific rigor, feasibility, and generalizable practice relevance, as well as working collaboratively with practice partners to select and implement study methods.

Therapists’ Attitudes Towards Psychotherapeutic Strategies in Community-Based Psychotherapy with Children with Disruptive Behavior Problems

Little is known about what individual treatment strategies therapists providing usual care psychotherapy consider the most valuable to their practice. The Therapeutic Strategies Survey (TSS) assesses therapists’ attitudes about the value of 27 individual treatment strategies in their practice with children with disruptive behavior problems in community-based outpatient psychotherapy. Findings indicate that therapists from multiple professional disciplines highly value many individual psychotherapeutic strategies, and consider strategies common to a majority of evidence-based practices (EBPs) for this population at least as important as strategies not emphasized in EBPs. Implications for developing therapist training and implementation of EBPs are discussed.

Parent Training Interventions for Children with Autism Spectrum Disorders

A number of parent training programs for parents of children with ASD have been developed. An overview and rationale for why parent training for ASD differs from other childhood groups will be described. An overview of the major parent training methods used for ASD, the research to support them, and the effects achieved will be discussed.

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.

Comparing Child, Parent, and Family Characteristics in Usual Care and Empirically Supported Treatment Research Samples for Children with Disruptive Behavior Disorders

This study compared data from 34 research trials of five empirically supported treatments (ESTs) with one large usual care (UC) sample on child, parent, and family characteristics for children with Disruptive Behavior Disorders. Large variations were found within and across ESTs on sample characteristics during the past two decades. Most parent and family characteristics were not reported in EST studies. Statistical comparisons between UC and EST samples revealed that occurrences of child demographics and symptom severity levels were similar, but occurrences of most parent and family characteristics were different, with higher rates of problems for the UC sample. Results indicate that UC clients have complex needs, with multiple child, parent, and family issues. The findings are discussed in relation to the importance of acknowledging parent and family contextual variables in implementation efforts.