Tyler Sasser and Dr. Jared Warren, Assistant Professor Department of Psychology
The latest research has shown that 1 in 5 children meet criteria for a mental disorder and 1 in 10 children experience significant impairment in the family, school, and community due to a mental disorder (Huang et al., 2005). Unfortunately, only about one quarter of these children needing mental health services receive care (Ringel & Sturm, 2001). Although only a small portion of impaired children receive care, substantial progress has been made in developing effective treatments for this population. However, there are many unresolved issues surrounding child and adolescent psychotherapy.
One unresolved issue regards examining moderators (characteristics that influence the extent to which change may occur) and mediators (causes or mechanisms of change) of successful therapeutic change, or “answering why and how treatment works” with children and adolescents (Kazdin & Nock, 2003, p.1117). Thus, while many efforts have been made to examine treatment technique, or to discover if a given treatment is effective, little attention has focused on discovering specific mechanisms and child-, parent-, or family-related conditions or characteristics predictive of outcomes (Kazdin, 2003; Kazdin & Nock, 2003; Kazdin, Bass, Ayers, & Rodgers, 1990). Despite the calls for further attention on moderators and mediators in child and adolescent psychotherapy research, “[n]o detectable movement has been made toward rectifying these gaps” (Kazdin & Nock, 2003, p.264). A clearer understanding of moderators and mediators might allow clinicians to increase positive outcomes and reduce or even prevent negative outcomes by applying treatments to patients to which they are likely to respond.
Another issue requiring increased attention in child psychotherapy research regards the design and use of clinical support tools, or assessment measures intended for treatment planning (Beutler, Malik, Talebi, Fleming, & Moleiro, 2004). In a review of the use of measures in treatment planning, Beutler et al. (2004) stated that “[c]linicians require focused tools specific to the task of assessing relevant patient qualities to guide treatment decisions” (p. 134). Kazdin (1995a; 1995b) has called for instruments capable of assessing domains related to positive outcomes. Such a process would entail identifying specific mechanisms and child-, parent-, or family-related conditions or characteristics that moderate or mediate treatment outcomes and combining them into a composite treatment instrument. Another essential part of this process, which is often lacking, is to obtain a normative sample against which clinicians can compare patients’ progress in these domains (Durlak, Wells, Cotten, & Johnson, 1995; Kazdin, 1995a). An instrument assessing domains predictive of positive outcomes would allow clinicians to address the needs of individual patients in many ways.
As the next step in a line of programmatic research evaluating change processes in child psychotherapy, the purpose of this study is to establish normative base rates for a questionnaire, the Measure of Youth Moderators and Mediators (MYMM), evaluating several domains predictive of child psychotherapy outcomes such as parenting behaviors, parent stress, perceptions of social support, youth self-efficacy, and motivation for change. The questionnaire consists of empirically-derived items related to positive and negative treatment outcomes. Data from this project will be used to establish base rates to which data from actual clinical cases will later be compared. Ultimately, this questionnaire will be used to as a tool for treatment planning and to enhance the clinical decision-making of mental health professionals who work with children and adolescents. It is hypothesized that the measure developed in this study will reliably and validly assess moderators and mediators of successful treatment outcomes.
Since receiving funding to conduct this study, essential steps have been taken to commence data collection. Prior to conducting studies involving human subjects, permission must be granted by Brigham Young University’s Institutional Review Board (IRB). Therefore, my initial task was to complete the exhaustive “Human Subjects Research Application” detailing each aspect of our proposed study, including a description of our study rationale, subjects, recruitment procedures, study methods, the MYMM, and data analyses. As part of the application, we were required to provide consent and assent forms, recruitment scripts, and the MYMM. Because this study proposes to develop the MYMM and collect normative data for the measure, many hours were spent working with and analyzing previously-collected data in order to procure empirically-derived items for the measure. During research planning, I was given the opportunity to design the study and receive feedback from Dr. Warren and benefited greatly from his mentorship as we attended to each vital detail. Subsequent to submitting the IRB application, I also had the opportunity to receive feedback from the board, whereupon I addressed study details and resubmitted the application for approval. IRB approval has since been received and we are in the process of beginning participant recruitment and data collection.