Research and Health Utilization Research and Health Utilization Around Conduct ProblemsAround Conduct Problems

Scott T. Ronis, Ph.D.

Department of Psychology

University of New Brunswick

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Background to Disruptive Behaviour Problems

• Behaviours that violate the rights of others or that bring someone into conflict with societal norms

• Involves difficulties in emotional and behavioural regulation

• Several psychiatric disorders (based on DSM-5 and ICD-10) represent a range of disruptive behaviour problems

– Intermittent Explosive Disorder– Oppositional Defiant Disorder– Conduct Disorder– Substance Use Disorders

Complexities in Identifying Behaviour Problems

• High comorbidity

• Unspecified or undiagnosed mental health problems may include behaviour problems

• In practice, diagnoses lack developmental context

• Time spent on defining problems do not necessarily equate to knowledge of handling problems

Ecological Models

Society/Culture Neighborhood

SchoolPeers

Child

Family

Correlates of Youth with Behaviour Problems

Research suggests that multiple risk factors are linked with serious behaviour problems in youth:

• Individual factors (e.g., externalizing and internalizing problems, difficulties with emotion regulation, intellectual deficits, neurobiological factors)

• Family factors (e.g., low warmth, high conflict, low monitoring, harsh or inconsistent parenting, large family size, instability)

• Parental problems (e.g., spousal violence, substance abuse, history of mental health problems, parental criminality)

• Peer relations (e.g., social isolation, immaturity, association with delinquent peers)

• Academic performance (e.g., low achievement, behavior problems, learning disabilities)

• Neighborhood factors (e.g., exposure to violence, limited resources)

• Cultural factors (e.g., norms for disruptive behaviour)

Defining Empirically-Based Practices (EBPs)

EBP movement in general began over 60 years ago

Child/youth psychotherapy research followed

There have been advances in distinguishing programs that work from those that do not work or do not have adequate support

Dealing with the real world: Moving from efficacy to effectiveness

EBP Resources

American Psychological Association’s Division 53: www.effectivechildtherapy.com

Coalition for Evidence-Based Policy: www.toptierevidence.org

Blueprints for Healthy Youth Development: www.blueprintsprograms.com

SAMHSA: www.nrepp.samhsa.gov

OJJDP: www.ojjdp.gov/mpg

Office of Justice Programs: www.crimesolutions.gov

National Child Traumatic Stress Network: www.nctsn.org/resources/topics/treatments-that-work/promising-practices

Continuum of Care

Universal Prevention

Secondary Intervention (Selective Prevention)

Tertiary Intervention

Model Universal Prevention EBPs

Programs Setting Costs Benefits Positive Impacts

LifeSkills Training School for early adolescence

$34 pp $1,290 pp* AOD use, Delinquency, Violence

Positive Action School for late childhood & early adolescence (& optional parenting classes)

~$400/class N/A AOD use, Academic problems, Delinquency, Internalizing problems, Violence

Project Towards No Drug Abuse

School for late adolescence

$14 pp $123 pp* AOD use, Violent victimization

Promoting Alternative Thinking Strategies

School for late childhood

$115 pp ($19) pp* Aggression, Conduct problems, Emotion regulation, Internalizing problems

*Washington State Institute for Public Policy

Model Secondary Intervention EBPsPrograms Setting Costs Benefits Positive Impacts

Functional Family Therapy

Families for early to late adolescence

$3,262 pp $70,370 pp* Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence

New Beginnings (Interventions for Children of Divorce)

Parent training (and optional parent-child groups) for late childhood to late adolescence

~$595/pp N/A AOD use, Aggressive behaviour, Internalizing & externalizing problems, Mental health, Relationships with parents

Nurse-Family Partnership

Parent training from pregnancy to 2 years of age

$9,600 pp $22,781 pp* AOD use, Child maltreatment, Delinquency, Employment, Mental health, Physical health & well-being

Project Towards No Drug Abuse

School for late adolescence

$14 pp $123 pp* AOD use, Violent victimization

*Washington State Institute for Public Policy

Model Tertiary Intervention EBPs

Programs Setting Costs Benefits Positive Impacts

Functional Family Therapy

Families for early to late adolescence

$3,262 pp $70,370 pp* Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence

Multidimensional Treatment Foster Care

School for late childhood & early adolescence (& optional parenting classes)

$7,922 pp $39,197 pp* Delinquency, Illicit drug use, Violence

Multisystemic Therapy

School for late adolescence

$7,370 pp $32,121 pp* Delinquency, Illicit drug use, Internalizing & externalizing problems, Relationship with parents, Sexual violence

*Washington State Institute for Public Policy

Journey Through Various Systems

• Historical context• Collaborative Model of Response

Action Plan for Mental Health in New Brunswick, 2011

Journey Through Various Systems

Looking Ahead at Utilization of Services in Atlantic Canada

• Addressing youth mental health needs is a moving target that needs continuous re-evaluation

• Identifying the needs of youth through administrative/survey data and qualitative interviews

• Who are the “providers”? What are they doing?

• Need to facilitate the use of effective interventions and services

• Need to keep an eye on costs and benefits as well as barriers/redundancy in services

There is no health without mental health (World Health Organization, 2010)