I recently received an email from Molly Brunk, Ph.D., MST Services Director of Quality Assurance, asking if CDR could shed light on the needs of children referred to Evidence Based Treatments (EBTs) in Pennsylvania. I was very glad to receive this request from an esteemed stakeholder such as MST International. MST is one of the most well-respected behavioral EBTs in the world, and helping them answer questions that help them do their work is completely in our non-profit mission to advance a data-driven human services system. So I dove right in, and found some interesting stuff.
CDR has CANS and ANSA data on many different EBTs (you can follow some of this data on our web page under “Reports.”) However, for this analysis I focused on the three child EBTs with the largest implementations in Pennsylvania, namely Parent-Child Interaction Therapy (https://pcit-training.com/), Functional Family Therapy (https://www.fftllc.com/), and of course, Multisystemic Therapy (http://www.mstservices.com/). I approached the analysis by finding all children who had been assessed with our automated CANS tool, The DataPool™, in the five county Capital Area, and who had been referred to one of these EBTs. I then did a modified Needs Profile Analysis, where I identified:
- The top 6 most actionable* items from the Mental Health & Risk domains (e.g. “Clinical” needs)
- The top 4 most actionable* items from the Functioning domain
- The top 3 most actionable* items from the Caregiver domain
The results can be found on these tables below. (*Just a reminder: “actionable” means that an item was scored as a 2 or 3 … so below you are seeing the percentage of each population that had those items as needing to be on the treatment plan during the initial assessment that resulted in referral to the EBT).
Functional Family Therapy Prescribed from an Initial Evaluation (N = 31, 2018 – Present)
Multisystemic Therapy Prescribed from an Initial Evaluation (N = 357, 2014 – Q1 Present)
Parent-Child Interaction Therapy Prescribed from an Initial Evaluation (N = 185, 2014 – Q1 Present)
I’m sure readers can find some of their own insights while reading these tables. But let me highlight some things that strike me:
First, are the similarities. These are all programs that deal with externalizing children, and we can see this in the fact that oppositional behavior dominates the clinical needs for all three, and dangerousness to others, impulsivity, and anger problems are also found along with it. Further, it is striking that caregiving needs are similar across all three programs with knowledge deficits being present in ~20% of each program’s population, and resource concerns are also significant needs for caregivers receiving referral to these services. Last, all three programs see functional problems in home and school.
After laying out the similarities, it is also striking the nuanced differences between the programs. And even more to the point, it is really impressive how the CANS is able to capture these differences, and it answers a nagging suspicion that is often leveled at the CANS that it can’t possibly be sensitive enough to sort people to programs according to specific details. I think we see here that while the CANS certainly cannot account for all details of a person’s complicated life, it is impressive how much truly can be captured with its variegated items.
Consider Functional Family Therapy, while treating a similar population to MST in age and symptoms, has always had a unique approach to dealing with externalizing teens that focuses on mending family relationships. It is thus interesting to see that the population referred has much more depression and anxiety than we see in MST, and also the externalizing behaviors it addresses include a lot of relational
“secondary gain” behaviors. Further, FFT’s population has a high percentage of peer/social functioning problems, pointing to the program’s unique approach to dealing with relational problems to address externalizing problems.
MST, in contrast, is known to have higher risk populations, and to take a more structural approach to dealing with the problem of externalizing teens. We can see this in its profile, which includes antisocial behavior at ~34% (a very high actionability rate for an item that is relatively rare when our Pennsylvania data is considered as a whole). Also, MST is the only program on this list that has Supervision as a caregiver concern, and this makes perfect sense with its model, which is primarily concerned with helping caregivers attain healthy hierarchy in the family system, since supervision deficits concretely mean that the caregivers are not able to maintain appropriate order in the home, and intervention to help with this problem is necessary.
Everyone who is certified on a communimetric tool knows one must “consider culture and developmental contexts” before interpreting TCOM data. In the context of comparing PCIT to MST or FFT it is important to note that fundamentally, PCIT is an outpatient treatment for younger children, and MST & FFT are community-based treatments for teens. This difference can help us understand why one of PCIT’s most pressing problems is running away from the classroom. Further, secondary gain behavior like negative attention seeking is very prominent in this program, because that is also more common with the younger children.
In conclusion, I think this is a nice, simple example of how well the CANS is able to identify the differences between populations in programs that share similarities, but have their own unique recipes for change. If you have any other observations, please send them along. There is a wealth of insight in any CANS profile, and only people talking about what they see will help us all gain insights for perfecting our system of care for children and families.