Collaborative Problem Solving reduces children's emotional and behavioral difficulties and parenting stress: Two key mechanisms.

OBJECTIVES: This study aimed to evaluate the effectiveness of the Collaborative Problem Solving (CPS) approach in home-based family therapy and to explore two hypothesized mechanisms of change. METHOD: Sixty-seven families with children aged 3-12 years old completed a 12-week home-based CPS treatment program. Parent-report measures were completed pre- and post-intervention, including measures on parents' fidelity of using CPS, parents' empathy, children's executive functioning, children's behavioral difficulties, and parenting stress. RESULTS: There were significant reductions in children's behavioral difficulties and parenting stress, and significant improvements in children's executive functioning and parents' empathy. These improvements were greatest for parents who had the greatest fidelity to CPS. Improvements in children's executive functioning and parents' empathy mediated the relationship between parents' CPS fidelity and outcomes. CONCLUSIONS: These results provide evidence that home-based family treatment with CPS may achieve positive child and family outcomes by building children's executive function skills and improving parents' empathy.

An open trial of Collaborative Problem Solving in a naturalistic outpatient setting.

Collaborative Problem Solving (CPS) is an intervention for reducing children's challenging behaviors. The aim of the present study was to evaluate the effects of family therapy using CPS in an outpatient clinic that specializes in treating children with challenging behaviors. One hundred and twenty families presented for treatment. Diagnoses at intake were varied, and 100 children (83%) had symptoms that were in the clinical range at intake. Parents reported significant change in their understanding of challenging behavior and prediction of children's behavioral symptoms 3 months into treatment. Furthermore, children's improvement was predicted by their parents' increased understanding that cognitive skill deficits are responsible for challenging behavior. These results suggest that using CPS in community-based, outpatient family treatment is effective for helping children who exhibit a range of clinical symptoms. Results provide insights for clinical practice and research on CPS.

Pragmatic fidelity measurement in youth service settings.

Background: Fidelity measurement is critical for developing, evaluating, and implementing evidence-based treatments (EBTs). However, traditional fidelity measurement tools are often not feasible for community-based settings. We developed a short fidelity rating form for the Collaborative Problem Solving (CPS) approach from an existing manualized coding system that requires extensive training. We examined the reliability and accuracy of this short form when completed by trained observers, untrained observers, and self-reporting providers to evaluate multiple options for reducing barriers to fidelity measurement in community-based settings. Methods: Community-based treatment providers submitted recordings of youth service sessions in which they did, or did not, use CPS. For 60 recordings, we compared short-form fidelity ratings assigned by trained observers and untrained observers to those provided by trained observers on the manualized coding system. For 141 recordings, we compared providers' self-reported fidelity on the short form to ratings provided by trained observers on the manualized coding system and examined providers' accuracy as a function of their global fidelity. Results & Conclusions: The short form was reliable and accurate for trained observers. An assigned global integrity score and a calculated average of component scores on the short form, but not component scores themselves, were reliable and accurate for observers who had CPS expertise but no specific training on rating CPS fidelity. When providers self-reported fidelity on the short form, their global integrity score was a reliable estimate of their CPS integrity; however, providers with better CPS fidelity were most accurate in their self-reports. We discuss the costs and benefits of these more pragmatic fidelity measurement options in community-based settings.

Developing brief, easy-to-use, and reliable tools to measure how well providers deliver evidence-based treatments (EBTs) in community clinical settings is critical to ensure the benefits of EBTs. However, reliable tools are often too time-consuming and not feasible to use in community settings because they require independent observers to receive intensive training on a coding system and to observe live or recorded treatment sessions for reliable and accurate evaluation. This paper describes steps we took to develop a more practical measure of how well providers deliver one EBT, Collaborative Problem Solving (CPS), based on a previously validated measure, to explore whether the quality of the measure can be maintained while reducing the need for training independent observers and the need for recording treatment sessions. This work contributes to the growing efforts of developing more pragmatic fidelity measures and introduces a new tool, the CPS Practice Integrity Form (CPS-PIF), as a promising measure for community-based clinical settings using CPS.