A Comparison of Two Treatments: Collaborative and Proactive Solutions and Parent Management Training for Disruptive Behaviours in Youth delivered in a Community-Based Setting.

Two active treatments are compared: Collaborative and Proactive Solutions (CPS) vs Parent Management Training (PMT) for the treatment of oppositional defiant disorder in youth. 160 youth, aged 7-14 years were randomised to one of the active conditions. Treatments were delivered face-to-face up to 16 x 1 hour sessions, once a week for 16 weeks. Treatment was delivered to individual families only. Both parent/s and child attended each session. Treatment was delivered in a urban community-based psychology clinic. Following treatment families were offered 5 monthly booster sessions by phone to consolidate sessions. In these booster sessions parents reported how they were progressing and troubleshot any behaviour problems. The therapist then advised how to use previously taught skills in these situations. Phone calls ranged from 2-15 minutes. Families were advised of the option to access boosters, but they were optional. Collaborative and Proactive Solutions is a cognitive behavioural model developed by Dr Ross Greene. The CPS model posits that challenging behaviours occur when a child's skills do not match the demands of the given situation eg., flexibility, transitioning, maintaining focus. CPS treatment focuses on helping parents identify their child’s lagging skills and reframe their perception of their child’s behavior using this conceptualization (Greene, 1998). From there, the parent(s) and young person identify current “unsolved problems” and are coached in steps to solve the problems collaboratively and proactively. CPS entails four treatment modules (a) psychoeducation and identification of unsolved problems, which explains the conceptualization of CPS and identifies the unsolved problems precipitating challenging behavior; (b) prioritizing unsolved problems based on their relationship to safety, gravity, or frequency; (c) learning about Plan A, B, and C and the concept that parents have a choice of how to respond to an unsolved problem; and (d) clinician modeling and coaching the use of Plan B to help parents and children solve problems together proactively. Plan A is parents responding to challenging behaviors in a unilateral manner. Plan B is parent and child collaborating to come up with a solution for the problem that preempts the challenging behaviour, and Plan C is putting aside expectations they have of the child to meet certain expectations. The CPS materials can be accessed via Dr Ross Greene. They can not be accessed from any other organisation. Supplementary handouts were provided at the majority of sessions. They were already created and not created specifically for this study. Handouts for PMT are available in Barkeley's Defiant Child Manual. Handouts for CPS are readily available at: https://livesinthebalance.org/our-solution/#our-solution-overview Treatment was delivered by experienced clinical psychologists (5 year plus experience) and graduate interns from a masters of Clinical Psychology program. Training for therapists in both CPS and PMT conditions consisted of a one-day workshop, reading the manuals, listening to audiotapes of the entire course of treatment for 3 previous clients (approximately 40 hours), and 1-2 hours of weekly clinical supervision (dosage was matched for PMT and CPS). Adherence to the allocated therapeutic model was assessed by having an independent rater, experienced in both therapies, code random audiotaped therapy sessions using the Session Content Analysis checklist (Ollendick et al., 2016). Independent raters, masked to the treatment being delivered, listened to an audio recording of a therapy session and then rated the presence or absence of treatment components on a 6-item scale. Each therapist also attended regular clinical supervision.