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Lu Wang, Samantha J. Stoll, Christopher J. Eddy, Sarah Hurley, Jocelyn Sisson, Nicholas Thompson, Jacquelyn N. Raftery-Helmer, J. Stuart Ablon, and Alisha R. Pollastri

Developing brief, easy-to-use, and reliable tools to measure how well providers deliver evidence-based treatments in community clinical settings is critical to ensure the benefits of these treatments. However, reliable tools are often too time-consuming and not feasible to use in community settings because they require independent observers to receive intensive training on a coding system and to observe live or recorded treatment sessions for reliable and accurate evaluation.

This paper describes steps Think:Kids took to develop a more practical measure of how well providers deliver one evidence-based treatment, Collaborative Problem Solving (CPS), based on a previously validated measure, to explore whether the quality of the measure can be maintained while reducing the need for training independent observers and the need for recording treatment sessions. This work contributes to the growing efforts of developing more pragmatic fidelity measures and introduces a new tool, the CPS Practice Integrity Form (CPS-PIF), as a promising measure for community-based clinical settings using CPS.

The CPS Practice Integrity Form (CPS-PIF) allows us to measure whether CPS learners are doing CPS the way it is intended to be done. That is important when we are implementing in service settings (to see which learners may need more support) and when we are doing studies on CPS outcomes. The CPS-PIF is a relatively simple tool that can be completed by CPS experts from Think:Kids or by CPS Certified staff in organizations implementing the approach.

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Samantha J. Stoll, Jerry D. Hartman, David Paxton, Lu Wang, J. Stuart Ablon, Bruce D. Perry & Alisha R. Pollastri

Point-and-Level (P&L) systems are commonly used for behavior management and modification in youth residential treatment centers. In 2019, the Association of Children’s Residential Centers (ACRC) released a position paper urging youth residential programs to abolish prescriptive, universally applied point-and-level systems because they are inconsistent with the principles of trauma-sensitive care and can be counterproductive to treatment. Despite this, few residential agencies have executed this change, possibly due to the complexities of dismantling long-held practices, concerns about youth safety, and lack of knowledge about other trauma-sensitive approaches.

In this case study, we describe how The Village Network de-implemented its universal point-and-level system across three residential campuses, replacing it with the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving® (CPS). An analysis of administrative data before and after removing the point-and-level system suggests no evidence of increased safety risk for youth or staff. We discuss the agency’s strategies for de-implementation and the determinants that helped and hindered the process and provide recommendations for other residential agencies seeking to make this change.

This is the first detailed account of the process that can be used to de-implement a point-and-level system in youth residential treatment, which we hope will inspire others to begin engaging in the process of replacing points-and-levels with more trauma-informed practices to understand and address challenging behaviors in residential care.

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A screening tool for cross-diagnostic skill deficits underlying youth behavioral challenges

Lu Wang, Alisha R. Pollastri, Pieter J. Vuijk, Erin N. Hill, Brenda A. Lee, Anna Samkavitz1, Ellen B. Braaten, J. Stuart Ablon, and Alysa E. Doyle

In this paper, we examined the Think:Kids skills assessment survey, called the Thinking Skills Inventory (TSI), to see if results on the TSI were comparable to much longer and more costly measures that are usually given during neuropsychological assessments. For this study, parents whose children were receiving neuropsychological testing were asked to complete a TSI about their children’s skills in five areas: attention and working memory, cognitive flexibility, language and communication, emotion- and self-regulation, and social thinking.

The scores on the TSI were correlated with the other neuropsychological measures, and scores on the TSI predicted several psychological disorders as well as aggressive behavior. This suggests that the TSI, a brief and free parent-report measure, can be used to screen for cognitive skill deficits that are relevant to children’s psychological needs and treatment. The TSI may be useful in youth mental health settings to assist with treatment planning and to inform whether a child should receive further evaluation.

Additional Resources

These resources are user-friendly derivatives of the Thinking Skills Inventory (TSI).

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The Value of Implementation Frameworks: Using Active Implementation Frameworks to Guide System‐wide Implementation of Collaborative Problem Solving

Alisha R. Pollastri Ph.D., Lu Wang Ph.D., Soo Jeong Youn, J. Stuart Ablon Ph.D., Luana Marques

Abstract

In the last decade, many implementation frameworks have emerged that consolidate the research on implementation science, guiding purveyors and service agencies in improving implementation of evidence‐based practices (EBPs). In this paper, we describe how Think:Kids utilized the active implementation frameworks (AIFs) to define and standardize strategies for site‐wide implementation of Collaborative Problem Solving. We illustrate what implementation looked like before and after using AIFs to understand implementation, as well as some ways in which using the AIFs helped the purveyor identify, and then overcome, barriers to implementation. This paper provides a model for others who seek to use AIFs to guide their implementation practices, or more broadly, an illustration of how to use any implementation framework to ensure best practices in implementation.

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Effects of a Collaborative Problem Solving Parent Group on Parent and Child Outcomes

Lu Wang, Ph.D., Samantha Stoll, B.Sc., Michael Hone, M.Ed, J. Stuart Ablon, Ph.D., and Alisha R. Pollastri, Ph.D.

Abstract

In this paper, we compare parents who take a Collaborative Problem Solving (CPS) parent class to parents who are on a waitlist. Parents learning CPS reported significant improvements on their child's learning targets and conflict, and changes were sustained six months later. Children’s behavior improved significantly in the treatment group by the six-month follow-up. These findings support CPS parent groups as an economical and effective approach for parents of children with behavioral difficulties.

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Development and Evaluation of an Audio Coding System for Assessing Providers’ Integrity to Collaborative Problem Solving in Youth-Service Settings

Pollastri, A. R., Wang, L., Raftery-Helmer, J. N., Hurley, S., Eddy, C. J., Sisson, J., Thompson, N., & Ablon, J. S. 

 

Collaborative Problem Solving (CPS) is a widely disseminated, neurobiologically based, trauma-sensitive treatment for children’s challenging behavior. Measuring treatment integrity is critical to support implementation and continued research on the approach. This study provides psychometric support for a system that can be used to measure whether practitioners are using the Collaborative Problem Solving treatment approach with integrity, or as intended by the developers of the approach. Researchers and practitioners can use this system to advance their skill and understanding of CPS, and its development provides a model to support the creation of integrity measurement systems for other therapeutic approaches.

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Collaborative Problem Solving Reduces Children's Emotional and Behavioral Difficulties and Parenting Stress: Two Key Mechanisms

Georgina H. Heath,  Christopher Fife‐Schaw, Lu Wang, Christopher J. Eddy, Michael J. G. Hone, Alisha R. Pollastri

 

 

Abstract

This study aimed to evaluate the effectiveness of the Collaborative Problem Solving (CPS) approach in home‐based family therapy and to explore two hypothesized mechanisms of change.

There were significant reductions in children's behavioral difficulties and parenting stress, and significant improvements in children's executive functioning and parents’ empathy. These improvements were greatest for parents who had the greatest fidelity to CPS. Improvements in children's executive functioning and parents’ empathy mediated the relationship between parents’ CPS fidelity and outcomes.

These results provide evidence that home‐based family treatment with CPS may achieve positive child and family outcomes by building children's executive function skills and improving parents’ empathy.

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Alisha R Pollastri, Lu Wang, Christopher J Eddy, J Stuart Ablon

This is the first study showing that Collaborative Problem Solving is effective for helping children who exhibit a range of clinical symptoms in community-based outpatient family treatment, and that improvements in children’s symptoms in outpatient family therapy occur due in part to changes in parents’ understanding and behavior.

Abstract

Collaborative Problem Solving (CPS) is an intervention for reducing children’s challenging behaviors. The aim of the present study was to evaluate the effects of family therapy using CPS in an outpatient clinic that specializes in treating children with challenging behaviors. One hundred and twenty families presented for treatment. Diagnoses at intake were varied, and 100 children (83%) had symptoms that were in the clinical range at intake. Parents reported significant change in their understanding of challenging behavior and prediction of children’s behavioral symptoms 3 months into treatment. Furthermore, children’s improvement was predicted by their parents’ increased understanding that cognitive skill deficits are responsible for challenging behavior. These results suggest that using CPS in community-based, outpatient family treatment is effective for helping children who exhibit a range of clinical symptoms. Results provide insights for clinical practice and research on CPS.

This study was published in Clinical Child Psychology and Psychiatry.

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