Staff-Child Interaction Therapy versus Treatment as Usual in Community-Based Wraparound Services: An Evaluation of Feasibility and Child Behavior Problems.

摘要

Wraparound services are a well-known, widely implemented community-based model developed to treat children with a variety of severe emotional disturbances (Clark & Clarke, 1996). Although results have demonstrated some positive outcomes (Suter & Bruns, 2009), significant weaknesses have also been noted including negative findings (Bertram, Suter, Bruns & O'Rourke, 2011) and a variety of methodological limitations (Suter & Bruns, 2009). States have recently begun to examine the empirical basis of wraparound programs to better understand their implementation and effectiveness (Community Data Roundtable, 2015).;The current study examined the implementation of Staff-Child Interaction Therapy (SCIT), a manualized treatment developed at West Virginia University to treat children between ages 2-9 years with severe behavior problems. Based off of Parent-Child Interaction Therapy (PCIT; McNeil & Hembree-Kigin, 2010), an established, evidence-based practice for young children with disruptive behavior disorders, SCIT was implemented by bachelors-level, community-based wraparound therapists during in-home treatment sessions with their child clients and their primary caregivers. Therapists (SCIT: n = 41; TAU: n = 32) were primarily Caucasian (87.7%) females (84.9%) with 45.15 months of therapy experience. Child clients were primarily male (76.1%) with an average age of 5.44 years. Children were primarily diagnosed with an Autism Spectrum Disorder (n = 44), Attention Deficit Hyperactivity Disorder (n = 19), Disruptive Behavior Disorder Not Otherwise Specified (n = 18), Oppositional Defiant Disorder ( n = 16) Conduct Disorder (n = 3), Post Traumatic Stress Disorder (n = 2), Intellectual Disability ( n = 2), and another diagnosis (n = 18). Many children possessed multiple diagnoses.;SCIT staff were trained in a series of three workshops, spaced approximately seven weeks apart, in which the Child Directed Interaction (CDI; relationship building) and Adult Directed Interaction (ADI; discipline) phases of treatment were taught. Workshops included didactics, live role play, quizzes and practice toward mastery of CDI and ADI skills. Implementation of the treatment began following the second workshop. SCIT therapists received consultation calls throughout treatment to promote fidelity. Attention control therapists received three workshops and continued to implement treatment as usual with their clients. Attention control workshops included didactics and discussion of compassion fatigue, vicarious trauma, and workforce turn over. No SCIT skills were taught. Primary caregivers and therapists completed the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999) prior to, during, and following treatment. Qualitative information was gathered on therapists' perceptions of treatment as usual, workshop satisfaction, and SCIT following treatment.;Primary results indicated that parents believed that the intensity of children's behavior problems decreased significantly more for children in the SCIT condition as compared to children in the TAU condition following SCIT implementation (F (1, 33) = 5.135, p = .03). Similarly, a trend toward significance indicated that behavior problems decreased more for children in the SCIT condition as compared to children in the attention control TAU condition (F (1, 37) = 3.69, p = .06 from the therapist's perspective. Large effect sizes for children in the SCIT group were present according to parents and therapists as compared to small to medium effect sizes for children in the attention control group. Additionally, SCIT therapists (n = 19) delivered an average of 7.82 hours of SCIT and an average of 43.39 hours of TAU service to SCIT clients over the 7-week course of treatment. TAU therapists ( n = 32) spent an average of 9.42 hours per week with the client and delivered an average of 65.95 total hours of service over the 7-week course of treatment.;Feasibility analyses indicated that the materials needed for SCIT training would cost approximately ;Results indicated that SCIT may be a more effective, cost-effective intervention for children presenting to wraparound services with disruptive behaviors as compared to wraparound services as usual. Additionally, SCIT therapists demonstrated high rates of acceptability as compared to TAU as SCIT therapists reported a highly positive impact of the short-term intervention on children's behavior and therapist's skills.;Limitations of the current study included high levels of attrition, small sample size, a lack of complete randomization, and a variety of policy-level challenges. Additional research is needed to better understand the impact of SCIT as compared to treatment as usual on children in wraparound services. Further work should focus on improving the effectiveness of wraparound by increasing the quality of therapist training, integrating more components of evidence-based intervention into wraparound services, and decreasing therapist turn over.