T h e M e n n i ng e r C l i n i c
Adolescent Treatment Program Research
V o l u m e 1 , I ss u e 3
S e p t em b e r 20 1 1
R ESEARCH N EWS
TANGIBLE INCENTIVES INCREASE
F O L L O W - U P P A R T I C I PA T I O N
CARLA SHARP, PHD &CRYSTAL CARBONE, BS
INSIDE THIS ISSUE:
Tangible Incentives and
Follow-up Participation
1
A New Measure of
Social Cognition for
Adolescents
1
Comparing Parent and
Self Reports in Assessing
Adolescent Disorders
2
Comparison of Screening
Instruments for Youths
3
Assessment of BPD in
Inpatient Adolescents
3
Welcome New ATP
Research Team Members
4
Retaining participation in longitudinal studies can be challenging (Henderson, Weight,
Nixon, & Hart, 2010), especially when the sample consists of adolescent inpatients. There is a
lack of research examining retention methods
to encourage continued participation in treatment outcome studies with adolescents. As a
result, the current study seeks to address these
challenges by examining various strategies
implemented to maintain the rate of adolescent and parent participation at discharge from
the Adolescent Treatment Program, as part of
the ongoing outcomes based research protocol
at The Menninger Clinic.
A total of 194 families were approached to
participate in the outcomes study, with 16 families declining participation, and 92% of families
consenting for research participation. For this
paper, the participating families have been
assigned to three groups: Cohort 1 included 34
families who were frequently contacted via email
and phone to offer time point reminders with no
direct incentive from 04/2009 – 11/2009; Cohort
2 included 58 families that received the option to
complete online-based assessments in the place
of paper-based assessments, and these families
included youth who received a gift card for completion of each follow time point from 11/2009 –
07/2010; and Cohort 3 currently includes 46
families that received a goodie bag at the discharge time point from 07/2010 to current (in
addition to the above mentioned incentives).
Results demonstrated that introduction of
paper-based assessments, on-line assessments
and gifts cards did not increase retention rates for
youth. However, introduction of goodie bags at the
discharge time point significantly increased follow
up rates for both youth and parents. Additionally,
while the introduction of web-based assessments
and gift cards did not increase retention rates at
youth, these incentives did increase the retention
rate for parents at the discharge time point. This
finding demonstrates the utility of all incentive
strategies in retaining parental participation and
decreasing youth attrition at discharge. Of particular interest is the notion that goodie bags may
present a tangible reminder of the continued relationship with the treatment facility. Findings from
this study will be presented at the 45th Annual
Convention of the Association for Behavioral and
Cognitive Therapies in Toronto, Canada.
A N EWLY A DA P T E D M E A S U R E O F S O C IA L
COGNITION FOR ADOLESCENTS
BY CAROLYN HA, BS
Is it Ɵme to
complete your
surveys? Check us
out on the web!
h ps://outcomes.menninger.edu Adolescence is a time of great change where
social interaction from peers and others play an
important role in influencing self-development.
More importantly, for adolescents seeking
treatment for mental health problems, the ability to build and maintain a relationship with the
therapist plays an integral role in positive treatment outcomes. One factor underlying this
ability is the social-cognitive capacity of the
patient.
Research has demonstrated a link between
early experiences in childhood along with the
formation of attachment styles and socialcognitive abilities in typical development. The
model theorizes that secure attachment is the
basis from which social-cognitive capacities develop. According to Dr. Fonagy's model, socialcognitive capacity involves the individual’s ability
to understand or reflect on the context of, or the
causes of, self and others’ thoughts and feelings.
This ability is referred to as reflective function,
and has been shown to play an important role in
positive treatment response in adults. (Continued
on Page 2.)
Page 2
Is it Ɵme to
complete your
surveys? Check us
out on the web!
C O M PA R I N G P A R E N T A N D S E L F R E P O R T S
IN ASSESSING ADOLESCENT DISORDERS
BY CRAIG WHITE, BS
The Child Behavior Checklist
(CBCL) and Youth Self Report
(YSR) are two commonly used
tests that assess psychopathology in adolescents. They are
completed by parents and their
children, respectively, upon
admission to The Menninger
Clinic’s ATP, assisting Clinic
staff in creating individualized
treatment plans for clients,
based on their most significant
mental health care needs.
While the CBCL and YSR are
well-validated from previous
research, their original scoring
scales did not coincide with
DSM-IV classifications, which
are the standards of diagnoses
for all mental disorders. To
address this issue, six DSMoriented scales were
developed, though
little research has
been performed to
validate the usefulness of these new
scales.
Thus, we
sought to determine
the appropriateness of
the standardized cutoff scores for the CBCL
and YSR DSM-Oriented
scales in predicting
diagnoses of adolescent disorders, using
the
Computerized
Diagnostic Interview
Schedule for Children: Youth
Version (CDISC-Y), a structured
interview of symptomology in
adolescents, as the gold standard of comparison for identifying client externalizing and
internalizing problems.
Using Receiver Operating
Characteristic (ROC) analysis,
which yielded a statistic of
predictive value for the new
CBCL and YSR scales against
the criteria of positive diagnosis via the CDISC-Y, we determined the accuracy of correctly
diagnosing the presence or
absence of a disorder in a sample of Menninger ATP patients.
We also examined the predictive power of a range of potential diagnostic cut-off scores for
the new scales. We found the
CBCL to be fair, and the YSR to
be fair to excellent, in predicting
DSM diagnoses, suggesting that
both measures adequately discriminate cases of disorders,
particularly the YSR. We also
discovered lower appropriate
cut-off scores for identifying
disorders in adolescent inpatients. We believe these results
will be useful for future clinical
application of the DSM-Oriented
CBCL and YSR scales in diagnosing adolescent patients.
Results from this study was
presented at the Association for
Behavioral and Cognitive Therapies in San Francisco, CA.
Source of the Curve
—
YSR Conduct
Problems T-score
— CBCL Conduct
Problems T-score
Sensitivity
h ps://outcomes.menninger.edu V o l u m e 1 , I ss u e 3
— Reference Line
1 - Specificity
SOCIAL-COGNITIVE MEASURE CONTINUED...
“...an important
part of the
foundation of any
therapeutic
relationship is
social cognition...”
It is currently unknown whether reflective function is important in affecting change in
adolescent treatment because
few social-cognitive measures
have been developed for this
age range. The major disadvantages to existing measures
for adolescents include costly
administration and coding time.
In the current study, we
adapted a self-report measure
of reflective function for use in
adolescents called the Reflective Function Questionnaire for
Youth (RFQY) from an existing
version developed by Fonagy
and colleagues for use in
adults. We looked at the relationships between the newly
adapted measure and existing
social cognitive measures.
Initial analyses revealed that
the RFQY does relate to existing social cognitive measures.
These initial findings support
the use of the newly adapted
self-report questionnaire of
social cognition in adolescents.
Given that an important
part of the foundation of any
therapeutic relationship is
social cognition, it is essential
to assess these capacities effectively in adolescence. Our
findings will help to improve
upon the scarcity of quick and
cost-effective social-cognitive
assessments for adolescents
and further establish the link
between social-cognition and
psychopathology, which will
help to inform development of
future therapies and interventions for adolescents. Findings
from this study have been accepted to the 45th Annual Convention of the Association for
Behavioral and Cognitive Therapies in Toronto, Canada.
R e s e a r c h N ew s
Page 3
ASSESSING BORDERLINE PERSONALITY
D I S O R D E R I N I N PA T I E N T A D O L E S C E N T S
BY CAROLYN HA, BS
Borderline Personality Disorder (BPD) can be a challenging
disorder marked by intense
and unstable interpersonal
relationships, difficulties in
emotion regulation, and increased impulsivity. Research
has demonstrated that children and adolescents diagnosed with Borderline Personality Disorder (BPD) face more
clinical challenges in comparison to other personality disor-
ders. Therefore, it is important to adequately measure these symptoms as they
emerge in childhood so that
interventions may take place
to change the developmental
trajectory. The Childhood
Interview for Borderline Personality Disorder (CI-BPD) is a
semi-structured interview that
was developed specifically for
use with youth populations.
Our findings from a sample
of inpatients ages 12
to 17 at The Menninger Clinic, Adolescent Treatment Program, demonstrated
support for the use of
the CIBPD in diagnosing adolescents with
BPD. In fact, there
was a significant relationship with other
measures of BPD and independent clinician diagnosis.
Adolescents with BPD had significantly higher severity and
over-representation of Axis I
disorders, and had significantly
more self-harm compared to
other psychiatric patients without the BPD diagnosis. Our
findings demonstrate that the
CIBPD is a valid measure for
use in adolescent inpatient
settings. Adequate measurements are essential to identifying the disorder in children and
adolescents so that interventions may be provided early on
before these traits become
difficult to treat in adulthood.
Findings from this study will
be presented at the annual
convention of the Texas Psychological Association in San
Antonio, Texas.
C O M PA R I N G S C R E E N I N G I N S T R U M E N T S
FOR ADOLESCENTS
How to deal
with Bullying
•
•
•
•
•
•
•
BY STEPHANIE KOVACS, PHD
Adolescence is a critical
time in which early detection of
mental illness can change the
course of a child’s future and
improve quality of life into
adulthood. This is especially
true for teens receiving inpatient hospital services. Clinicians at The Menninger Clinic
recognize the importance of
completing treatment as quickly as possible so that teens can
return home and get back to
living full and happy lives. This
means that researchers must
work harder to streamline the
assessment process so that
treatment can be as efficient
as possible.
While longer assessment
instruments provide richer
details about a patient, they do
so at extensive time, energy,
and financial resources. Some
assessment questionnaires
can last for several hours,
which can be frustrating for
both parents and youth. Stress
levels are high enough when
a teen has entered the hospital, so it is important to find
instruments that can yield
the same information in less
time.
Good instruments do not
always have to be long, as
the present study showed.
Three screening instruments
of different lengths were examined in their ability to detect thirteen common emotional and behavioral disorders. The instruments were
the Strength and Difficulties
Questionnaire (SDQ), the
Child Behavior Checklist
(CBCL), and the Youth Self
Report (YSR). Data from 161
adolescents and their parents were examined from the
Adolescent Treatment Program (ATP), and scores of the
three measures were compared against actual diagnoses of the teens. Results
indicated that the SDQ func-
tioned nearly as well as the
CBCL and YSR in flagging adolescents for possible mental
illness. This was surprising
given that the SDQ was the
shortest of all the instruments,
at only 25 questions compared
to several hundred.
The SDQ seems to provide
useful information quickly and
easily, making it an efficient
screener for time-sensitive,
stressful situations. Additional
research is necessary with larger samples, but this study
opened an important gateway
to better streamline the assessment process so that time can
be better spent evaluating and
treating the specific problem
areas.
Tell them to stop
Walk away
Protect yourself
Tell an adult you trust
Find a safe place
Stick together
Find opportunities to
make new friends
Remember:
Your feelings are important!!
• Do not blame yourself
•
•
Be proud of who you are
Do not be afraid to ask
for help
Source:
www.stopbullying.gov
WELCOME TO NEW RESEARCH STAFF!!
CLINICAL PSYCHOLOGY INTERN:
RACHAEL WHITE
T h e M e n n i n g e r C li n i c
ATP Research
2801 Gessner Road
Houston, TX 77080
Phone: 713-275-5451
E-mail: outcomes@menninger.edu
We’re on the web! Greetings. My name is Rachel White and I am the Psychology Intern
on the ATP unit. My role within the ATP Research Team is to assist in
research activities such as idea development, data analysis, and manuscript publication. In particular, I hope to understand how attachment
is transmitted across generations and into peer relationships. On the
ATP unit, I am responsible for psychological testing, individual therapy, and group facilitation.
I pursued my doctorate at the University of Central Florida in Orlando before moving to Houston
to work at The Menninger Clinic. I look forward to graduating next summer following the completion
of my internship. I have been working with children and families for six years in the areas of assessment and treatment. My passion for research with adolescents began prior to graduate school and
I have developed a programmatic line of research examining adolescent adjustment from an ecological perspective. In addition to my primary research, I have participated in projects examining
attachment, the effects of parental mood on their ratings of children’s behavior, and Attention Deficit/Hyperactivity Disorder. Outside of my career, I enjoy spending time with my miniature schnauzers, cooking, and exploring Houston. I look forward to being part of the ATP Research Team and
working with all of the wonderful families at The Clinic.
h ps://outcomes.menninger.edu CLINICAL PRACTICUM STUDENT:
RADHIKA REDDY
Our Collaborators:
The University of Houston
Baylor College of Medicine
Hello, everyone. Although only a few weeks on the job, I can already
sense the warmth and community atmosphere at the Adolescent Treatment Program unit at The Menninger Clinic, and am thrilled to be a part of
this group. As this year’s clinical practicum student, I am excited to work
with all of you and hope to make an impact. In my role, I will primarily be
conducting interviews and co-leading groups. I hope my passion and diverse experiences will make
these even more enjoyable and beneficial. Additionally, I will be contributing to the exciting and
developing research base that will ultimately benefit patients at Menninger.
To tell you a little about myself, I am a third-year student in the clinical psychology PhD program
at the University of Houston. Much of my past research has focused on anxiety and cross-cultural
mental health issues. I moved from California just a few years ago but am finding Houston to be
growing on me more each day. I would love to meet and learn more about all of you so please feel
free to drop a line or arrange a chat. I feel honored to work with some of the most amazing researchers and clinicians in the field, as well as such a great batch of adolescents.
RESEARCH COORDINATOR I:
ANDREW SCHRAMM
Editor: Carolyn Ha
Clinical Psychology Doctoral Student
University of Houston
Developmental Psychopathology Lab
Project Leader: ATP Research
Email: cha@menninger.edu
Phone: 713-275-5451
As a new member of the Adolescent Treatment Program’s research team, I have the pleasure of witnessing first-hand the unprecedented care that is provided by the staff of The Menninger Clinic and
the comprehensive research program that complements it. This symbiotic relationship results in the collection of important data, which
allows scholars to answer questions about the adolescents we care for. Believe it or not, there are
many clinical and scientific questions that exist in this discipline. Thus, obtaining this information,
making conclusions, and sharing those conclusions with scholars throughout the nation ultimately
results in better care for adolescents like your own.
Thank you for being a part of this effort by agreeing to participate and by taking the time to complete the surveys we send you at each follow-up time point. Your time and effort is truly a service to
adolescents and their families throughout the country who will benefit from the improved conceptualization of problems adolescents experience and the enhanced care provided as a result. Thanks,
also, for welcoming me aboard.
I spent the last two years here in Houston as an elementary school teacher, a meaningful diversion from my longstanding interest in clinical psychology. I’m excited to work with youth in this specialized setting in which I witness immense personal growth regularly. I look forward to speaking
with many of you soon as we call to touch base with you about your follow-up assessments!