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.

Collaborative Problem Solving (CPS) is a widely disseminated, neurobiologically based, trauma-sensitive treatment for children’s challenging behavior. Measuring treatment integrity is critical to support implementation and continued research on the approach. This article presents the development and psychometric evaluation of an observational system, the CPS Manualized Expert-Rated Integrity Coding System (CPS-MEtRICS), for measuring CPS treatment integrity. Audio recordings of in-home treatment sessions (159 CPS and 82 treatment-as-usual) were independently rated by pairs of seven trained coders for integrity and the affective aspect of client–provider relationship. Results showed satisfactory interrater reliability (intraclass correlations [ICCs] 0.64–0.86). Additionally, the integrity scores on the CPS-MEtRICS discriminated between providers delivering CPS and treatment-as-usual, while these two groups did not differ in general client–provider affective bond, supporting the construct and discriminant validity of ratings using the system. This study provided evidence for the reliability of the CPS-MEtRICS and the validity of its integrity ratings, which can be used for research on CPS and which will provide the foundation for other CPS integrity measurement tools useful in practice settings. This article also provides a model that can be used when developing integrity measurement systems for other therapeutic approaches.

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. K E Y W O R D SCollaborative Problem Solving, emotional and behavioral problems, empathy, executive functioning, parent stress 1 | INTRODUCTION Collaborative Problem Solving (CPS) is an approach for understanding and reducing emotional and behavioral difficulties among children and adolescents, and is frequently applied in family therapy to reduce parenting stress and family dysfunction. The philosophy of the CPS approach is that difficulties such as oppositionality, defiance, aggression, avoidance, and withdrawal are caused by the mismatch between an individual's neurocognitive skills and the skills needed to handle a demand (Greene, 1998;Greene & Ablon, 2005). The neurocognitive skills needed may be in executive functioning (including working memory, attention, emotion regulation, and cognitive flexibility), or in nonexecutive areas such as language/communication or social thinking.The practice of CPS includes two main phases: assessment and intervention. Specific activities within these two phases can be completed by any adult caregiver, including a parent, teacher, or mental health provider. In the assessment phase of the CPS approach, an adult caregiver identifies a target youth's lagging skills, and creates a list of expectations and triggers that are difficult for the youth to handle. These expectations and triggers comprise a list of "problems to solve" in the intervention phase of the approach. During the intervention phase, the youth and adult solve those problems collaboratively, at times also adjusting demands to match the skill level of the youth (Ablon, 2019).The CPS approach has been applied in a number of outpatient, inpatient, and school settings across North America with documented benefits (for a review of outcomes across settings, see Pollastri, Epstein, Heath, & Ablon, 2013).Evaluations of CPS in outpatient settings have found that CPS is effective fo...