Outcome Studies with Longterm Followup Outcome Studies Followup

Outcome Studies with Long-term Follow-up § Outcome Studies § Follow-up Studies – Mc. Neil et al. , 1991 – Funderburk et al. , 1998 – Eisenstadt et al. , 1993 – Eyberg et al. , 2001 – EFFICACY STUDY – AUSTRALIAN STUDY Nixon et al. , 2003 – AUSTRALIAN STUDY – MAINTENANCESTUDY • Eyberg et al. , 1995 • Schuhmann et al. , 1998 • In progress • Boggs et al. submitted • Hood & Eyberg, 2003 • Nixon et al. , 2003 • In progress

First Long-term Follow-up Study of PCIT § 13 of 20 families participated § Followed 1 and 2 years after treatment § Demographic characteristics – – 100% boys 84% Caucasian Mean age = 4. 7 Median income = $15 K Eyberg, Funderburk, Hembree-Kigin, Mc. Neil, Querido, & Hood (2001) Child & Family Behavior Therapy

§ Effect Size Interpretations g. Small = . 20 -. 40 g. Medium =. 40 -. 60 g. Large =. 60 -. 80 g. Very large =. 80 - 1. 00 g. Astronomical = >1. 00

ECBI Intensity Scores and 2 -Year Effect Size 2. 32 Eyberg et al. , 2001

ECBI Problem Score and 2 -Year Effect Size 2. 47 Eyberg et al. , 2001

Werry-Weiss-Peters Activity Scale and 2 Year Effect Size 1. 39 Eyberg et al. , 2001

Parenting Stress Index Child Domain and 2 Year Effect Size 1. 71 Eyberg et al. , 2001

Parenting Stress Index Parent Domain and 2 Year Effect Size . 70 Eyberg et al. , 2001

DPICS Alpha Compliance and 2 Year Effect Size . 85 Eyberg et al. , 2001

DPICS Deviant Behavior Composite and 2 Year Effect Size . 54 Eyberg et al. , 2001

DPICS Description & Reflection and 2 Year Effect Size . 79 Eyberg et al. , 2001

DPICS Parent Verbal and Physical Negative 1. 11 Eyberg et al, 2001.

Therapy Attitude Inventory Eyberg et al. , 2001

Generalization of Treatment Effects to the School l l e h s t u n In a § Treated children improved more than untreated classroom controls on measures of conduct problems § Less evidence of treatment effect on measures of hyperactivity and social skills Mc. Neil et al. , 1991

SESBI Intensity Scale § Funderburk et al. , 1998

SESBI Problem Scale § Funderburk et al.

Revised Conners Subscales Funderburk et al. , 1998

SOCS Compliance Funderburk et al. , 1998

SOCS Appropriate Behavior Funderburk et al.

SOCS On-Task Behavior Funderburk et al.

Efficacy Study Results … ll e h s t u In a n § Treatment group showed significant improvements in child & parent functioning relative to waitlist controls (except DAS and BDI) § Treatment gains maintained at 4 -month follow-up § Predictors of dropout were maternal distress and observed maternal critical/sarcasm toward child

Boggs 1 - to 3 -Year Follow-up of Efficacy Study § 23 Dropouts § 23 Treatment completers • • 78% boys 74% Caucasian Mean age at pre-treatment = 4. 9 Mean Hollingshead Index = 35 Boggs, Eyberg, Edwards, Rayfield, Jacobs, & Bagner, in preparation

Dropouts Completers p <. 01 Boggs et al.

Dropouts Completers p <. 001 Boggs et al.

Dropouts Completers p <. 001 Boggs et al.

Dropouts Completers p <. 05 Boggs et al.

Dropouts Completers ns Boggs et al.

Follow-up of the Efficacy Study 4 to 6 Years After Treatment § 23 families (completers) – 70% boys – 83% Caucasian – Mean age at pre-treatment = 5. 0 – Mean Hollingshead Index = 40 Hood & Eyberg, 2003

Parenting Locus of Control and 4 -6 Year Effect Size 1. 29 Hood & Eyberg, 2003

ECBI Problem Scale and 4 -6 Year Effect Size 1. 40 Hood & Eyberg, 2003

ECBI Intensity Scale and 4 -6 Year Effect Size (6 children above the cutoff at longterm follow-up) 1. 43

The Maintenance Study § Goal – To prevent relapse for ALL children § Assumptions – Early conduct disorders are persistent and recurrent – Treatments that end as soon as the problems first remit may not consolidate gains sufficiently for all families – Timely boosters my prevent relapse

Design § Participants – Estimated 80 treatment completers § Randomize completers – Two-year Maintenance Treatment (MT) – Follow-up Assessments Only (AO) § Assessments – Six brief quarterly phone assessments – Two major yearly assessments

The Maintenance Treatment § Monthly phone calls provide – Support – Monitoring – Intervention § Monitoring checks on – child behavior problems – parent mood/stress – parent follow-through with PCIT

Three Levels of Intervention Level I (5 -15 minute call) – reinforce parent follow through – brief suggestions if indicated – show concern for parent well-being – encourage continued participation

Maintenance Interventions Level II (15 -60 minutes) – Level I components plus – Address identified problem • Empathic listening • Engage parent problem solving • Outline a plan to solve problem – Brief follow-up call 1 week later

Maintenance Interventions Level III (a clinic session) § When – Monitoring call indicates crisis – Level II problem has persisted – Parent calls and requests clinic session § Involves – Providing support – Problem solving – Observing parent-child interactions and coaching if indicated – Developing a plan

Maintenance Study 1 -1 -03 § 81 families enrolled so far § 22 families dropped out § 19 families currently in treatment § 40 families have completed treatment § 37 families have completed the post assessments èRandomly assigned to either maintenance treatment or control Eyberg & Boggs, 1999 -2004 NIMH RO 1 MH-60632

Families Randomized to Group So Far § Post-treatment – Maintenance Tx - 14 families – Assessment Only - 13 families § 6 -month follow-up – Maintenance Tx - 12 families – Assessment Only - 10 families Eyberg & Boggs 1 -1 -03

Maintenance Study Standard Treatment Results ll e h s t u n In a CBCL Externalizing Scale

ECBI Intensity Scale Eyberg & Boggs

ECBI Problem Scale Eyberg & Boggs

Beck Depression Inventory Eyberg & Boggs

PSI-SF Parental Distress

PSI-SF Parent-Child Dysfunctional Interaction Eyberg & Boggs

PSI-SF Difficult Child Eyberg & Boggs

Conclusions Immediate outcome g. All studies consistent g. Clinically meaningful changes g. Parent and family functioning g. Child behavior at home & school g. Parent-child interactions

Conclusions Long-term outcome g. Very little decline in first year g. Greater decline in second year g 25% back to baseline after fourth year g 75% maintain long-term gains n. Maintenance treatment aimed at the 25% n. May not see differences until 2 nd follow-up year