Beyond the Clinic: Access Early Intervention- An e-Health treatment for childhood behaviour disorders

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Copyright: Kirkman, Jessica
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Abstract
In Australia, less than 17% of children requiring treatment access a mental health service (Sawyer et al., 2000). In rural areas, access rates are even lower, and mental health services are not readily available. Treatment in the city can involve significant travel and time away from home, and services can only be brief and intense. The current project involves the development and preliminary evaluation of one of Australia’s first online treatments for parents of children with behavioural disorders. This thesis was primarily concerned with enhancing the reach of parent training interventions and evaluating the efficacy of an alternative online format. Phase one of this project involved developing an online system for measuring engagement and change in relation to an online version of an existing treatment (Dadds & Hawes, 2006). This included development of an interactive measurement system within the online platform to assess parenting style, child behaviour, engagement patterns and client satisfaction. With limited opportunities to directly observe families engaging in treatment online, systematically measuring training effectiveness has become more challenging. Thus the second phase of the thesis involved the development and validation of a new change measure, the Knowledge of Parenting Strategies Scale, to assess changes in parental knowledge stemming directly from engagement in this treatment. In a series of studies, N = 806 parents participated in research to develop, refine and assess the psychometric properties of the new measure. The third phase of the project involved a preliminary trial into the online platforms effectiveness, through a comparison to a matched sample of clients receiving treatment-as- usual (TAU) at the Sydney based clinic. Participants in the trial were 47 families who resided within and outside the Sydney catchment area in regional New South Wales. Families participating in the e-health group watched video modules, before connecting with a psychologist through videoconference each week. Parents in both groups indicated they were satisfied with their treatment, with parents in the e-health group indicating the website was acceptable, interesting, easy to use, efficient and innovative. E-health parents were engaged with the video modules and parents in both groups were engaged with their therapy sessions regardless of the medium. Parent’s ratings of the therapeutic alliance formed was equivalent between the two groups, while clinician’s ratings were significantly higher for the e-health group. Overall clinicians spent less time treating e-heath families and indicated feeling more empowered and having higher self-efficacy to treat TAU families. At post-assessment, parents in both groups indicated significantly lower levels of dysfunctional parenting and problematic child behaviour, and higher levels of confidence, self-efficacy and knowledge of effective parenting strategies. Importantly, the two treatment modalities were found to produce equivalent outcomes, demonstrating Internet-based parent training programs can bring about significant improvements in child conduct problems. Finally, an exploratory analysis of predictors of treatment outcome revealed that, for those receiving treatment in-person, higher parent engagement was associated with lower levels of oppositional behaviour at post treatment. For those receiving treatment online, increases in mother’s knowledge predicted clinician’s rating of oppositional behaviour at post treatment. In summary, while treating childhood behavioural disorders is a complex issue, this project has demonstrated that an innovative, e-health solution delivers outcomes equivalent to more expensive and less accessible in-person solutions currently used.
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Author(s)
Kirkman, Jessica
Supervisor(s)
Dadds, Mark
Kimonis, Eva
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Publication Year
2015
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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