codcod afcc 2012 presentation
TRANSCRIPT
CHILDREN OF DIVORCE-COPING WITH DIVORCE
(COD-COD) :
AN INTERNET-BASED PREVENTION PROGRAM
Jesse Boring, Ph.D.
Arizona State University – Prevention Research Center
ACKNOWLEDGMENTS
I am deeply indebted to the following people for their support
of the CoD-CoD program:
Irwin Sandler, Keith Crnic, Sandy Braver, John Horan, Jenn-
Yun Tien
Joanne Rzucidlo, Taylor Cody, Jessica Mueller, Silvia Baez
Joanne Pedro-Carroll, Arnold Stohlberg, Sharlene Wolchick
Matthew Berry
My Family
The study was partially funded by the ASU Graduate College
Completion Fellowship.
WHY DEVELOP AN ONLINE PROGRAM FOR
CHILDREN OF DIVORCE?
Children of divorce are at increased risk for a range of
poor developmental outcomes (Amato, 2001).
Divorce is widespread
Over 1 million children experience divorce each year (U.S. Census, 2008).
Children of divorce can be helped by prevention programs targeting developing coping skills
Children of Divorce Intervention Program
Children’s Support Group
INTERNET INTERVENTIONS
Internet-Based Program Advantages
For Users
Available at the time and place of the users choosing
Availability of specialized expertise
Reduced threat of stigma/fear of disclosure
Instant user access
For Researchers/Developers
Program fidelity
Low provision cost per user
Ability to collect usage data
Ability to revise instantly
INTERNET INTERVENTIONS
Internet intervention programs have now been used in a wide variety of capacities Depression
Anxiety
Eating Disorders
Smoking Cessation
Asthma Management
Meta-analyses indicate potential effectiveness of internet-based programs
Spek et al., 2007
Barak et al., 2008
…and also that field has long way to go
THE DARK AGES PART I: THE RESEARCH
Few trials include a randomized control group
Many studies include inadequate measures
Level of specificity at which the literature can inform
how to make a good program is very low.
Bright colors
THE DARK AGES PART II: THE PROGRAMS
Common problems for internet-based interventions.
Low recruitment rates Mailed brochures, internet recruitment
2.4 in 1000 (Clarke, et al., 2005)
High Attrition 18.6% program completion (Buller et al., 2006)
Efficacy of reminders
2.6 log-ins to 5.9 log-ins
Low satisfaction 5.9 out of 10 (Vorhees et al., 2005)
Most programs just aren’t very cool yet.
EXAMPLE COD-COD ACTIVITIES
Overview of Module Structure
Replacing Hurtful Thoughts with Hopeful Thoughts
Deciding If a Problem Is Yours To Fix
The 4 Steps of Good Communication: Step #3
Module 3 Home Practice: Talk To Your Parent
PROGRAM DESIGN INNOVATIONS OF COD-COD
Personal approach Use of humor
Module structure designed to enhance engagementHome Practice Review Program Goal Intro Video
Content Home Practice Assignment Quiz Video Game
Highly interactive (activities and dynamic content)
Creation and tracking of goal With contingent feedback on creating goal and progress
Focus on in-program skills practice.
Home Practice (with feedback on attempts)
CONTENT CREATION FOR COD-COD
The skills and information taught in CoD-CoD are
based on the available evidence-based programs
for children from disrupted families.
The Family Bereavement Project
The Children of Divorce Intervention Program
The Children’s Support Group
Research on children of divorce guided the
distillation process.
COD-COD THEORETIC MODEL
Internalizing
Symptoms
Externalizing
Symptoms
Coping Efficacy
Children’s Divorce
Appraisals
Avoidant Coping
Active Coping
Intervention
Condition
THEORY OF THE PROGRAM
Problem-solving training
Positive cognitive restructuring
Psycho-education
Active Coping
Feeling awareness
Relaxation
Distraction coping
Avoidant
Coping
Coping
Efficacy
Controllability of Stressors
Reduce wishful thinking
Peer Testimonials
Simulated Coping Practice
Divorce
Appraisals
Positive cognitive restructuring
Divorce information
Intervention
Program
Elements
Modifiable
Mediators
COD-COD TRIAL DESIGN
Recruitment
Court Records – Maricopa County
147 children ages 11-16 randomized used block
random assignment based on risk scores.
“Treatment As Usual” control
Intended to approximate best case scenario in using online
resources currently available for children of divorce.
PARTICIPANTS
147 children and adolescents
78 females and 69 males
Ages 11-16. Mean age was 13.78 (1.66).
Divorce latency mean was 1.23 years (1.08).
Divorce filing date, not divorce decree
Ethnic composition includes:*
75.2% Non-Hispanic white, 15.8% Hispanic, 3.8% Non-
Hispanic Black, 3.7%, 0.8% Native American, and 1.4%
other.
Average years of mother's education was 14.82
(2.93). *
Court Records
(25-45 months old)
n1= 818
Provided Data
Parent [n = 66 (89.19%)]
Child [n = 64 (86.49%)]
Randomized
n = 112 families
[n = 147 children]
Program Condition, [n = 74]
Control Condition, [n = 73]
Court Records
(3-16 months old)
n = 1364
Refused/Unable to Contact
n = 227
Ineligible, n = 2
Sent Invitation
Letters
Attempted
Phone Contact
n= 247
Attempted
Phone Contact
n = 763
Sent Pre-Tests
n = 18 families
[n = 24 children]
Sent Pre-Tests
n = 97 families
[n = 128 children]
Did Not Complete Pre-
Tests
n = 0
[n = 0]
Refused/Unable to Contact
n = 652
Ineligible, n = 14
Did Not Complete Pre-
Tests
n = 4
[n = 7]
Provided Data
Parent [n = 71 (97.26%)]
Child [n = 71 (97.26%)]
Pre-Test
Program Condition Control Condition
Data Collected ¹Parent Assessment: n = 116, [n = 147]
Child Assessment: n =116, [n = 146] ²
Post-Test
(1-Month)
1 One family with 2 children entered
the study through clinician referral.
2 One child did not complete the
pre-test assessment.
PROCESS DATA
89 % Home practice participation rate
92% of completers stated that the home practice was
helpful to them.
92% of program completers reported that they had
made progress toward the their program goal.
PROGRAM GOAL EXAMPLES
To not get so angry all the time.
I would like to understand how to better control my emotions
For my parents to stop putting me in the middle of their problems.
I would like to not feel so sad
To try not to hide feelings from friends and family.
PROGRAM COMPLETION RATE
Completion Rate Comparison
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Mood Gym 2009 (a)
Mood Gym 2009 (b)
BRAVE Online 2008
Project CATCH-IT 2008 (BA)
BRAVE Online 2011
Mood Gym 2006
Project CATCH-IT 2008 (MI)
CoD-CoD
NARRATIVE FEEDBACK: CHILD
“I thought this program wasn't going to help at all but I was wrong my parents divorce is so much easier to deal with now. Thank you.”
11-year old girl
“CoD-CoD changed my life by making it a little easier.”
14-year old boy
“It was great. Jesse was funny.”
13-year old boy
“It taught me to control my emotions and solve difficult problems. I can also stop myself before I say something that will most likely hurt someone else.”
14-year old girl
NARRATIVE FEEDBACK: PARENT
She is able to tell me when I am talking about something that I should only talk about with her
father. She stops me to let me know it should be between me and my ex.
-Mother of 13 year-old girl
He has expressed on numerous occasions that he feels the program continues to help him deal
with situations that arise concerning me and his dad. Thank you for including him, I see a real
change in his coping skills. I hope that the program is able to help many others to come.
-Mother of 11-year old boy
Recently, my son and I missed a flight at the airport. I was very frustrated with the way
the airlines handled the situation and it showed! My son, on the other hand, handled the
situation with uncommon maturity. I was very impressed when he told me that he was utilizing
some of the techniques that he had learned during your online program to manage the stress.
Great Job! Maybe I should have done the program with him.
-Father of 13-year old boy
I watched my son a few times as he was completing his modules. He really took time and
enjoyed the videos and information provided. It has been a positive experience, and in the short
time V. participated, he has learned positive life lessons and is applying them to his daily
activities and decisions. -Mother of 15 year-old boy
I think it made my child think a lot about ways to work though problems. She presented me with
an idea of how to resolve an argument that we had and it was a really good idea that involved
expressing feelings in a constructive manner. I was pretty impressed
-Mother of 13 year-old girl
MAIN EFFECTS
Intent-to-Treat Analysis
Reduced Total Mental Health Problems (SDQ)
d = .37
Reduced Emotional Problems (SDQ)
d = .37
ANALYSIS OF MODERATION
Variables examined as possible moderators
Baseline Variable Levels
Risk
Age
Gender
Divorce Latency
Three of the moderators examined did not significantly moderate any program effects:
child gender, child age, and divorce latency
Two of moderators examined moderated program effects on two variables:
Baseline Variable Level
Risk
T2 SDQ-
Total
T1 SDQ-
Total
T1 SDQ-Total
x Condition
T2 Coping
Efficacy
Program
Condition
T1 Coping
Efficacy
.69***
-.16***
.73***
-.15†
T1 Coping Efficacy x
Condition -.30*
-.06
Coping Efficacy
.30*
Low T1
T2 SDQ-
Emotional
T1 SDQ-
Emotional
T2 Coping
Efficacy
Program
Condition
T1 Coping
Efficacy
Coping Efficacy
.69***
-.17***
.60***
.30*
Low T1
T1 Coping Efficacy x
Condition -.30*
-.11*
T2 BPI-
Total
T1 BPI-
Total
T1 Risk
x Condition
T2 Coping
Efficacy
Program
Condition
T1 Coping
Efficacy
-.01
.69***
-.10*
.50***
-.32†
T1 Coping Efficacy x
Condition -.30*
T1 Risk
-.22†
Coping Efficacy
.30*
Low T1
MAJOR FINDINGS
The CoD-CoD program demonstrated positive effects to reduce children’s mental health problems and to improve coping efficacy.
Program effects are strongest for children with greatest initial risk/symptomatology.
Only randomized controlled trial of an internet-based program for children and adolescents to date to use an active control condition.
First experimental trial of an internet-based program for children of divorce.
CoD-CoD’s high program completion rate suggests that program elements designed to increase engagement were effective.
POSSIBLE USES FOR COD-COD
Adjunct to counseling
Stand alone universal prevention (with support).
May be particularly appropriate with high risk children.
The program is being made available commercially
Starting July 2012
Please leave me your e-mail if you’d like a program preview.
Feel free to contact me with any questions at:
FUTURE DIRECTIONS FOR PROGRAM REVISION
Add a Parent Component
Mobile Application To Support Program
Parent and Participant Testimonials
Weekly Chat Room / Moderated Forum
Further Individualization
Content (Topics, Skills, Shortening Program)
Presentation (Videos, Videogames, Narration, etc.)
Use Usage Data To Retool Program
Follow-Up Modules
EXTRA STUFF THAT MIGHT BE HANDY
Program Outline by Module
Wave 1 Demographics + Pre-Test Equivalence
PROGRAM COMPLETION
68.9% of CoD-CoD participants completed the entire
program.
Average number of modules completed = 3.83.
76.6% of the 5-module program
84.9% of BTN participants completed the entire program.
Average number of modules completed = 1.78.
89.04% of the 2-module program