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

Abstract

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...

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

“…These are key tenets of CPS, and parents’ learning and adherence to this philosophy have been hypothesized as mechanisms that drive the benefits of CPS; parents who learn these concepts may behave more consistently with CPS in their day-to-day interactions, thus extending the benefits of the treatment beyond therapy sessions. Prior evidence for this mechanism was found in intensive home-based treatment (Heath et al, 2020). The relationship between parents’ learning and outcomes in this study provide compelling additional support for this theory of change; further research will be critical to establish a causal relationship.…”

“…The CPS-AIM-P has 11 items and uses a 7-point Likert scale, ranging from “Strongly Agree” to “Strongly Disagree.” Items from two subscales were used in the current study to measure CPS learning targets, including Philosophy (the extent to which parents adhere to the CPS philosophy of “skill not will”) and Prediction (parents’ ability to predict when their child’s challenging behavior will occur). Scales showed good to excellent internal consistency (Cronbach’s alpha =0.77, 0.80, respectively), and a composite score combining these subscales can be used to represent parents’ overall understanding of CPS (e.g., Heath et al, 2020). Higher scores indicate more adherence to the CPS philosophy and greater ability to predict problems.…”

Development and evaluation of an audio coding system for assessing providers’ integrity to collaborative problem solving in youth-service settings.

“…Finally, in the intervention phase, the provider or caregiver engages the child in problem-solving conversations in a manner that not only finds solutions for those specific problems that address both the child’s and adult’s concerns but also improves the adult–child relationship and builds the child’s neurocognitive skills (Greene & Ablon, 2005). The CPS theory of change posits that use of CPS will increase a youth’s ability to adhere to adult expectations and decrease challenging behaviors through three key mechanisms: by solving existing problems through solving problems collaboratively; by building youths’ skills such as flexibility, perspective taking, and frustration tolerance so that the youth can better meet expectations and handle triggers that arise in the future; and by improving the youth–adult relationship (Heath et al, 2020; Pollastri & Wang, 2019). While this theory of change has some empirical support, no research thus far has determined the degree to which providers’ integrity to particular aspects of treatment delivery may be driving these outcomes.…”

“…expectations and decrease challenging behaviors through three key mechanisms: by solving existing problems through solving problems collaboratively; by building youths' skills such as flexibility, perspective taking, and frustration tolerance so that the youth can better meet expectations and handle triggers that arise in the future; and by improving the youth-adult relationship (Heath et al, 2020;. While this theory of change has some empirical support, no research thus far has determined the degree to which providers' integrity to particular aspects of treatment delivery may be driving these outcomes.…”

“…While this theory of change has some empirical support, no research thus far has determined the degree to which providers' integrity to particular aspects of treatment delivery may be driving these outcomes. Over time, CPS has been increasingly implemented with youth and families and has gained substantial evidence for its association with reductions in challenging behavior in residential and inpatient programs, community-based service settings, and in outpatient and in-home family treatment settings (Heath et al, 2020;Pollastri et al, 2013. In an RCT, CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up and was found to be at least as effective as behavioral parent training (PT) in reducing behavior symptoms.…”