Evidence Base for the Collaborative Problem Solving® Approach
Collaborative Problem Solving is one of only a few approaches that has demonstrated remarkable effectiveness in a number of different settings. Below you’ll find a comprehensive review of research across all settings, as well as other published research studies listed by the settings in which they were conducted. For more information, contact: ThinkKidsResearch@partners.org
Pollastri, A., Epstein, L., Heath, G., and Ablon, J., 2013. The Collaborative Problem Solving Approach: Outcomes Across Settings. Harvard Review of Psychiatry, v. 21, p. 188-195.
This article reviews all known research on outcomes related to the use of Collaborative Problem Solving in outpatient, inpatient, and residential treatment programs, schools, and juvenile justice facilities through the Summer of 2013. It gives brief descriptions of the other research articles listed on this webpage (published prior to 2013) as well as a number of unpublished studies that were made known to Think:Kids staff through personal communications. It is a great place to start, in order to understand the range and scope of research related to CPS. View the abstract.
Greene, R., Ablon, J., Goring, J., Raezer-Blakely, L., Markey, J., Monuteaux, M., Henin, A., Edwards, G. and Rabbitt, S., 2004. Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children With Oppositional-Defiant Disorder: Initial Findings. Journal of Consulting and Clinical Psychology, v. 72, no. 6, p. 1157-1164.
This study was the first empirical study of the CPS approach – a randomized, controlled clinical trial conducted in the Department of Psychiatry at Massachusetts General Hospital. This study compared CPS to a commonly used and empirically supported treatment called Parent Management Training (PMT) with 47 affectively dysregulated children with Oppositional Defiant Disorder. CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up. These improvements were in all instances equivalent, and in many instances superior, to the improvements produced by PMT. View the article.
Johnson, M., Östlund, S., Fransson, G., Landgren, M., Nasic, S., Kadesjö, B., Gillberg, C. and Fernell, E., 2012. Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children – an open study of collaborative problem solving. Acta Paediatrica, ISSN0803-5253.
In this study, 17 children with both Oppositional Defiant Disorder (ODD) and ADHD received 6 to 10 weeks of outpatient family therapy using CPS. ADHD and ODD symptoms decreased significantly from baseline to post-treatment, and 53% of children were rated by their pediatrician as “much” or “very much” improved post-treatment. At 6-month follow-up, 81% of participants were rated by pediatrician as “much” or “very much” improved. All children (regardless of medication status) continued to improve from post-treatment to follow-up. View abstract.
Inpatient Psychiatry Units
Greene, R., Ablon, J. and Martin, A., 2006. Use of Collaborative Problem Solving to Reduce Seclusion and Restraint in Child and Adolescent Inpatient Units. Psychiatric Services Journal, v. 57, no. 5, p. 610-612.
This empirical study examined changes on the first child inpatient psychiatry unit to implement Collaborative Problem Solving- the Child Assessment Unit at Cambridge City Hospital. Restraints decreased from 281 events in the 9-months before intervention 1 event during a 15-month followup. Short holds decreased from 100+ per month to under 10 per month. Average staff and patient injuries decreased from 10.8 to 3.3 per month. View the abstract.
Martin, A., Krieg, H., Esposito, F., Stubbe, D. and Cardona, L., 2008. Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study. Psychiatric Services Journal, v. 59, no. 12, p. 1406-1412.
This study was conducted by independent investigators who were interested in determining whether results from the previous study could be replicated at the Yale – New Haven’s Children’s Hospital. Restraints used in response to challenging/aggressive behavior decreased from 263 to 7 per year, and duration of restraints decreased significantly. Seclusions decreased from 432 to 133 per year, and duration of seclusions also decreased significantly. View the abstract.
Mohr, W., Olson, J., Branca, N., Martin, A. and Pumariega, A., 2009. Beyond Points and Levels Systems: Moving Toward Child-Centered Programming. American Journal of Orthopsychiatry, v. 79, no. 1, p. 8-10.
This article provides a critical review of the theory behind and use of motivational systems in residential treatment facilities, inpatient psychiatry units and schools. The authors describe the process of implementing Collaborative Problem Solving as a child-centered alternative to point and level systems at the Yale Child Study Center. The process of implementation was conducted with extensive training and consultation from Dr. Ablon, and many of the details of the culture change that took place and the critical ingredients that made it successful are detailed in the article. This article should be helpful to others interested in implementing the model in their programs. View abstract.
Residential Treatment Programs
Pollastri, A., Lieberman, R., Boldt, S. and Ablon, J.S., 2016. Minimizing Seclusion and Restraint in Youth Residential and Day Treatment through Site-Wide Implementation of Collaborative Problem Solving, Journal of Residential Treatment for Children & Youth, pp. 185-205. View the abstract.
Stewart, S., Rick, J., Currie, M. and Rielly, N., 2009. Collaborative Problem-Solving Approach in Clinically-Referred Children: A Residential Program Evaluation. Prepared for the Center of Excellence in Children’s Mental Health, Children’s Hospital of Eastern Ontario, EIG #901.
This report documents the effectiveness of the Collaborative Problem Solving approach in a residential setting. The report is the first systematic study to demonstrate effectiveness of CPS in settings where it is often implemented – residential treatment, and it documents improvement in child functioning across several areas including significant gains in the development of specific social skills. This was the first study to validate the skills training aspect of the approach empirically. Children and adolescents in the study showed enhanced participation in their communities after treatment and many gains were maintained at six-month follow up including a further reduction in behavioral outbursts. View the full report.
Epstein, T., & Saltzman-Benaiah, J., 2010. Parenting children with disruptive behaviours: evaluation of a collaborative problem solving pilot program. Journal of Clinical Psychology Practice, 1(1), pp. 27-40.
Our colleagues from Toronto published a study attesting to the effectiveness of a parenting group intervention based on the CPS model and evaluated its feasibility and efficacy. Significant improvements in child behavior were reported by both mothers and fathers at the end of the intervention and follow-up. There were also significant reductions in mothers’ stress. View the article
Reducing Teacher Stress
Schaubman, A., Stetson, E. and Plog, A., 2011. Reducing Teacher Stress by Implementing Collaborative Problem Solving in a School Setting. School Social Work Journal, v. 35, no. 2, pp. 72-93.
Think:Kids Certified Trainers working in the Cherry Creek Schools in Colorado piloted the CPS approach in an alternative middle school setting and showed significant reductions in teacher stress and office referrals for disciplinary reasons. View the abstract.
Stetson, E. and Plog, A., 2016. Collaborative Problem Solving in Schools: Results of a Year-Long Consultation Project. School Social Work Journal, v. 40, issue 2, pp. 17-36.
This study assessed the impact of a year-long intensive CPS consultation project aimed at increasing the skills of staff serving students with significant social-emotional and behavioral needs. Results show that teachers who learned CPS reported significantly reduced levels of stress when working with challenging students. Further, both parent and student reports indicated a reduction in problem behaviors. Results also indicate that students built skills in the areas of behavior regulation and emotional control. View the abstract.
Disruptive Behavior Disorders
Pollastri A.R., Rosenbaum C., Ablon J.S. (2019) Disruptive Behavior Disorders. In: Wilson H., Braaten E. (eds) The Massachusetts General Hospital Guide to Learning Disabilities Current Clinical Psychiatry. Humana Press, Cham. Assessing Learning Needs of Children and Adolescents. pp. 207-220.
The Massachusetts General Hospital Guide to Learning Disabilities is a vital tool for child psychiatrists, students, assessment professionals, and other professionals studying or working with children suffering from learning disabilities. This chapter covers oppositional defiant disorder (ODD) and conduct disorder (CD), which are commonly considered disruptive behavior disorders, and also briefly discusses disruptive mood dysregulation disorder (DMDD) for the purpose of differential diagnosis. Each disorder is reviewed for symptoms, neurocognitive features, risk factors, and the prognosis. We then focus our discussion on how to assess the impact of disruptive behavior disorders on learning and how best to intervene to minimize such impact. View the abstract.
Symptom Improvement vs. Functioning
Becker, K., Chorpita, B. and Daleiden, E., 2011. Improvement in symptoms versus functioning: how do our best treatments measure up?. Adm Policy Ment Health, v. 38, n. 6, pp. 440-458.
This article highlights the CPS approach as one of the few of more than 750 treatment protocols targeting child mental health problems that demonstrated improvements in functioning as opposed to simply symptom reduction. While we’d like to think that these exciting results are due to our emphasis on skills training rather than simply symptom reduction, future research is needed to test this hypothesis. View the abstract.
Reliability and Validity of CPS Measure
Wang, L., Pollastri, A. R., Vuijk, P. J., Hill, E. N., Lee, B. A., Samkavitz, A., … & Doyle, A. E. (2019). Reliability and Validity of the Thinking Skills Inventory, a Screening Tool for Cross-Diagnostic Skill Deficits Underlying Youth Behavioral Challenges. Journal of Psychopathology and Behavioral Assessment, 41(1), 144-159
Our Thinking Skills Inventory (TSI) measure, which is a tool that screens for skill deficits and was developed by our Think:Kids team, has now been published in the Journal of Psychopathology and Behavioral Assessment. This paper explains how our TSI is a valid and reliable way to identify variation in skill domains relevant to a range of psychopathology which may be useful in youth mental health settings to assist with treatment planning and to inform referral for further evaluation. Consistent with what we say in our CPS trainings, skills deficits on the TSI also predicted aggressive behavior, regardless of diagnosis. View the abstract here.
Due to data like these, our Collaborative Problem Solving approach has been elevated to Level 2 support on the Blue Menu of Evidence-Based Psychosocial Interventions for Youth (https://www.practicewise.com/Community/BlueMenu) with Delinquency and Disruptive Behavior on the PracticeWise Evidence-Based Services (PWEBS) Database.
We are listed as a research-based intervention that meets key service and treatment needs of children and their parents. Specifically, the Family First catalog lists our Collaborative Problem Solving approach as an intervention that can be accessed by child welfare agencies via the new federal law, the Families First Prevention Services Act (FFPSA) in foster and adoptive care settings. Family First Interventions Catalog via Casey Family Programs.
The Collaborative Problem Solving approach has also been selected as a researched practice by the California Evidence-Based Clearinghouse for Child Welfare (CEBC). This listing serves to advance the effective implementation of evidence-based practices for children and families involved with the child welfare system. http://www.cebc4cw.org/program/collaborative-problem-solving/detailed
In addition, Collaborative Problem Solving has been accepted for review by the National Registry of Evidence-based Programs and Practices (NREPP), which is coordinated by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Status as evidence-based practice has been achieved in places like the state of Oregon where the Division of Addictions and Mental Health is helping sponsor training throughout their children’s mental health system with our help. We are thrilled that training in our approach has recently been written into the administrative rules in Oregon due to the evidence base. If you are interested in studying your use of the approach or already have data to share from your setting, please email us. – See more at: http://www.thinkkids.org/learn/research/#sthash.lmRlwMXv.dpuf
Click here to watch video of Dr. Ablon describing results in restrictive facilities that have implemented the model.