Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting

Therapeutic Focus on Strengths is Associated with Improved Functioning and Higher Clinical Progress in Children's Public Mental Health Care

Prior findings suggest a greater therapeutic focus on strengths is associated with a higher likelihood of successful treatment discharge in youth public mental health treatment. To build upon previous research, the present study examined whether and to what extent therapeutic focus on strengths was associated with changes in day-to-day functioning and treatment progress over the course of therapy. This study used multilevel modeling techniques to analyze 12 consecutive years of standardized routine clinical service data from a public mental health care system which served youth and families who were typically from underserved and low-income backgrounds. The sample comprised 2362 youth with an average age of 13.51 (2.9 SD) years receiving at least 3 months of standards-based intensive in-home (SB-IIH) treatment services. Most youth in the sample identified as multi-ethnic (62.5%) and male (61%). Therapeutic focus on strengths was measured as a proportion of overall treatment targets endorsed by therapists. A greater focus on strengths during the first 5 months of SB-IIH services was a significant predictor of improved functioning at the end of treatment and higher average monthly scores on a measure of treatment progress even after accounting for other predictors, including level of impairment at treatment start. Practice-based findings suggest a greater focus on strengths in youth treatment services might be beneficial in improving functioning and treatment progress. Study findings highlight the need for further research in other clinical youth samples. Clinical practice, dissemination, implementation, and future research implications are discussed.

Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data

Disruptive behavior disorders (DBDs) are common mental health problems among early childhood American youth that, if poorly managed, pose costly psychological and societal burdens. There is limited real world evidence on how parent management training (PMT) - the evidence-based treatment model of choice - implemented in common practice settings within the United States influences the behavioral progress of early childhood DBDs, and the risk factors associated with poor outcomes. This study used data from a measurement feedback system implemented within a U.S.-based private practice to study how behavioral outcomes change as a function of PMT treatment engagement and associated risk factors for 4-7 year-old children diagnosed with DBDs. Over 50% of patients reached optimal outcomes after 10 appointments. Attending 24-29 appointments provided maximum treatment effect - namely, 75% of patients reaching optimal outcomes by end of treatment. Outcomes attenuate after reaching the maximum effect. Patients also had higher odds of reaching optimal outcomes if they had consistent attendance throughout the treatment course. Notable risk factors associated with lower odds of reaching optimal outcomes included Medicaid insurance-type, greater clinical complexity, and having siblings concurrently in treatment. Increased implementation of systems that monitor and provide feedback on treatment outcomes in U.S.-based practice settings and similar investigations using its data can further enhance 'real world' management of early childhood DBDs among American youth.

Clinician-Identified Factors in Success of Parent-Directed Behavioral Therapy for Children's Tantrums

Disruptive behavior disorders (DBD) are the most common behavioral health problems in young American children. When not well-managed in early childhood, DBD can progress to lifetime mental health problems with personal, economic, as well as societal impacts. The evidence-based intervention of choice for DBD is outpatient parent-directed behavioral therapy (PDT). However, little is known about clinicians' perspectives on the factors influencing PDT's effectiveness in routine care. The current study directly assesses clinicians' perspectives on factors they believe impact PDT's success for disruptive behavior problems, in particular tantrums, at two outpatient behavioral therapy clinics specializing in PDT. In-depth interviews with 19 clinicians across three experience levels (doctoral intern, post-doctoral, licensed staff psychologist) were conducted and analyzed using qualitative methods. Two major themes were identified as enabling and limiting treatment success: (1) appointment attendance, (2) primary caregiver buy-in to treatment approach. Additional identified factors include caregiver's familial and social support, caregiver's physical and emotional capacities, complexity of the child's behavior problems, the extent to which the home environment can support positive changes, competing family/home demands, and care coordination among hospital programs. The primary factors identified by clinicians highlight the importance of fostering appointment attendance and parental psychoeducation that can be addressed by implementing multi-level administrative, training, and clinical initiatives to improve PDT's real-world effectiveness for DBD.

Practices Derived from the Evidence Base for Depression Predict Disruptive Behavior Progress in Adolescent Community Mental Health Care

Disruptive behavior problems develop along multiple causal pathways and are associated with a wide variety of co-occurring problems, including mood disorders. In usual care, effective treatment practices for youth disruptive behavior might differ from what the efficacy research suggests, given treatment setting and population demographic differences. The current study examined whether practices derived from the evidence base for disruptive behavior and/or depressed mood predicted progress on disruptive behavior problems in an adolescent usual care sample. Monthly clinical data, including therapeutic practices, treatment targets, and progress on selected treatment targets, for 1210 youth ages 13-17 who received intensive in-home services and were treated for disruptive behavior problems were examined utilizing multilevel modeling techniques. Practices derived from the evidence base for only depressed mood and practices derived from both disruptive behavior and depressed mood literatures predicted disruptive behavior progress, while practices derived from only the disruptive behavior evidence-based literature did not. All five practice elements exclusive to depressed mood treatment predicted positive disruptive behavior progress, while two of eleven disruptive behavior practices and four of seven practices derived from both problem areas predicted positive progress. Findings held when other predictors were included as covariates, including youth age and functional impairment. Although directionality remains unclear and further research is vital, usual care settings might present barriers to disruptive behavior treatment as prescribed by the evidence base, and youth-focused treatments based on depressed mood treatments merit further examination as a potentially promising route to effective treatment in such settings.

The Spillover Effects of Supportive Neighboring Behavior on Mental Health and Career Satisfaction: A Longitudinal Research on Chinese Low-Income Employees

Background

We examined the effects of supportive neighboring behavior on mental health and career satisfaction among Chinese low-income employees. We further examined the mediating roles of work interference with family (WIF) and of family interference with work (FIW) in this relationship.

Methods

A total of 220 Chinese low-income employees were selected via two-wave longitudinal survey in China; the time distance was five weeks. They completed questionnaires on their self-reported supportive neighboring behavior, work-family conflict, general mental health and career satisfaction. Afterwards, we adopted a structural equation modeling (SEM) to examine our hypotheses by R (Version 3.5.3) and Lavaan Package (Version 0.6-3).

Results

Supportive neighboring behavior (Time 1) improved good mental health (Time 2) and career satisfaction (Time 2). Work interference with family (Time 1) mediated the effect of neighboring behavior on mental health while family interference with work (Time 1) mediated the effect of neighboring behavior on mental health and career satisfaction.

Conclusion

Our findings suggest that supportive neighboring behavior is vital in mitigating mental health problems and enhancing career satisfaction by decreasing work interference with family and family interference with work. Our research expands the scope of current literature on community support by incorporating bi-directional supportive neighboring behavior. By adopting family interference with work and work interference with family as mediators, our research examines the spillover mechanisms through which career satisfaction and mental health are influenced by supportive neighboring behavior.