Sasser, Tyler

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					                                     Sasser, Tyler
     Development of a Measure for Child Psychotherapy Process and
                         Outcome Research
             Faculty Mentor: 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.

Beutler, L. E., Malik, M., Talebi, H., Fleming, J., & Moleiro, C. (2004). Use of Psychological
      Tests/Instruments for Treatment Planning. In M.E. Maruish (Eds.), The use of psychological testing
      for treatment planning and outcomes assessment (111-145). Mahwah, N.J.: Lawrence Erlbaum
Durlak, J. A., Wells, A. M., Cotton, K. J., & Johnson, S. (1995). Analysis of selected methodological issues in
      child psychotherapy research. Journal of Clinical Child Psychology, 24, 141-148.
Huang, L., Stroul, B., Friedman, R., Mrazek , P., Friesen, B., Pires, S., & Mayberg, S. (2005). Transforming
      Mental Health Care for Children and Their Families. American Psychologist, 60(6), 615-627.
Kazdin, A. E. (2003). Psychotherapy for Children and Adolescents. Annual Review of Psychology, 54, 253-
Kazdin, A. E. (1995). Child, parent, and family dysfunction as predictors of outcome in cognitive-behavioural
      treatment of antisocial children. Behaviour Research and Therapy, 33(3), 271-281.
Kazdin, A. E. (1995). Scope of Child and Adolescent Psychotherapy Research: Limited Sampling of
      Dysfunctions, Treatments, and Client Characteristics. Journal of Clinical Child Psychology, 24(2), 125-
Kazdin, A. E., Bass, D., Ayers, W.A., & Rodgers, A. (1990). Empirical and Clinical Focus of Child and
      Adolescent Psychotherapy Research. Journal of Consulting and Clinical Psychology, 58(6), 729-740.
Kazdin, A. E. & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy:
      methodological issues and research recommendations. Journal of Child Psychology and Psychiatry,
      44(8), 1116-1129.
Ringel, J. S. & Sturm, R. (2001). National Estimates of Mental Health Utilization and Expenditures for
      Children in 1998. Journal of Behavioral Health Services & Research, 28(3), 319-333.