measures - rtckids.fmhi.usf.edurtckids.fmhi.usf.edu/rtcconference/handouts/pdf/21/session...

21st Annual RTC ConferencePresented in Tampa, February 2008

Copyright 2008 by Kay Hodges, Ph.D. (3600 Green Court, Suite 110, Ann Arbor, MI 48105; Ph. 734-769-9725; Fax 734-769-1434; [email protected]). Do not copy, distribute, or disseminate without prior written permission from the author. Presented at the 21st

Annual Research Conference – A System of Care for Children’s Mental Health: Expanding the Research Base in Tampa, FL, February,2008.

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Copyright 2008 by Kay Hodges, Ph.D.

Outcome Indicators for Youths’Functioning and Parents’ ChildManagement Skills: Results for

PMTO Trainees

Kay Hodges, Ph.D.Kay Hodges, Ph.D.February 2008February 2008

TAMPATAMPA

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Authors Hodges, Kay, Ph.D.

Professor, Department of PsychologyEastern Michigan University

Wotring, Jim, M.S.W. Formerly, Director of Programs for Children with SEDMichigan Department of Community Health

Forgatch, Marion S., Ph.D. Senior Research ScientistImplementation Sciences International, Inc.Oregon Social Learning Center

Lyon, Ashley, B.A.Institute for the Study of Children, Families & CommunitiesGraduate Student at Eastern Michigan University

Spangler, Jamie, B.A.Institute for the Study of Children, Families, & CommunitiesEastern Michigan University

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Measures

Youth Functioning: CAFAS

Parenting Skills: Caregiver Wish List

4


4

CAFAS SUBSCALES

Moods/Emotions

Self-HarmfulBehavior

Substance Use

Thinking

School/Work

Home

Community

BehaviorTowardOthers

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5

Each of the 8 subscales has problems,strengths and goals.

For each Subscale, problems are divided into4 levels of impairment:

Severe Moderate Mild Minimal/None

30 20 10 0

For problems, raters select behavioral descriptors thatdescribe child’s severest functioning in the last 3months.

CAFAS: The Essentials

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A Strength-Based Self-ReportQuestionnaire for Assessing

Parenting Skills

Caregiver Wish List




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Self-Report by caregiver

-Based & Skills-Based

Skills that can be taught by a “coach” (therapist)

Asks about caregiver’s parenting skills across sixmajor skill areas

Caregivers are full participants – gets their “buy in”

While answering the questions, caregivers “tell their story”

Contains “Scientific Secrets” to managing difficult youths (What parent behaviors lead to

improved behavior in a youth with behavioralproblems?)

Caregiver Wish List

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Caregiver Wish List Domains

Providing Direction &

Following Up

Encouraging Good

Behavior

Discouraging

Undesirable Behavior

Monitoring Activities

Connecting Positively

with Youth

Problem Solving

Orientation

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Skills to Develop is the “AnswerKey” (Under Questions)

Caregiver’s answers are transferred to answer key via carbonless copy

Used to “cross walk” from caregiver’s answers to specific skill building needed

Used to design treatment objectives

Can be shared with caregiver for purpose of collaboratively selecting skills to be addressed in treatment

Scores generated can be used to assess change in caregiver’s perception over time

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Example Question and Answer Key

ANSWER KEY FOR THE “SKILL WISH LIST FOR YOU” Domain & Skills Q

#

Response Options

Providing Direction and Following Up 1 Hardly

ever

Once in a

while

Sometimes Often Most of the

time

Structure Organized; has set expectations and routines

(which have socialization value)

!

1

!

!

2

!

3

!

4

!

5

SKILL WISH LIST FOR YOU

Questions Q #

Response Options

How often do you structure your child's time with set chores or routines (for

example, when to go to bed, when TV can be watched or computer games

played, when schoolwork is done)?

1 Hardly

ever

!

!

Once in a

while

!

Sometimes

!

Often

!

Most of

the time

!

Answer key identifies the skill strengths and deficits which correspond to each question.

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Data For Naturalistic Field Study

N=18 Trainee Therapists

Limitations:

Incomplete data collection

Non-equivalent samples

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Participant Criteria No criteria imposed, except that youth lives

at home with at least one caregiver For purposes of facilitating training, plan

was to restrict by age and CAFAS scores: Age: 5-12 years old CAFAS: presence of significant behavior problems

CAFAS home subscale = 20 (moderate) or 30(severe) and

CAFAS Behavior Toward Others subscale or Schoolsubscale = 20 (moderate) or 30 (severe)

CAFAS: absence of serious comorbidity No 30’s on: Moods/Emotions, Self-Harmful,

Substance Use, Thinking, & Community subscales

Lifting restrictions resulted in morechallenging cases




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PMTO and “Before PMTO” Cases to Date

70.867.8% Male

9.19AverageAge

4993n

CaregiverWishList*CAFAS

(N=18 trainees) PMTO

7063.9

9.69.4

2036

CaregiverWishList*CAFAS

Before PMTO

*Caregiver Wish List was optional at the beginning of the project; 4 trainees did not contributeCWLs to “Before PMTO” group

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87

59.7

77.568.1

0

20

40

60

80

100

Avera

ge S

co

re

PMTO Before PMTO

Change in Average CAFAS Total Score

from Intake to Last CAFAS

Pre Post

CAFAS Total Score

d = .88(p<.000)

(NS)

All t-tests are significant. For d statistics, .20=small effect,.50=moderate, >.80=large

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18.1

12.4

21.5

14.8

20.6

13.7

17.3

13

0

5

10

15

20

25

Ave

rag

e S

co

re

School/Work Home Behavior Toward

Others

Moods/

Emotions

PMTO Sample: Change in Average Score on CAFAS

Subscales from Intake to Last CAFAS

Pre Post

CAFAS Subscale Scores for PMTO

d = .57(p<.000)

d = .68(p<.000)

d = .79p<.000

d = .57p<.000

All t-tests are significant. For d statistics, .20=small effect,.50=moderate, >.80=large 16


CAFAS Subscale Scores for BEFORE PMTO

17.8

15.6

19.216.9

18.116.1 15.6

14.2

0

5

10

15

20

Ave

rag

e S

core

School Home Behavior TowardOthers

Moods/ Emotions

Before PMTO: Change in Average Score on CAFAS

Subscales from Intake to Last CAFAS

Pre Post

NS NS NS NS

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CAFAS Outcome IndicatorProportion of Youths Improved:

Clinically Meaningful Reduction in CAFAS Total Score(>=20 pts)

64.5

36.1

0

10

20

30

40

50

60

70

PMTO Before PMTO

PMTO Before PMTO

% o

f You

ths

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No Severe Impairments at Last CAFAS(Restricted to Youths with 1 or More Severe Impairments at Intake)

63.3

37.5

0

10

20

30

40

50

60

70

PMTO Before PMTO

PMTO Before PMTO

% o

f You

ths




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Not SED at Last CAFAS(Defined Here as Total CAFAS Score of 40 or Less)

34.4

17.6

0

10

20

30

40

50

60

70

PMTO Before PMTO

PMTO Before PMTO

% o

f You

ths

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Caregiver Wish List

d = 1.18 (p<.000) (NS)

43.3

31.9

39.2 38.6

0

10

20

30

40

50

Ave

rag

e S

core

PMTO Before PMTO

Change in Average Total Score for "Wish List for Your Child"

(Higher Score = Greater Behavioral Problems for Youth -

Worse)

Pre Post

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Caregiver Wish List

d = 1.41 (p<.000)

d = .59(p<.017)

177206.8

175.5190

0

50

100

150

200

250

Ave

rag

e S

co

re

PMTO Before PMTO

Change in A verage Total Score for "Wish List For You"

(Higher Score = More Skillful Caregiver Behavior - Better)

Pre Post

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Outcome for Domains of theCaregiver Wish List

Providing Direction& Following Up

MonitoringActivities

DiscouragingUndesirable

Behavior

EncouragingGood Behavior Connecting Positively

with Youth

Problem SolvingOrientation

d=.84, p<.000

d=1.27, p<.000

d=.84, p<.000

d=.85, p<.000

d=.59, p<.000

d=.65, p<.000NS

NS

NS

NS

NS

d=.70,p<.006

PMTO = red Before PMTO = purple

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Summary: T-Tests Comparing Pre to PostMeasure PMTO

d statisticBefore PMTO

d statistic

CAFAS

Total Score .88*** NS

School .57*** NS

Home .68*** NS

Behavior T/ Others .79*** NS

Moods .57*** NS

Caregiver Wish List

Child Total (non-compliance) 1.18*** NS

Caregiver Skills

Total Score 1.41 *** .59*

Providing Direction .84 *** NS

Encouraging .84 *** NS

Discouraging 1.27 *** NS

Monitoring .65 *** .70**

Connecting .59 *** NS

Problem Solving .85 *** NS

*** p<.000, ** p<.01, * p<.05; large effect in red 24


Summary: PMTO in the Field

On money as usual in economicallychallenged state

Naturalistic study

First wave of state-sponsored training




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CONTACT INFORMATION

Kay Hodges, Ph.D. [email protected]

Jim Wotring M.S.W. [email protected]

Marion S. Forgatch, Ph.D. [email protected]

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