Search

Mental health organizations that serve youth are under pressure to adopt measurement-based care (MBC), defined as the continuous collection of client-report data used to support clinical decision making as part of standard care. However, few frameworks exist to help leadership ascertain how to select an MBC approach for a clinical setting. This paper seeks to define how an MBC approach can display clinical utility to provide such a framework. Broadly, we define clinical utility as evidence that an MBC approach assists stakeholders in fulfilling clinical goals related to care quality (i.e., improve client clinician alliance and clinical outcomes) at the client (i.e., youth and caregiver), clinician, supervisor, and administrator levels. More specifically, our definition of clinical utility is divided into two categories relevant to the usability and usefulness of an MBC approach for a specific setting: (a) implementability (i.e., evidence indicating ease of use in a clinical setting) and (b) usefulness in aiding clinical activities (i.e., evidence indicating the potential to improve communication and make clinical activities related to care quality easier or more effective). These categories provide valuable information about how easy an MBC approach is to use and the potential benefits that the MBC data will confer. To detail how we arrived at this definition, we review prior definitions of clinical utility, discuss how previous definitions inform our definition of clinical utility for MBC, and provide examples of how the concept of clinical utility can be applied to MBC. We finish with a discussion of future research directions.

An observational coding system was developed to track clinical change in children with autism spectrum disorder (ASD) during psychotherapy. The Pediatric Autism Spectrum Therapy Observation System (PASTOS) consists of 23 items divided into 5 subscales and is used to rate child behaviors in individual psychotherapy sessions. Manual-based cognitive behavioral therapy session transcripts of 22 children diagnosed with ASD (IQ > 70) and a concurrent anxiety disorder (M = 9.41 years, SD = 1.56 years) enrolled in a randomized, controlled trial were coded. Results suggested that the PASTOS exhibited promising interrater reliability, internal consistency, convergent validity at post-treatment, and treatment sensitivity. The PASTOS may be a useful tool for studying process and outcome in psychotherapy research on children with ASD.

Improving social, emotional, and behavioral outcomes of students with and at-risk for emotional and behavioral disorders (EBD) remains a challenge for educators, and it has long been noted that teachers do not consistently use effective instructional practices with students with EBD. Identifying evidence-based practices that address the problems experienced by students with EBD is a priority for the field, but there exist implementation challenges in authentic classroom settings. The purpose of this article is to address one implementation barrier by distilling the common practice elements found in evidence-based programs (EBPs) and practices delivered by teachers designed to target the social, emotional, and behavioral problems in young students. We conducted a systematic review of EBPs and early elementary classroom practices that have been evaluated in randomized group designs, quasi-experimental designs, and single-case experimental designs. A total of 103 articles employing 68 group (n = 53 randomized group designs, n = 15 quasi-experimental designs) and 35 single-case designs were identified, and an iterative process was used to identify common practice elements. Twenty-five practice elements were identified and submitted to review by experts. After expert review, 24 practice elements remained. Implications for practice and training as well as future research are discussed.

Students' early school experiences have a significant and long-term effect on key academic and social/behavioral outcomes. Evidence-based programs that both increase the quantity and quality of positive teacher-student interactions and decrease the frequency of negative teacher-student interactions may be critical for changing negative patterns and improving students' early learning environments. The purpose of this article is to describe the iterative development of one such program, BEST in CLASS--Elementary, which has been adapted from an evidence-based program designed to reduce risk for emotional/behavioral disorders by improving teachers' interactions and relationships with preschool-age children with chronic problem behavior. Following a brief description of the parent program, 4 overlapping phases of intervention adaptation and development are described. Future directions for the intervention and applications of this iterative process tointervention developmentwork and research are discussed. [This paper was published in "Elementary School Journal" (EJ1217810).]

Improving social, emotional, and behavioral outcomes of students with and at-risk for emotional and behavioral disorders (EBD) remains a challenge for educators, and it has long been noted that teachers do not consistently use effective instructional practices with students with EBD. Identifying evidence-based practices that address the problems experienced by students with EBD is a priority for the field, but there exist implementation challenges in authentic classroom settings. The purpose of this article is to address one implementation barrier by distilling the common practice elements found in evidence-based programs (EBPs) and practices delivered by teachers designed to target the social, emotional, and behavioral problems in young students. We conducted a systematic review of EBPs and early elementary classroom practices that have been evaluated in randomized group designs, quasi-experimental designs, and single-case experimental designs. A total of 103 articles employing 68 group (n = 53 randomized group designs, n = 15 quasi-experimental designs) and 35 single-case designs were identified, and an iterative process was used to identify common practice elements. Twenty-five practice elements were identified and submitted to review by experts. After expert review, 24 practice elements remained. Implications for practice and training as well as future research are discussed. [The article was published in "Journal of Emotional and Behavioral Disorders" (EJ1215242).]

Teachers sometimes struggle to deliver evidence based programs designed to prevent and ameliorate chronic problem behaviors of young children with integrity. Identifying factors associated with variations in the quantity and quality of delivery is thus an important goal for the field. This study investigated factors associated with teacher treatment integrity of BEST in CLASS, a tier-2 prevention program designed for young children at risk for developing emotional/behavioral disorders. Ninety-two early childhood teachers and 231 young children at-risk for emotional/ behavioral disorders participated in the study. Latent growth curve analyses indicated that both adherence and competence of delivery increased across six observed time points. Results suggest that teacher education and initial levels of classroom quality may be important factors to consider when teachers deliver tier-2 (i.e., targeted to children who are not responsive to universal or tier-1 programming) prevention programs in early childhood settings. Teachers with higher levels of education delivered the program with more adherence and competence initially. Teachers with higher initial scores on the Emotional Support subscale of the Classroom Assessment Scoring System (CLASS) delivered the program with more competence initially and exhibited higher growth in both adherence and competence of delivery across time. Teachers with higher initial scores on the Classroom Organization subscale of the CLASS exhibited lower growth in adherence across time. Contrary to hypotheses, teacher self-efficacy did not predict adherence, and teachers who reported higher initial levels of Student Engagement self-efficacy exhibited lower growth in competence of delivery. Results are discussed in relation to teacher delivery of evidence-based programs in early childhood classrooms.

Educators are increasingly being encouraged to implement evidence-based interventions and practices to address the social, emotional, and behavioral needs of young children who exhibit problem behavior in early childhood settings. Given the nature of social-emotional learning during the early childhood years and the lack of a common set of core evidence-based practices within the early childhood literature, selection of instructional practices that foster positive social, emotional, and behavioral outcomes for children in early childhood settings can be difficult. The purpose of this paper is to report findings from a study designed to identify common practice elements found in comprehensive intervention models (i.e., manualized interventions that include a number of components) or discrete practices (i.e., a specific behavior or action) designed to target social, emotional, and behavioral learning of young children who exhibit problem behavior. We conducted a systematic review of early childhood classroom interventions that had been evaluated in randomized group designs, quasi-experimental designs, and single-case experimental designs. A total of 49 published articles were identified,and an iterative process was used to identify common practice elements. The practice elements were subsequently reviewed by experts in social-emotional and behavioral interventions for young children. Twenty-four practice elements were identified and classified into content (the goal or general principle that guides a practice element) and delivery (the way in which a teacher provides instruction to the child) categories. We discuss implications that the identification of these practice elements found in the early childhood literature has for efforts to implement models and practices.

The measurement of treatment integrity is critical to evaluate the efficacy and effectiveness of evidence-based programs (EBPs) designed to improve the developmental outcomes of young children at risk of emotional/behavioral disorders. Unfortunately, the science of treatment integrity measurement lags behind the development and evaluation of EBP for young, high-risk children. This article describes the development and preliminary psychometric properties of the BEST in CLASS Adherence and Competence Scale (BiCACS), designed to measure the adherence and competence of delivery of the BEST in CLASS prevention program. Independent observers coded videotaped (n = 116) and live (n = 289) observations of teachers delivering the BEST in CLASS program. The BiCACS showed good interrater reliability and analyses provided some support for the validity of the measure. Implications for future research and integrity measurement work are discussed. [This paper was published in "Journal of Emotional and Behavioral Disorders" (EJ1044702).]

Young children with and at risk for emotional/behavioral disorders (EBD) present challenges for early childhood teachers. Evidence-based programs designed to address these young children's behavior problems exist, but there are a number of barriers to implementing these programs in early childhood settings. Advancing the science of treatment integrity measurement can assist researchers and consumers interested in implementing evidence-based programs in early childhood classrooms. To provide guidance for researchers interested in assessing the integrity of implementation efforts, we describe a conceptual model of implementation of evidence-based programs designed to prevent EBD when applied in early childhood settings. Next, we describe steps that can be used to develop treatment integrity measures. Last, we discuss factors to consider when developing treatment integrity measures with specific emphasis on psychometrically strong measures that have maximum utility for implementation research in early childhood classrooms. [This article was published in "Journal of Early Intervention," (EJ1019931).]

Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure's established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.

ObjectiveTo compare the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT) and child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders at a 1-year follow-up.MethodThirty-five children (6-13 years old) randomly assigned to 12-16 sessions of family-focused CBT (FCBT) or child-focused CBT (CCBT) participated in a 1-year follow-up assessment. Independent evaluators, parents, and children rated anxiety and parental intrusiveness. All were blind to treatment condition and study hypotheses.ResultsChildren assigned to FCBT had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but not child-report scores. Exploratory analyses suggested the advantage of FCBT over CCBT may have been evident more for early adolescents than for younger children and that reductions in parental intrusiveness may have mediated the treatment effect.ConclusionFCBT may yield a stronger treatment effect than CCBT that lasts for at least 1 year, although the lack of consistency across informants necessitates a circumspect view of the findings. The potential moderating and mediating effects considered in this study offer interesting avenues for further study.