CHILDREN OF DIVORCE-COPING WITH DIVORCE (COD-COD) :

AN INTERNET-BASED PREVENTION PROGRAM

ACKNOWLEDGMENTS I am deeply indebted to the following people for their

support of the CoD-CoD program:

Irwin Sandler, Keith Crnic, Sandy Braver, John Horan, Jenn-Yun Tien

Joanne Rzucidlo, Taylor Cody, Jessica Mueller, Silvia Baez

Joanne Pedro-Carroll, Arnold Stohlberg, Sharlene Wolchick

Matthew Berry My Family

The study was partially funded by the ASU Graduate College Completion Fellowship.

WHY DEVELOP AN ONLINE PROGRAM FOR CHILDREN OF DIVORCE?

Children of divorce are at increased risk for a range of poor developmental outcomes (Amato, 2001).

Divorce is widespread Over 1 million children experience divorce each year

(U.S. Census, 2008).

Children of divorce can be helped by prevention programs targeting developing coping skills Children of Divorce Intervention Program Children’s Support Group

INTERNET INTERVENTIONS

Internet-Based Program AdvantagesFor Users

Available at the time and place of the users choosing Availability of specialized expertise Reduced threat of stigma/fear of disclosure Instant user access

For Researchers/Developers Program fidelity Low provision cost per user Ability to collect usage data Ability to revise instantly

INTERNET INTERVENTIONS

Internet intervention programs have now been used in a wide variety of capacities Depression Anxiety Eating Disorders Smoking Cessation Asthma Management

Meta-analyses indicate potential effectiveness of internet-based programs Spek et al., 2007 Barak et al., 2008

…and also that field has long way to go

THE DARK AGES PART I: THE RESEARCH

Few trials include a randomized control group

Many studies include inadequate measures

Level of specificity at which the literature can inform how to make a good program is very low. Bright colors

THE DARK AGES PART II: THE PROGRAMS

Common problems for internet-based interventions. Low recruitment rates

Mailed brochures, internet recruitment 2.4 in 1000 (Clarke, et al., 2005)

High Attrition 18.6% program completion (Buller et al., 2006) Efficacy of reminders

2.6 log-ins to 5.9 log-ins

Low satisfaction 5.9 out of 10 (Vorhees et al., 2005)

Most programs just aren’t very cool yet.

COD-COD WAS DESIGNED TO BE COOL

AFCC 3-1 (Home Practice Check-In)

Mod1-1- (Intro Video)

AFCC3-4 (Problems, inside tools, outside tools, actions)

**animations + adaptation/video example**

AFCC 3-5 (Deciding if a problem is your job to fix)

**interactive activity*****

AFCC2-25 (Choosing A Home Practice Activity)

Video Game

PROGRAM DESIGN INNOVATIONS OF COD-COD

Personal approach Use of humor

Module structure designed to enhance engagementHome Practice Review Program Goal Intro Video Content Home Practice Assignment Quiz Video Game

Highly interactive (activities and dynamic content)

Creation and tracking of goal With contingent feedback on creating goal and progress

Focus on in-program skills practice.

Home Practice (with feedback on attempts)

CONTENT CREATION FOR COD-COD

The skills and information taught in CoD-CoD are based on the available evidence-based programs for children from disrupted families. The Family Bereavement Project The Children of Divorce Intervention Program The Children’s Support Group

Research on children of divorce guided the distillation process.

COD-COD THEORETIC MODEL

Internalizing Symptoms

Externalizing Symptoms

Coping Efficacy

Children’s Divorce Appraisals

Avoidant Coping

Active Coping

Intervention Condition

THEORY OF THE PROGRAM

Problem-solving training Positive cognitive restructuring Psycho-education

Active Coping

Feeling awareness Relaxation Distraction coping

Avoidant Coping

Coping Efficacy

Controllability of Stressors Reduce wishful thinking Peer Testimonials Simulated Coping Practice

Divorce Appraisals

Positive cognitive restructuring Divorce information

Intervention Program Elements

Modifiable Mediators

COD-COD TRIAL DESIGN

Recruitment Court Records – Maricopa County

147 children ages 11-16 randomized used block random assignment based on risk scores.

“Treatment As Usual” control Intended to approximate best case scenario in using

online resources currently available for children of divorce.

PARTICIPANTS

147 children and adolescents 78 females and 69 males

Ages 11-16. Mean age was 13.78 (1.66). Divorce latency mean was 1.23 years (1.08).

Divorce filing date, not divorce decree Ethnic composition includes:*

75.2% Non-Hispanic white, 15.8% Hispanic, 3.8% Non-Hispanic Black, 3.7%, 0.8% Native American, and 1.4% other.

Average years of mother's education was 14.82 (2.93). *

Court Records (25-45 months old)

n1= 818

Provided DataParent [n = 66 (89.19%)]Child [n = 64 (86.49%)]

Randomizedn = 112 families

[n = 147 children]

Program Condition, [n = 74]Control Condition, [n = 73]

Court Records (3-16 months old)

n = 1364

Refused/Unable to Contactn = 227

Ineligible, n = 2

Sent Invitation Letters

Attempted Phone Contact

n= 247

Attempted Phone Contact

n = 763

Sent Pre-Testsn = 18 families

[n = 24 children]

Sent Pre-Testsn = 97 families

[n = 128 children]

Did Not Complete Pre-Testsn = 0

[n = 0]

Refused/Unable to Contactn = 652

Ineligible, n = 14

Did Not Complete Pre-Testsn = 4

[n = 7]

Provided DataParent [n = 71 (97.26%)]Child [n = 71 (97.26%)]

Pre-Test

Program Condition Control Condition

Data Collected ¹Parent Assessment: n = 116, [n = 147]

Child Assessment: n =116, [n = 146] ²

Post-Test(1-Month)

1 One family with 2 children entered the study through clinician referral.

2 One child did not complete thepre-test assessment.

PROCESS DATA

89 % Home practice participation rate

92% of completers stated that the home practice was helpful to them.

92% of program completers reported that they had made progress toward the their program goal.

PROGRAM GOAL EXAMPLES To not get so angry all the time.

I would like to understand how to better control my emotions

For my parents to stop putting me in the middle of their problems.

I would like to not feel so sad

To try not to hide feelings from friends and family.

PROGRAM COMPLETION RATE

Completion Rate Comparison

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

NARRATIVE FEEDBACK: CHILD

“I thought this program wasn't going to help at all but I was wrong my parents divorce is so much easier to deal with now. Thank you.”

11-year old girl

“CoD-CoD changed my life by making it a little easier.”14-year old boy

 

“It was great. Jesse was funny.”

13-year old boy

“It taught me to control my emotions and solve difficult problems. I can also stop myself before I say something that will most likely hurt someone else.”

14-year old girl

NARRATIVE FEEDBACK: PARENT She is able to tell me when I am talking about something that I should only talk

about with her father. She stops me to let me know it should be between me and my ex. -Mother of 13 year-old girl

He has expressed on numerous occasions that he feels the program continues to help him deal with situations that arise concerning me and his dad. Thank you for including him, I see a real change in his coping skills. I hope that the program is able to help many others to come.  -Mother of 11-year old boy

Recently, my son and I missed a flight at the airport. I was very frustrated with the way the  airlines handled the situation and it showed! My son, on the other hand, handled the situation with uncommon maturity. I was very impressed when he told me that he was utilizing some of the techniques that he had learned during your online program to manage the stress. Great Job! Maybe I should have done the program with him.

-Father of 13-year old boy

I watched my son a few times as he was completing his modules. He really took time and enjoyed the videos and information provided.  It has been a positive experience, and in the short time V. participated, he has learned positive life lessons and is applying them to his daily activities and decisions. -Mother of 15 year-old boy

I think it made my child think a lot about ways to work though problems. She presented me with an idea of how to resolve an argument that we had and it was a really good idea that involved expressing feelings in a constructive manner. I was pretty impressed -Mother of 13 year-old girl

MAIN EFFECTS

Intent-to-Treat Analysis

Reduced Total Mental Health Problems (SDQ) d = .37

Reduced Emotional Problems (SDQ) d = .37

ANALYSIS OF MODERATION

Variables examined as possible moderators Baseline Variable Levels Risk Age Gender Divorce Latency

Three of the moderators examined did not significantly moderate any program effects: child gender, child age, and divorce latency

Two of moderators examined moderated program effects on two variables: Baseline Variable Level Risk

GROUP X BASELINE SDQ-TOTAL

GROUP X BASELINE COPING EFFICACY

T2 SDQ-Total

T1 SDQ-Total

T1 SDQ-Totalx Condition

T2 Coping Efficacy

ProgramCondition

T1 CopingEfficacy

.69***

-.16***

.73***

-.15†

T1 Coping Efficacy x Condition

-.30*

-.06

Coping Efficacy .30*

Low T1

T2 SDQ-Emotional

T1 SDQ-Emotional

T2 Coping Efficacy

ProgramCondition

T1 CopingEfficacy

Coping Efficacy

.69***

-.17***

.60***

.30*

Low T1

T1 Coping Efficacy x Condition

-.30*

-.11*

T2 BPI-Total

T1 BPI-Total

T1 Riskx Condition

T2 Coping Efficacy

ProgramCondition

T1 CopingEfficacy

-.01

.69***

-.10*

.50***

-.32†

T1 Coping Efficacy x Condition -.30*

T1 Risk

-.22†

Coping Efficacy .30*

Low T1

MAJOR FINDINGS

The CoD-CoD program demonstrated positive effects to reduce children’s mental health problems and to improve coping efficacy.

Program effects are strongest for children with greatest initial risk/symptomatology.

Only randomized controlled trial of an internet-based program for children and adolescents to date to use an active control condition.

First experimental trial of an internet-based program for children of divorce.

CoD-CoD’s high program completion rate suggests that program elements designed to increase engagement were effective.

POSSIBLE USES FOR COD-COD

Adjunct to counseling

Stand alone universal prevention (with support). May be particularly appropriate with high risk children.

The program is being made available commercially Starting July 2012

Please leave me your e-mail if you’d like a program preview. Feel free to contact me with any questions at:

jesse.boring@familytransitions-ptw.com

FUTURE DIRECTIONS FOR PROGRAM REVISION

Add a Parent Component Mobile Application To Support Program Parent and Participant Testimonials Weekly Chat Room / Moderated Forum Further Individualization

Content (Topics, Skills, Shortening Program) Presentation (Videos, Videogames, Narration,

etc.) Use Usage Data To Retool Program Follow-Up Modules

EXTRA STUFF THAT MIGHT BE HANDY

Program Outline by Module Wave 1 Demographics + Pre-Test Equivalence

PROGRAM COMPLETION 68.9% of CoD-CoD participants completed the

entire program. Average number of modules completed = 3.83.

76.6% of the 5-module program

84.9% of BTN participants completed the entire program. Average number of modules completed = 1.78.

89.04% of the 2-module program

CONTROL CONDITION: SITE #1

CONTROL CONDITION: SITE #2