Examining psychotherapy processes for children with conduct problems

Aim: Goals of this project: (1) characterize the psychotherapeutic strategies therapists use treating children with disruptive behavior problems in community-based clinics, (2) examine how these strategies are consistent and inconsistent with evidence-based practices (EBP), and (3) identify child and therapist characteristics associated with greater use of EBP. Methods: Participants included 92 therapists from 6 clinics, representing multiple disciplines and theoretical orientations; 80% are female; 58% are Caucasian and the range of years of experience is 0-25 years. Child participants included 219 children ages 4-13 years (mean = 8.9); 73% are male and 46% are Caucasian. All psychotherapy sessions for up to 16 months were videotaped; a random selection of 946 were coded using the TPOCS, yielding frequency and intensity ratings for 27 therapeutic strategies. Inter-rater reliability is adequate (ICC =.74). Results: The most frequent therapeutic strategies were: identifying strengths, using positive reinforcement, and psychoeducation (present in >50% of sessions). Infrequent strategies included assigning homework and addressing client-therapist relationship (present in <20% of sessions). Observed intensity of intervention strategies is generally low to moderate. In multi-level modeling analyses, a number of child and therapist characteristics were identified as significant predictors of EBP strategy intensity. Discussion: Community based therapists are using many therapeutic strategies consistent with EBP, but at lower intensity; other EBPs are being used infrequently. We will discuss how these descriptive data can be used to tailor clinician training and supervision interventions to improve integration of elements of EBP in usual care settings. Funded by NIMH 1R01MH66070