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 one agency de-implemented its universal P & L 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 the removal of P & L 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.

Background:Fidelity measurement is critical for developing, evaluating, and implementing evidence-based treatments (EBTs). However, traditional fidelity measurement tools are often not feasible for community-based settings. We developed a short fidelity rating form for the Collaborative Problem Solving (CPS) approach from an existing manualized coding system that requires extensive training. We examined the reliability and accuracy of this short form when completed by trained observers, untrained observers, and self-reporting providers to evaluate multiple options for reducing barriers to fidelity measurement in community-based settings.Methods:Community-based treatment providers submitted recordings of youth service sessions in which they did, or did not, use CPS. For 60 recordings, we compared short-form fidelity ratings assigned by trained observers and untrained observers to those provided by trained observers on the manualized coding system. For 141 recordings, we compared providers' self-reported fidelity on the short form to ratings provided by trained observers on the manualized coding system and examined providers' accuracy as a function of their global fidelity.Results & Conclusions:The short form was reliable and accurate for trained observers. An assigned global integrity score and a calculated average of component scores on the short form, but not component scores themselves, were reliable and accurate for observers who had CPS expertise but no specific training on rating CPS fidelity. When providers self-reported fidelity on the short form, their global integrity score was a reliable estimate of their CPS integrity; however, providers with better CPS fidelity were most accurate in their self-reports. We discuss the costs and benefits of these more pragmatic fidelity measurement options in community-based settings.

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.

Anxiety, one of the most common underlying causes of challenging student behavior, typically goes undiscovered and unaddressed through school-based behavior supports. Jessica Minahan and Stuart Ablon combine their expertise as a behavior analyst and a psychologist to outline how best to support students whose anxiety leads to challenging behavior. They describe the role of anxiety in challenging behavior and introduce skill-building approaches that help students develop the skills they need to succeed. These approaches can help teachers analyze skill deficits in students with anxiety, identify strategies to prevent anxiety from escalating, and build skills by combining opportunities to practice problem solving with specific strategies to manage anxiety.

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 article presents the development and psychometric evaluation of an observational system, the CPS Manualized Expert-Rated Integrity Coding System (CPS-MEtRICS), for measuring CPS treatment integrity. Audio recordings of in-home treatment sessions (159 CPS and 82 treatment-as-usual) were independently rated by pairs of seven trained coders for integrity and the affective aspect of client-provider relationship. Results showed satisfactory interrater reliability (intraclass correlations [ICCs] 0.64-0.86). Additionally, the integrity scores on the CPS-MEtRICS discriminated between providers delivering CPS and treatment-as-usual, while these two groups did not differ in general client-provider affective bond, supporting the construct and discriminant validity of ratings using the system. This study provided evidence for the reliability of the CPS-MEtRICS and the validity of its integrity ratings, which can be used for research on CPS and which will provide the foundation for other CPS integrity measurement tools useful in practice settings. This article also provides a model that can be used when developing integrity measurement systems for other therapeutic approaches. Public Significance Statement This study provides psychometric support for a system that can be used to measure whether practitioners are using the Collaborative Problem Solving (CPS) 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.

Twenty-one parents participated in a Collaborative Problem Solving (CPS) parent group targeting children’s challenging behavior; 18 parents were in a waitlist control group. All parents completed pre- and post-treatment measures on CPS learning targets, their child’s behavior, and relationship quality, and parents in the treatment group completed measures six months later. Only parents learning CPS reported significant improvements on learning targets and conflict, and changes were sustained six months later. Children’s behavior improved significantly in the treatment group by six-month follow-up. These findings support CPS parent groups as an economical and effective approach for parents of children with behavioral difficulties.

This chapter orients or reorients the reader to the fundamental philosophy and practice of Collaborative Problem Solving. It presents basic information about effectiveness of the approach across different settings and provides a rationale for this volume as a resource for individuals looking to implement CPS organization-wide.

This chapter examines the Collaborative Problem Solving (CPS) approach from a neurodevelopmental perspective and highlights the neurobiological mechanisms that are hypothesized to mediate and influence the various stages of the Plan B process. This chapter concludes that CPS adheres to the major principles known to be optimal for intentional change in the neural networks that mediate the motor, social, emotional, and cognitive functions in the brain and that CPS should be considered a trauma-sensitive and trauma-focused intervention.

Disruptive behavior disorders are psychiatric disorders in which the hallmark feature is behavior that violates the rights of others and/or brings an individual into conflict with others or with society. Some examples of such behaviors include rule-breaking, defiance, aggression, and destruction of property. 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.

Deficits in a range of skill domains (including executive functioning, emotion regulation, social cognition and language/communication) are associated with disrupted youth behavior and functioning across mental health diagnoses. The identification of skill deficits are important for effective treatment planning, particularly for personalized interventions. While there are multiple ways to assess these skills, parent/caregiver reports represent an important information source. To date, no single, brief measure has been developed that gathers parent/caregiver ratings across this range of constructs. We have developed a short caregiver-report questionnaire (the Thinking Skills Inventory; TSI), to screen for skill deficits. Here, we examine the reliability and validity of this rating scale in 384 youth who were consecutively referred for neuropsychiatric evaluation. A primary caregiver completed the TSI as well as other established measures. Exploratory and confirmatory factor analyses support five subscales on the TSI: Attention and Working Memory, Language and Communication, Emotion Regulation, Cognitive Flexibility, and Social Thinking Skills. The subscales showed moderate to high internal consistency (Cronbach’s alphas range from 0.84 to 0.91). Correlations with established caregiver-report measures confirm their convergent and discriminant validity, and associations with multiple clinical diagnoses and cross-diagnostic aggressive behavior further support the utility of the scale for our intended purpose. In sum, this free, brief measure is a valid and reliable way to identify variation in skill domains relevant to a range of psychopathology. The TSI may be useful in youth mental health settings to assist with treatment planning and to inform referral for further evaluation.

Despite a growing understanding of the need to reduce seclusion and restraint (S/R) in all types of youth psychiatric facilities, published accounts of success in the psychological literature have been limited to inpatient facilities. Furthermore, existing publications on successful S/R reduction rarely include details about implementation that would be helpful to other agencies looking to follow their lead. This article presents the case of one multiservice agency that reduced S/R rates in youth residential and day treatment programs after adopting the Collaborative Problem Solving (CPS) approach. It includes detailed information on implementation, data illustrating the reduction of S/R after CPS implementation, and discussion of possible benefits to youth outcomes and organizational costs.

There has been increasing demand on psychodynamicially oriented therapists to empirically demonstrate the effectiveness of their interventions, and to associate these interventions with successful therapeutic outcome. Studies focused on psychoanalytic process have identified several process-related variables influencing the nature of the treatment and have demonstrated how therapy process changed over time, along with associations between process variables and outcome (Ablon, Levy, and SmithHansen 2011). The good nature of the interaction of the therapeutic dyad, 602878 APAXXX10.1177/0003065115602878Poster SummariesPoster Summaries research-article2015

Das Psychotherapie Prozess Q-Set (PQS) von Enrico E. Jones wird vorgestellt, und seine Anwendung zur Einschätzung einer analytischen Sitzung wird anhand des Musterfalls der Stunde 152 aus der Behandlung der Amalie X erläutert. Zudem wird mit einer Methode zur Messung der Therapieadhärenz anhand des PQS gezeigt, dass und inwiefern die vorgestellte Sitzung einer idealtypischen psychoanalytischen Sitzung entspricht. Es wird aufgezeigt, dass ein analytischer Prozess mit dem PQS systematisch und empirisch untersucht werden kann und dennoch in Übereinstimmung mit der klinischen Einschätzung ist, auch wenn die Komplexität einer analytischen Sitzung nicht vollkommen erfasst werden kann. Die Bedeutung des PQS und mögliche weitere Entwicklungen und Anwendungen werden kritisch diskutiert.

In the last decade, Collaborative Problem Solving (CPS) has become a popular approach to managing the challenging behaviors of children and adolescents, and has established a growing evidence base for reducing oppositional behavior and related outcomes. In contrast with standard behavioral methods that provide incentives for meeting adult expectations, CPS focuses on identifying and treating lagging cognitive skills that interfere with children's ability to meet these expectations. Since the majority of CPS outcomes have been evaluated in clinical and educational settings as part of internal quality-improvement efforts, only a small proportion of these findings has been published in peer-reviewed academic journals. Here, we describe the CPS approach and provide a summary of all known published and unpublished findings related to its implementation in outpatient, inpatient, residential, juvenile justice, and educational settings. Finally, we provide specific recommendations for future research on the model.

Observer ratings in psychotherapy are a common way of collecting information in psychotherapy research. However, human observers are imperfect instruments, and their ratings may be subject to variability from several sources. One source of variability can be raters' assessing more than 1 instrument at a time. The purpose of this research is to investigate whether it is possible to have raters assess 2 different psychotherapy process measures simultaneously and still produce dependable scores. Two studies were designed. The first compared scores assessed by raters who rated either 1 instrument or 2 instruments simultaneously. The second compared scores of raters who assessed 2 instruments simultaneously and scores of expert raters who assessed 1 instrument. The results show that variability in scores is largely due to differences across the object of measurement (e.g., patients). Small variability was reported for raters, raters' interaction with patients, and whether the rater assessed 1 instrument or 2 instruments simultaneously. The results are promising for the quality of observer ratings of psychotherapy process and for the feasibility of future psychotherapy process research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Back to table of contents Previous article Next article Communications and UpdatesFull AccessManual of Panic Focused Psychodynamic Psychotherapy: eXtended RangeJ. Stuart Ablon, Ph.D., and Raymond A. Levy, Psy.D.J. Stuart AblonBoston, Mass.Search for more papers by this author, Ph.D., and Raymond A. LevyBoston, Mass.Search for more papers by this author, Psy.D.Published Online:1 Jul 2012https://doi.org/10.1176/appi.ajp.2012.12020222AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by BuschFredric N., MilrodBarbara L., SingerMeriamne B., and AronsonAndrew C.. London, Routledge, 2011, 230 pp., $34.95.Empirical research in psychodynamic psychotherapy has been delayed in its development relative to research for other modes of psychotherapy, but clinician/researchers have emerged both nationally and internationally over the past decades to demonstrate the efficacy of the treatment (1). Among psychodynamic treatments, psychotherapy for panic disorder and other anxiety disorders, the topic of this excellent volume, has been the most thoroughly studied and researched. We benefit from the depth of knowledge and empirical approach that are demonstrated in this follow-up to the authors' 1997 edition (2).The treatment described adds to the evidence-based cognitive-behavioral treatments already available to clinicians. Having multiple efficacious treatments for panic disorder reflects psychotherapy's version of the trend toward personalized medicine. As researchers and clinicians, our responsibility is to find “the right treatment for the right patient.” A psychodynamic approach offers patients with curiosity about the source of their panic symptoms, psychological avoidance, and inhibitions an empirical model rich in opportunity for exploration of the psychological meaning of their difficulties. The authors describe the extensive pilot work that resulted in this manual. Multiple clinical trials, funded by the National Institute of Mental Health, over the past decade have demonstrated that their panic-focused psychodynamic psychotherapy treatment decreases symptoms and improves general patient functioning.What distinguishes this book from the previous volume is the extension of the treatment principles beyond symptoms of panic disorder to a broader range of anxiety disorders. In addition, as the authors explain, the volume presents “a more clearly articulated description of panic-focused psychodynamic psychotherapy as it has been practiced in our successful efficacy studies.” Researchers and clinicians alike will benefit from these refinements that are evident in this current edition. It is important to note, however, that while the authors express confidence in panic-focused psychodynamic psychotherapy as an effective treatment for patients with a variety of anxiety disorders, the treatment has not been formally studied in these contexts using randomized trials like the ones completed with panic disorder patients. It is this extension of treatment approaches beyond panic disorder that accounts for the subtitle of this volume—eXtended Range.The explanation of the treatment protocol itself proceeds from an exploration of psychodynamic theory and formulation to the clearly outlined three-phase treatment model: initial evaluation, interpretation of central conflicts and defense mechanisms, and termination. There is an emphasis on the description of the patient's relationship to the therapist and its possible connection to anxiety and panic symptoms. The authors' research has identified patterns of conflicts around separation, anger, development of independence, and sexuality that guide the focus of the treatment process. This information alone is useful to clinicians pursuing a psychodynamic approach to the treatment of patients with anxiety disorders and represents a wonderful example of how treatments can be designed around change processes that have been identified empirically (3).The empirically based manualized treatment described stops short of a session-by-session protocol because the authors recognize that patients bring their individual differences to treatment despite their common diagnoses. The authors also recognize that psychodynamic treatment principles and interventions may need to be used flexibly depending on the hour-to-hour complexities of the patient. Our own psychotherapy process research has suggested that it is truly impossible to fully control the process of psychotherapy as it is, and it should be a cocreated narrative between the patient and therapist (4, 5). Yet as this volume proves, suggested treatment focus and principles can be clearly articulated in a manner that helps therapists provide effective care for specific clinical problems without constricting or limiting the therapeutic process or detracting from the development of an effective therapeutic alliance.Completed after years of hard work in the demanding world of empirical research, this manual will be valuable to both experienced and newer psychodynamic psychotherapists. The value of the principles extends beyond panic disorder and the other anxiety disorders discussed. However, to the authors' credit, they make certain to state that their treatment approach should only be used by experienced clinicians because they recognize the need to make complex clinical adjustments based on a patient's course in any given psychotherapy. They ask less experienced clinicians to be supervised when utilizing the treatment.It is hard not to say that this manual, developed after years of clinical trials, experimentation, teaching, and revisions, represents the most fully developed and useful empirically based treatment that the world of psychodynamic psychotherapy has produced. We are all enriched by the ideas, principles, and manualized treatment offered in this important and excellent volume.Boston, Mass.Dr. Ablon is affiliated with the Department of Psychiatry, Massachusetts General Hospital, Boston, and is Associate Clinical Professor of Psychology, Department of Psychiatry, Harvard Medical School, Boston. Dr. Levy is Clinical Director of the Psychotherapy Research Program at Massachusetts General Hospital, Boston, and Assistant Clinical Professor, Department of Psychiatry, Harvard Medical School, Boston.The authors report no financial relationships with commercial interests.Book review accepted for publication February 2012.References1. Gerber AJ , Kocsis J , Milrod B , Roose SP , Barber JP , Thase ME , Perkins P , Leon AC: A quality-based review of randomized controlled trials of psychodynamic psychotherapy. Am J Psychiatry 2011; 168:19–28Link, Google Scholar2. Milrod B , Busch F , Cooper AM , Shapiro T: Manual of Panic-Focused Psychodynamic Psychotherapy. Washington, DC, American Psychiatric Publishing, 1997Google Scholar3. Ablon JS , Levy RA , Katzenstein T: Brand names of psychotherapy: identifying empirically supported change processes. Psychotherapy 2006; 43:216–231Crossref, Medline, Google Scholar4. Ablon JS , Jones EE: Validity of controlled clinical trials of psychotherapy: findings from the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 2002; 159:775–783Link, Google Scholar5. Ablon JS , Jones EE: How expert clinicians' prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychother Res 1998; 8:71–83Crossref, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 169Issue 7 July 2012Pages 763-764 Metrics PDF download History Accepted 1 February 2012 Published online 1 July 2012 Published in print 1 July 2012