taking evidence based programmes to the real world: the american experience and lessons for tallaght...

Taking Evidence Based Programmes to Taking Evidence Based Programmes to the Real World: The American the Real World: The American

Experience and Lessons for Tallaght Experience and Lessons for Tallaght WestWest

John E. LochmanThe University of Alabama

& Utrecht University

Box 870348, Department of Psychology, The University of AlabamaTuscaloosa, AL 35487

205-348-7678; [email protected]

Research and Policy Workshop – November 22, 2009

mailto:[email protected]

This presentation’s translational This presentation’s translational research topics:research topics:

Type 1: Risk factors for children’s antisocial behavior: a contextual social-cognitive model

Coping Power efficacy and effectiveness studies

Type 2: Coping Power dissemination study

Bench Bedside

Type 1 Translational Research

Is aggressive behavior a stable Is aggressive behavior a stable behavior pattern, or not?behavior pattern, or not?

00.5

11.5

22.5

33.5

44.5

5

6 10 11 12 13 14 15

Age

Ag

gre

ss

ion

Chronic Hi Desist Mod Desist Low Subgroup of chronic aggressive children are at risk of most physical violence during adolescence (Nagin & Tremblay, 1999)

Summary of Stability and Predictive Summary of Stability and Predictive Utility of Children’s AggressionUtility of Children’s Aggression

Aggressive behavior during early childhood predicts adolescent delinquency, substance use, and school problems

Thus, preventive interventions can target high risk aggressive children, and, from a prevention science perspective, these interventions should address the malleable risk factors that produce and maintain children’s aggressive behavior

Child Factors: biology and temperament

Family ContextNeighborhood ContextPeer ContextLater Emerging Child Factors: social cognitive processes

and emotional regulation

Family Context links to Childhood Family Context links to Childhood AggressionAggression

Parent depression and anxiety Marital conflict

These family factors can influence child behavior through their effect on parenting processes

Inconsistent Discipline Mediates Maternal Inconsistent Discipline Mediates Maternal Depression Effect on Child AggressionDepression Effect on Child Aggression

(Barry, Dunlap, Lochman & Wells, 2008, Child and Family Behavior Therapy)(Barry, Dunlap, Lochman & Wells, 2008, Child and Family Behavior Therapy)

Low SES

High Maternal Parenting

Stress

High Maternal Distress

Inconsistent Parenting Practices

Child Disruptive Behavior Problems

Maternal Distress Predicting ParentingMaternal Distress Predicting Parenting

Sample: 215 boys, overweighted for aggression; 9-12 years of age; 59% African-American

Maternal Distress and Parenting Predicting Maternal Distress and Parenting Predicting Child Aggression and Attention ProblemsChild Aggression and Attention ProblemsChild Disruptive Behavior Variables

MaternalDepression

Maternal Depression(controlling

for Inconsistent Discipline)

Inconsistent Discipline

(controlling for Maternal

Depression)

Aggression .12 * .09 .22 **

Marital Conflict and Parenting Predicting Marital Conflict and Parenting Predicting Child AggressionChild Aggression

(Baden, Lochman & Wells, under review)(Baden, Lochman & Wells, under review)

Sample: 74 boys, overweighted for aggression; 9-12 years of age; 46% African-American- in families with marital/cohabiting partner

Constructs (and measures)- Child Aggression (CBCL; TRF)- Marital conflict (Conflict Tactics Scale, verbal and physical aggression; O’Leary Porter Marital Discord)- Harsh parenting (Conflict Tactics Scale, verbal and physical aggression)

Multiple imputation for missing data

Marital Conflict and Parenting Predicting Marital Conflict and Parenting Predicting Child AggressionChild Aggression

Mediational model highlighting the significant indirect effect of marital conflict on children, supportive of the mediating role of aggressive parenting. Path coefficients (ab) and standard errors (Sa and Sb) were used in the Sobel test, Z = 2.170, p = 0.030.

0.438a (0.134Sa)0.493b (0.162Sb)

Time 1Aggress marital conflict (IV)

Time 3Children’s aggression (DV)

Time 2Aggressive parenting (Mediator)

Child Factors: biology and temperamentFamily Context

Neighborhood ContextPeer ContextLater Emerging Child Factors: social cognitive processes


Neighborhood ContextNeighborhood ContextNeighborhood crime rates and social cohesion can

affect disruptive behavior in children (Colder, Mott, Levy & Flay, 2000; Guerra, Huesmann & Spindler, 2003 Majumder, Moss & Murrelle,

1998; Maughan, 2001) , especially starting during middle childhood (Ingoldsby & Shaw, 2002)

Fite et al (2009):Neighborhood Disadvantage (census information: percent below poverty, percent receiving public assistance, percent of

adults unemployed, percent of adults with 12 or fewer years of education, etc), from 22 aggregated neighborhoods with126 at-risk aggressive children; 66% male; 79% African-American

Neighborhood EffectsNeighborhood Effects (Fite. Lochman, & Wells, 2009, Journal of Community Psychology) (Fite. Lochman, & Wells, 2009, Journal of Community Psychology)

Neighborhood Context: Predicting Neighborhood Context: Predicting Children’s Aggression in 6Children’s Aggression in 6thth Grade Grade (Beta)(Beta)

Neighborhood disadvantage predicts proactive but not reactive aggression

Proactive

Aggression

Reactive

AggressionGender .46* .19

Race -.18 -.04

5th grade Proactive Aggression

.08 .11

5th grade Reactive Aggression

.16 .14

Neighborhood Disadvantage

.25* .19

Child Factors: biology and temperamentFamily ContextNeighborhood Context

Peer ContextLater Emerging Child Factors: social cognitive processes


Peer ContextPeer Context Peer Rejection: By elementary school, aggressive behavior can

lead to peer rejection, although the relation is bidirectional (Coie, Dodge & Kupersmidt, 1990)

- Additive risk for aggression and rejection exists (Coie, Lochman, Terry & Hyman, 1992)

Deviant Peers: Peer rejection from the broad peer group may set the stage for involvement with deviant peers, which is itself a critical peer risk factor by adolescence

Proactive and Reactive Aggression and Proactive and Reactive Aggression and Substance Use Substance Use

(Fite, Colder, Lochman & Wells, 2007, Psychology of Addictive Behaviors)(Fite, Colder, Lochman & Wells, 2007, Psychology of Addictive Behaviors)

Sample: 126 at-risk aggressive children; 66% male; 79% African-American

Measures - Substance Use – Center for Substance Abuse Prevention Student Survey (3 items assessing whether ever had

alcohol, tobacco or marijuana use) – 8th – 9th grades

- Reactive and Proactive Aggression (Teacher rated; Dodge & Coie, 1987) – 5th grade

- Perceived Peer Delinquency - 8th grade- Peer Rejection – classroom sociometrics – 5th grade

Proactive and Reactive Aggression and Proactive and Reactive Aggression and Substance Use – Structural Equation ModelSubstance Use – Structural Equation Model

Chi Square (5)=3.64, p=.60, CFI=1.00, RMSEA=.00Chi Square (5)=3.64, p=.60, CFI=1.00, RMSEA=.00 (Fite, Colder, Lochman & Wells, 2007, Psychology of Addictive Behaviors)(Fite, Colder, Lochman & Wells, 2007, Psychology of Addictive Behaviors)

5th Gr Proactive Aggression

8th Gr Peer Delinquency

9th Gr Alcohol Use5th Gr Reactive Aggression

5th Gr Low Peer Acceptance

8th Gr Peer Delinquency

9th Gr Alcohol UseWith 126 at-risk aggressive children

Child Factors: biology and temperamentFamily ContextNeighborhood ContextPeer Context

Later Emerging Child Factors: social cognitive processes and emotional regulation

Social Cognitive Processes in Social Cognitive Processes in Aggressive ChildrenAggressive Children

(Crick & Dodge, 1994; Lochman, Whidby & FitzGerald, 2000)(Crick & Dodge, 1994; Lochman, Whidby & FitzGerald, 2000)

1. Cue encoding difficulties, by excessively recalling hostile social cues

2. Hostile attributional biases, and distorted perceptions of self and other in peer conflict situations

3. Dominance and revenge oriented social goals4. Generate less competent problem solutions, with fewer

verbal assertion, compromise and bargaining solutions5. Expect that aggressive solutions will work, and value

aggressive solutions more6. Poor enactment of solutions, due to weak social skills

Effects of Anger-Related Processes Effects of Anger-Related Processes on Social Information Processingon Social Information Processing

Attributions, physiological arousal, and reactive aggression

Effects of Threat Induction on Effects of Threat Induction on Boys’ Attributions and Heart Rate Boys’ Attributions and Heart Rate

(Williams, Lochman, Phillips & Barry, 2003, (Williams, Lochman, Phillips & Barry, 2003, Journal of Clinical Child and Adolescent PsychologyJournal of Clinical Child and Adolescent Psychology))

In response to experimental threat induction (stranger peer is angry and ready to fight), the most aggressive 4th grade boys have increases in heart rate and in hostile attributions

Correlation of .41 between heart rate increase and increase in hostile attributions

Reactive Aggression and Physiological Reactive Aggression and Physiological Response Following ProvocationResponse Following Provocation

(Clanton & Lochman, in preparation)(Clanton & Lochman, in preparation) 20 minute recovery:

After a 20 minute recovery period following children’s response to provocation on a computer game, higher levels of reactive aggression and anger were associated with greater difficulty in reducing arousal; no prediction of proactive aggression

Skin Conductance

Cortisol

Reactive Aggression (T)

ns 2.1*

Reactive Aggression (P)

3.1** ns

Aggressive Game Response

4.1** ns

State Anger ns

2.2*

Social Cognitive Processes in Social Cognitive Processes in Aggressive ChildrenAggressive Children

(Crick & Dodge, 1994; Lochman, Whidby & FitzGerald, 2000)(Crick & Dodge, 1994; Lochman, Whidby & FitzGerald, 2000)

1. Cue encoding difficulties, by excessively recalling hostile social cues

2. Hostile attributional biases, and distorted perceptions of self and other in peer conflict situations

3. Non-affiliative social goals4. Generate less competent problem solutions, with fewer

verbal assertion, compromise and bargaining solutions5. Expect that aggressive solutions will work, and value

aggressive solutions more6. Poor enactment of solutions, due to weak social skills

Reactive and Proactive Aggression Reactive and Proactive Aggression (Dodge & Coie, 1987; Dodge, Lochman, Harnish, Bates & Pettit, 1997; Lochman & Wells, 1999)(Dodge & Coie, 1987; Dodge, Lochman, Harnish, Bates & Pettit, 1997; Lochman & Wells, 1999)

Reactive Aggression:

Encoding errors Hostile attributions Lower perceived social and

general competence More sad and depressed More harsh and non-involved

parenting Neighborhood violence

Proactive Aggression:

Expectations that aggression will work

Low fearfulness Cognitive dysregulation –

little concern for long-term consequences or goals

Involved with peers who are approving of deviant behaviors

Contextual Social-Cognitive ModelContextual Social-Cognitive Model Background ContextBackground Context Mediational ProcessesMediational Processes OutcomesOutcomes

Community Context Neighborhood Problem

Family Context Maternal Depression Low Social Support Marital Conflict Low SES

Parenting Practices Context

Child Social Cognition and Self Regulation

Child's Perception of Peer Context

Proximal Aggressive Behavior

Substance Abuse

Delinquency

Academic Failure

Empirically Supported Treatment for Empirically Supported Treatment for Externalizing Disorders in School-age Externalizing Disorders in School-age

ChildrenChildren

Coping Power program

School Age Children: Coping PowerSchool Age Children: Coping Power Child Component Content

– Anger management training, including methods for self-instruction, distraction, and relaxation

– Perspective-taking and attribution retraining

– Social problem-solving in a variety of situations (peer, teacher, family)

– Resistance to peer pressure and focus on involvement with non-deviant peer groups

School Age Children: Coping PowerSchool Age Children: Coping Power Parent Component Content

– Positive attention and rewards for appropriate child behavior.

– Clear commands, rules, expectations, and monitoring.

– Use of consistent consequences for negative child behavior (response cost, time-out, withdrawal of privileges).

– Improvement of family communication and increasing family activities.

– Improvement of parents’ own stress management.

NIDA-funded Study of Coping Power NIDA-funded Study of Coping Power Child Component Only, and of Child Child Component Only, and of Child Component Plus Parent ComponentComponent Plus Parent Component

Lochman & Wells (2004), Lochman & Wells (2004), Journal of Consulting and Clinical Psychology, 72, 571-Journal of Consulting and Clinical Psychology, 72, 571-578578

Significant Contrasts Significant Contrasts (effect sizes) (effect sizes)

with Control Cell & Normative Comparison: with Control Cell & Normative Comparison: Outcomes at 1 Year Follow-upOutcomes at 1 Year Follow-up

Child Component Only

vs Control

Child + Parent Component

vs Control

Intervention Cells in Normative Range

Delinquency - .37* *

Substance Use (Parent-rated)

- .66* *

School Behavioral Improvement

.42* .34* *

Contextual Social-Cognitive Contextual Social-Cognitive Mediators and Child Outcome at a Mediators and Child Outcome at a One Year Follow-up: Mediation of One Year Follow-up: Mediation of

Coping Power EffectsCoping Power EffectsLochman & Wells (2002), Lochman & Wells (2002), Development and Psychopathology, 14,Development and Psychopathology, 14, 945-967 945-967

.19**

.12 .04 .10 .07 .21* -.22*

.26** -.22* -.11 -.14+ .14+ .19* .13

Intervention

Ethnic Status

Grade

Delinquency

Attributions

Screening Status

Outcome Expectations

Internal Control

Person Perception

Parental Inconsistency

Attributions


Internal Control

Person Perception


.11 .07 .02 .10 .07 .21* .14+ -.22* -.08 26** -.22* -. -.11 -.07 -.14+ .14+ .02

.19* .13 .21*

Intervention

Ethnic Status

Grade

Delinquency

Attributions

Screening Status


Internal Control

Person Perception


Attributions


Internal Control

Person Perception


One-Year Follow-up Outcomes One-Year Follow-up Outcomes for the CSAP-funded Studyfor the CSAP-funded Study

Lochman & Wells (2002) Lochman & Wells (2002) Psychology of Addictive Behaviors, Psychology of Addictive Behaviors,

16,16, S40-S54 Lochman, J.E. & Wells, K.C. (2003), S40-S54 Lochman, J.E. & Wells, K.C. (2003), Behavior Behavior Therapy, 34,Therapy, 34, 493-515 493-515

Substance UseSubstance Use (youth self report of use of (youth self report of use of Tobacco, Alcohol, and Marijuana in the past month)Tobacco, Alcohol, and Marijuana in the past month)

Coping Power vs Control: F(1,120)=10.8, p=.001Coping Power vs Control: F(1,120)=10.8, p=.001

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

3.6

3.7

Baseline 1 yr FU

Coping P

Control

Delinquent BehaviorDelinquent Behavior (Youth self report of theft, assault, property destruction, fraud, (Youth self report of theft, assault, property destruction, fraud,

and drug selling in the past month)and drug selling in the past month) Coping Power vs Control: F(1,129)=4.30, p=.04 Coping Power vs Control: F(1,129)=4.30, p=.04

6

6.2

6.4

6.6

6.8

7

7.2

1 yr FU

Coping P

Control

Teacher-rated Peer Aggressive Teacher-rated Peer Aggressive BehaviorBehavior

(fighting and harming others from the TOCA-R)(fighting and harming others from the TOCA-R)

Coping Power vs Control: F(1,80)=4.18, p=.04 Coping Power vs Control: F(1,80)=4.18, p=.04

0

1

2

3

4

5

6

Baseline 1 yr FU

Coping P

Control

Longer – Term 3 Year Follow-up:Longer – Term 3 Year Follow-up:TOCA Aggression: Coping Power vs ControlTOCA Aggression: Coping Power vs Control

0.00 1.17 2.34 3.51 4.68 5.86

CP vs C: AGGCONC*YEAR*CP

CP_YEAR

0.7

0.7

0.8

0.8

0.9

1.0

1.0

1.1

1.1

1.2

1.3

AGGCON_C

CPOWER = 0.000000

CPOWER = 1.000000

Coping Power Dissemination Study Coping Power Dissemination Study with Aggressive Deaf Childrenwith Aggressive Deaf Children

Lochman, J.E., FitzGerald, D.P., Gage, S.M., Kanakly, M.K., Whidby, J.M., Barry, Lochman, J.E., FitzGerald, D.P., Gage, S.M., Kanakly, M.K., Whidby, J.M., Barry, T.D., Pardini, D.A., & McElroy, H. (2001), T.D., Pardini, D.A., & McElroy, H. (2001),

Journal of the American Deafness and Rehabilitation Association, 35,Journal of the American Deafness and Rehabilitation Association, 35, 39-61 39-61

SampleSample

49 aggressive deaf children, based on teacher-rated aggression on a screening measure administered in residential school for the deaf

33 males, 16 females64% African American, 34% Caucasian, 2%

Hispanic

Competent Problem Solutions Competent Problem Solutions (verbal assertion, cooperation, positive action) (verbal assertion, cooperation, positive action) FF(1, 36 ) = 11.04, (1, 36 ) = 11.04, pp < .01 < .01

0

1

2

3

4

5

6

7

Coping Power Control

Baseline

Post

Coping Power Cost Effectiveness Coping Power Cost Effectiveness Study with ODD/CD Dutch Study with ODD/CD Dutch

Children in Child Psychiatry ClinicsChildren in Child Psychiatry Clinicsvan de Wiel, N.M.H., Matthys, W., Cohen-Kettenis, P.T., Maassen, G.H., van de Wiel, N.M.H., Matthys, W., Cohen-Kettenis, P.T., Maassen, G.H.,

Lochman, J.E., & van Engeland, H. (2007).Lochman, J.E., & van Engeland, H. (2007).Behavior Modification.Behavior Modification.

Zonnevylle-Bender, M.J.S., Matthys, W., van de Wiel, N.M.H., & Lochman, J. Zonnevylle-Bender, M.J.S., Matthys, W., van de Wiel, N.M.H., & Lochman, J. (2007) (2007) Journal of the American Academy of Child and Adolescent PsychiatryJournal of the American Academy of Child and Adolescent Psychiatry

van de Wiel, NMH, Matthys, W, Cohen-Kettenis, P, & van Engeland, H van de Wiel, NMH, Matthys, W, Cohen-Kettenis, P, & van Engeland, H

(2003), (2003), Behavior TherapyBehavior Therapy..

Results at 4 yr FU

Substance Use

CAU (N=31) UCPP(N=30) p

Tobacco (last month) 42% 17% 0.02

Alcohol (last month) 65% 67% ns

Marijuana (ever) 31% 13% 0.04

Dissemination of Coping Power to Dissemination of Coping Power to Real-World SettingsReal-World Settings

Bedside Practice

Type 2 Translational Research

Dissemination of Evidence-Based Dissemination of Evidence-Based InterventionsInterventions

The implementation and outcomes of programs have been found to be highly variable when programs have been disseminated, leading to the apparent failure of many effective interventions once they are in widespread use in education (Battistich, 2001; Kalafat et al.,

2007; Kam et al., 2003) and mental health settings (e.g., August,

et al., 2006; Henggeler et al., 1997; Schoenwald et al. 2004).

Dissemination within real-world Dissemination within real-world settings: training issuessettings: training issuesand organizational factorsand organizational factors

Training EffectsTraining Effects on Dissemination of on Dissemination of InterventionsInterventions

The nature of the training provided for an intervention can affect outcomes

Training that is intense, ongoing and carefully specified has led to greater adherence to the principles of the intervention protocol and to the strongest effects for MST (Henggeler et al, 1998)

Training Study: Field Trial Training Study: Field Trial Lochman, Boxmeyer, Powell, Qu, Wells, & Windle (2009). Lochman, Boxmeyer, Powell, Qu, Wells, & Windle (2009).

Journal of Consulting and Clinical PsychologyJournal of Consulting and Clinical Psychology..

School selection: 57 schools from 5 public school systems Range of urban and suburban schools in Alabama Random assignment by counselor to:

– Basic Training (CP-BT; 19 schools)– Intensive Training (CP-IT; 19 schools)– Care-as-usual comparison (C; 19 schools)

Field Trial MethodsField Trial MethodsParticipant selection: Teacher screening for “at-risk” youth

– Rated proactive and reactive aggressive behavior of all 3rd grade students

(Hill et al., 2004; Lochman & CPPRG, 1995)

– 3,774 3rd graders screened– 30% most aggressive eligible for participation– 531 participating students (79% of 670 contacted):

183 CP-BT schools; 168 in CP-IT; 180 in C 84% Af Am; 14% Cauc; 2% Other 95% retention at post-intervention (2 yrs after baseline)

Field Trial MethodsField Trial MethodsCounselor characteristics:49 counselors

– 17 in CP-BT, 15 in CP-IT, 17 in C– 8 counselors served 2 of the participating schools

96% Female, 4% Male51% Af Am, 49% Caucasian18% Doctoral level, 80% Master level, 2% BAYears experience:

– 9.9 in CP-BT, 11.9 in CP-IT, 8.8 in C

Field Trial MethodsField Trial MethodsCounselor characteristics (cont.): 80% indicated prior experience leading child groups

– Group counseling time was a requirement for guidance counselors

28% reported using some type of manualized group intervention – No specific program in widespread use

Field Trial MethodsField Trial Methods

Timeline:

3rd Grade 4th Grade 5th Grade

Child screening

Baseline

Assessment

Counselors Trained

Intervention underway

Midpoint Assessment

Intervention Continues

Post-Assessment

Field Trial MethodsField Trial MethodsTraining process:

(1) 3 days of workshop training(2) Monthly meetings (2 hours) while intervention underway

For CP-IT counselors only:For CP-IT counselors only:(3) Individualized feedback on audiotaped sessions(4) Technical assistance from trainers via telephone and email contacts

Results: Program Implementation - Results: Program Implementation - DeliveryDelivery

0

0.5

1

1.5

2

Mean ChildObjective

Completion

Mean ParentObjective

Completion

CP-BasicTrainingCP-IntensiveTraining

Not at all

Partially

Completely

Results: Program ImplementationResults: Program Implementation

Implementation Quality– Counselor engagement (audio coder ratings, with

children and with parents; 5-point ratings on 14 items on warm tone, tone not irritable, makes teaching moments, provides consequences for group rules, stops to clarify material; elaborates beyond manualized material, stimulates discussion, etc) – alpha: .86 (w/ children), .82 (w/ parents)

Results: Results: Implementation QualityImplementation Quality

1

2

3

4

5

Positive ChildGroup Leadership

Positive ParentGroup Leadership

CP-BasicTrainingCP-IntensiveTraining

p<.02

Results: Results: TrainingTraining OutcomesOutcomes

Outcomes:HLM used to evaluate if intervention condition/training

intensity influenced: -Children’s externalizing behavior problems -Child and parent mediating processes

Two-level model with:-Level 1 Students (within-unit model)

-Level 2 Counselors (between-unit model)

Results: Results: Training OutcomesTraining OutcomesTwo-level HLM model:

-Level 1 within-unit model in equation form as:

TRT1 and TRT2 are the two orthogonal contrasts, and X is baseline score.

Contrast TRT1 compares CP-IT vs Control. Contrast TRT2 compares CP-BT vs Control.

-Level 2 between-unit model in equation form as:

The Wald test compares CP-IT vs CP-BT.

Results: Training OutcomesResults: Training Outcomes CP-Intensive

vs Control

Estimate (SE)

Behavior Problems

BASC Externalizing (teacher-report)

-.41* (.11)

BASC Externalizing (parent-report)

-.23*(.12)

NYS Minor Assault (child-report)

-.25** (.12)

**p<.01, *p<.05,

CP-Intensive vs Control

Estimate (SE) Behavior Problems


-.41* (.11)


-.23*(.12)


-.25** (.12)

Targeted Processes

BASC Social/Academic (teacher)

.35* (.13)

BASC Social (parent) Outcome Expectations

(child)-.24* (.08)

APQ Inconsistent Discipline (parent)

**p<.01, *p<.05,


Estimate (SE)

CP-Basic vs Control:

Estimate (SE)

Behavior Problems


-.41* (.11)


-.23*(.12)


-.25** (.12)

Targeted Processes


.35* (.13) .24+ (.13)

BASC Social (parent)

Outcome Expectations (child)

-.24* (.08)


**p<.01, *p<.05, +p=.06


Estimate (SE)

CP-Basic vs Control:

Estimate (SE)

CP Intensive vs CP-Basic

Chi Square (DF)

Behavior Problems


-.41* (.11) 3.87 (1)*


-.23*(.12)


-.25** (.12) 6.23 (1)*

Targeted Processes


.35* (.13) .24+ (.13)

BASC Social (parent)

Outcome Expectations (child)

-.24* (.08) 5.64 (1)*


**p<.01, *p<.05, +p=.06

Conclusions/Implications for TrainingConclusions/Implications for Training Evidence-based prevention programs such as Coping Power

can be disseminated effectively to counselors in real-world settings, although:

The intensity of training makes a difference in whether improvements in children’s outcomes and mediating processes occur

Ongoing supervisory feedback about program implementation (particularly to foster client engagement) may be critical to promoting positive outcomes

The intensity of training required will likely vary according to the experience and prior training of the providers, to the type of psychopathology being addressed, and to the complexity of the program being used

The Effect of The Effect of School and Counselor School and Counselor CharacteristicsCharacteristics on Implementation of a on Implementation of a

Preventive InterventionPreventive Intervention

Lochman, Powell, Boxmeyer, Qu, Wells, & Windle. (in press). Lochman, Powell, Boxmeyer, Qu, Wells, & Windle. (in press).

Professional Psychology: Research and PracticeProfessional Psychology: Research and Practice

Systems Effects on Dissemination of Systems Effects on Dissemination of InterventionsInterventions

New interventions may need organizational support to be adequately implemented

Field Trial: Sample and DesignField Trial: Sample and Design

The two training conditions, with 32 counselors, were pooled for these analyses

Field Trial: Implementation AnalysesField Trial: Implementation Analyses

The predictors of implementation:

1. school environment (Moos’ Work Environment Scale; Moos, 1981) – completed by all 4th and 5th grade teachers

- staff relationships (staff cohesion and support)

- staff autonomy

- degree of managerial control

Field Trial: Implementation AnalysesField Trial: Implementation Analyses

2. counselor characteristics

- neuroticism (NEO Five Factor Inventory; Costa & McCrae, 1992)

- extraversion (NEO)

- openness (NEO)

- agreeableness (NEO)

- conscientiousness (NEO)

- cynicism (Cynicism about Organizational Change; Reichers et al, 1997)

Field Trial: Post AnalysesField Trial: Post Analyses

Implementation dependent variables are:1. Program Delivery– Objectives completed– Sessions scheduled

2. Implementation Quality– Counselor engagement (audio coder ratings, with children and with

parents)

Hierarchical Regression Analyses Beta Hierarchical Regression Analyses Beta Coefficients Coefficients (Standard Errors):(Standard Errors):

Program DeliveryProgram Delivery*p<.05, +p<.10*p<.05, +p<.10

Objectives Completed

Sessions Scheduled

Agreeableness .086* (.042) .185+ (.103)

Managerial Control -.286+ (.149)

Hierarchical Regression Analyses Beta Hierarchical Regression Analyses Beta Coefficients Coefficients (Standard Errors):(Standard Errors):

Counselor EngagementCounselor Engagement**p<.01, *p<.05**p<.01, *p<.05

With Children

With Parents

Conscientiousness .068* (.032)

Agreeableness .112** (.039)

Managerial Control X Cynicism -.734** (.200)

Autonomy X Cynicism .674** (.173)

Autonomy X Autonomy X CynicismCynicism

-1

-0.5

0

0.5

1

1.5

2

Low Autonomy High Autonomy

En

gage

men

t w

ith

Ch

ildre

n

Cynicism No

Cynicism Yes

Conclusions About Counselor and Conclusions About Counselor and School CharacteristicsSchool Characteristics

The GOOD NEWS: It is ok to be neurotic, not particularly open-minded, not particularly extraverted, and cynical if you are in the right work environment

Degree and quality of implementation can be influenced by agreeableness and conscientiousness of counselors and by characteristics of the school setting which interact with counselor characteristics (counselor cynicism in interaction with school autonomy and rigid managerial control)

taking evidence based programmes to the real world: the american experience and lessons for tallaght...

Documents