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Research and Health Utilization Research and Health Utilization Around Conduct ProblemsAround Conduct Problems
Scott T. Ronis, Ph.D.
Department of Psychology
University of New Brunswick
________________________________________
Background to Disruptive Behaviour Problems
• Behaviours that violate the rights of others or that bring someone into conflict with societal norms
• Involves difficulties in emotional and behavioural regulation
• Several psychiatric disorders (based on DSM-5 and ICD-10) represent a range of disruptive behaviour problems
– Intermittent Explosive Disorder– Oppositional Defiant Disorder– Conduct Disorder– Substance Use Disorders
Complexities in Identifying Behaviour Problems
• High comorbidity
• Unspecified or undiagnosed mental health problems may include behaviour problems
• In practice, diagnoses lack developmental context
• Time spent on defining problems do not necessarily equate to knowledge of handling problems
Ecological Models
Society/Culture Neighborhood
SchoolPeers
Child
Family
Correlates of Youth with Behaviour Problems
Research suggests that multiple risk factors are linked with serious behaviour problems in youth:
• Individual factors (e.g., externalizing and internalizing problems, difficulties with emotion regulation, intellectual deficits, neurobiological factors)
• Family factors (e.g., low warmth, high conflict, low monitoring, harsh or inconsistent parenting, large family size, instability)
• Parental problems (e.g., spousal violence, substance abuse, history of mental health problems, parental criminality)
• Peer relations (e.g., social isolation, immaturity, association with delinquent peers)
• Academic performance (e.g., low achievement, behavior problems, learning disabilities)
• Neighborhood factors (e.g., exposure to violence, limited resources)
• Cultural factors (e.g., norms for disruptive behaviour)
Defining Empirically-Based Practices (EBPs)
EBP movement in general began over 60 years ago
Child/youth psychotherapy research followed
There have been advances in distinguishing programs that work from those that do not work or do not have adequate support
Dealing with the real world: Moving from efficacy to effectiveness
EBP Resources
American Psychological Association’s Division 53: www.effectivechildtherapy.com
Coalition for Evidence-Based Policy: www.toptierevidence.org
Blueprints for Healthy Youth Development: www.blueprintsprograms.com
SAMHSA: www.nrepp.samhsa.gov
OJJDP: www.ojjdp.gov/mpg
Office of Justice Programs: www.crimesolutions.gov
National Child Traumatic Stress Network: www.nctsn.org/resources/topics/treatments-that-work/promising-practices
Continuum of Care
Universal Prevention
Secondary Intervention (Selective Prevention)
Tertiary Intervention
Model Universal Prevention EBPs
Programs Setting Costs Benefits Positive Impacts
LifeSkills Training School for early adolescence
$34 pp $1,290 pp* AOD use, Delinquency, Violence
Positive Action School for late childhood & early adolescence (& optional parenting classes)
~$400/class N/A AOD use, Academic problems, Delinquency, Internalizing problems, Violence
Project Towards No Drug Abuse
School for late adolescence
$14 pp $123 pp* AOD use, Violent victimization
Promoting Alternative Thinking Strategies
School for late childhood
$115 pp ($19) pp* Aggression, Conduct problems, Emotion regulation, Internalizing problems
*Washington State Institute for Public Policy
Model Secondary Intervention EBPsPrograms Setting Costs Benefits Positive Impacts
Functional Family Therapy
Families for early to late adolescence
$3,262 pp $70,370 pp* Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence
New Beginnings (Interventions for Children of Divorce)
Parent training (and optional parent-child groups) for late childhood to late adolescence
~$595/pp N/A AOD use, Aggressive behaviour, Internalizing & externalizing problems, Mental health, Relationships with parents
Nurse-Family Partnership
Parent training from pregnancy to 2 years of age
$9,600 pp $22,781 pp* AOD use, Child maltreatment, Delinquency, Employment, Mental health, Physical health & well-being
Project Towards No Drug Abuse
School for late adolescence
$14 pp $123 pp* AOD use, Violent victimization
*Washington State Institute for Public Policy
Model Tertiary Intervention EBPs
Programs Setting Costs Benefits Positive Impacts
Functional Family Therapy
Families for early to late adolescence
$3,262 pp $70,370 pp* Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence
Multidimensional Treatment Foster Care
School for late childhood & early adolescence (& optional parenting classes)
$7,922 pp $39,197 pp* Delinquency, Illicit drug use, Violence
Multisystemic Therapy
School for late adolescence
$7,370 pp $32,121 pp* Delinquency, Illicit drug use, Internalizing & externalizing problems, Relationship with parents, Sexual violence
*Washington State Institute for Public Policy
Journey Through Various Systems
• Historical context• Collaborative Model of Response
Action Plan for Mental Health in New Brunswick, 2011
Journey Through Various Systems
Looking Ahead at Utilization of Services in Atlantic Canada
• Addressing youth mental health needs is a moving target that needs continuous re-evaluation
• Identifying the needs of youth through administrative/survey data and qualitative interviews
• Who are the “providers”? What are they doing?
• Need to facilitate the use of effective interventions and services
• Need to keep an eye on costs and benefits as well as barriers/redundancy in services
There is no health without mental health (World Health Organization, 2010)