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Program Profile: Cognitive–Behavioral Intervention for Children with Emotional and Behavioral Disturbances

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on March 06, 2017

Program Summary

This cognitive–behavioral mentoring intervention was designed to improve child behavior and family functioning among 8- to 12-year olds with mental health disorders, and their primary caregivers. This program is rated Promising. There were significant differences between the intervention and control groups on measures of child behavior, parenting stress, perceived social support, and attachment to parents.

Program Description

Program Goals/Target Population
The Cognitive–Behavioral Intervention for Children with Emotional and Behavioral Disturbances aimed to improve child behavior (externalizing and internalizing behavior problems) and family functioning (parenting stress, perceived social support, and attachment to parents) by using mentors to provide training, coaching, modeling, and reinforcement in social communication and problem solving. The program targeted 8- to 12-year olds with emotional and behavioral disturbances, and their primary caregivers. More specifically, the program targeted children with mental health conditions classified as Axis I in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), including anxiety disorders (social anxiety disorder, posttraumatic stress disorder) and mood disorders (depression, bipolar disorder).
 
Program Components
This program was set within a rural community mental health center. Mentors met with children, one-on-one, once a week for 3 hours. During each mentoring session, mentors worked on specific goals using developmentally appropriate activities. Activities provided an opportunity to model, shape, rehearse, and reinforce appropriate interaction skills; and mentors used praise and a token economy to further reinforce appropriate use of problem-solving skills, communication, and affect regulation.
 
At the end of each session, mentors spoke briefly with parents to discuss completed activities, the child’s behavior, and the extent of the child’s progress.
 
Key Personnel
Mentors were paraprofessionals employed by the community mental health center. Mentors received a minimum of 8 hours of training covering program guidelines, structured activities, recipient rights, discipline strategies, mentor–parent interaction, and strategies for developing a positive mentoring relationship.
 
Program Theory
The focus of this cognitive–behavioral mentoring program is consistent with social learning theory (Bandura, 1977). Additionally, the focus on improving the parent–child relationship is consistent with the emphasis accorded to the influence of familial relationships on developmental outcomes as well as on the child’s relationship with others within his or her social network, as in the ecological model of development (Bronfenbrenner, 1979, 1986).

Evaluation Outcomes

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Study 1
The findings from the study by Jent and Niec (2006) showed that families in the cognitive–behavioral, mentoring intervention differed significantly from families in the control group on all the outcomes assessed.
 
Attachment to Parents
Mentored children had significantly higher scores on measures of attachment to parents at posttest, compared with children in the control group. 
 
Externalizing Behavior Problems
As reported by parents, mentored children had significantly fewer externalizing behavior problems at posttest, compared with children in the control group. 
 
Internalizing Behavior Problems
As reported by parents, mentored children had significantly fewer internalizing behavior problems at posttest, compared with children in the control group. 
 
Parenting Stress
Maternal caregivers of mentored children reported significantly less parenting stress at posttest, compared with maternal caregivers of children in the control group. 
 
Perceived Social Support
Maternal caregivers of mentored children reported significantly more parent-related social support at posttest, compared with maternal caregivers of children in the control group.
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Evaluation Methodology

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Study 1
Jent and Niec (2006) evaluated the effect of the intervention on children enrolled in a mentoring program at a rural midwestern community mental health center and their parents or legal guardians. Participating children were 8- to 12-years old, scored 2 or more standard deviations below the mean on the Peabody Picture Vocabulary Test–Third Edition, and were diagnosed with DSM-IV Axis I mental health disorders: 35 percent were diagnosed with ADHD, 17 percent with mood disorders, 15 percent with anxiety disorders, 8 percent with adjustment disorders, and 25 percent with other disruptive behavior disorders. 
 
Sixty children were assigned to either the intervention (n=30) or control condition (n=30). Mentoring was provided to children in the intervention condition in a one-on-one format by 24 paraprofessionals working at the mental health center; 92 percent of the mentors were college students at the time of the study. Mentors met with their assigned child once a week for 3 hours for at least 8 weeks. Children in the control condition were placed on a wait list and received no contact with mentors during the study period. 
 
There were no significant differences in age, gender, and level of dysfunction at baseline between children in the intervention and control conditions. The mentored group was 57 percent male, and the vast majority (97 percent) was white (with just 3 percent Hispanic). The control group was 64 percent male and 94 percent were white (with 3 percent Hispanic and 3 percent African American). Children in the intervention condition received an average of 75 weeks of mentoring; children in the control condition remained on the wait list for an average of 15 weeks. Participating children were also provided with a variety of mental health services, including wraparound services, psychiatric services, case management, family therapy, and individual therapy; children received, on average, one mental health service. 
 
Outcome measures included multiple measures of family functioning that were completed by participating children and their maternal caregivers at baseline and at the end of the intervention. Participating children completed the Parent Scale of the Inventory of Parent and Peer Attachment, which measured their perception of the quality of their relationship with their primary caregiver. Maternal caregivers completed the Behavior Assessment System for Children–Parent Report Form, which assessed the frequency with which their child portrayed three domains of behavior including externalizing problems, internalizing problems, and adaptive skills; the Parenting Stress Index–Short Form, which assessed the level of stress the parent was experiencing in relation to his or her parenting and the sources of stress in the areas of personal parental distress, parent–child interactions, and child behavioral characteristics; and the Social Skills Rating System–Parent Report Form, which assessed the frequency with which their child portrayed appropriate social skills and behaviors. Maternal caregivers also completed the Child and Adolescent Functional Assessment Scale at baseline, which assessed their child’s degree of impairment in emotional, behavioral, or substance use symptoms, and/or disorders.  

Analyses of covariance were conducted to test for differences between mentored and wait-list control groups on the measures described above. Analysis adjusted for the number of weeks of mentoring received or number of weeks on the wait list and number of mental health services received.
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Cost

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There is no cost information available for this program.
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Implementation Information

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Mentors received a minimum of 8 hours of training covering program guidelines, structured activities, recipient rights, discipline strategies, mentor–parent interaction, and strategies for developing a positive mentoring relationship. At the time of the 2006 study by Jent and Niec, 92 percent of the mentors were college students.
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Other Information

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Jent and Niec (2006) also assessed whether parenting stress, perceived parental social support, and attachment to parents mediated the estimated effects of mentoring on child externalizing and internalizing behavior problems. These analyses adjusted for time enrolled in the program and the number of mental health services received. Parenting stress was found to significantly and partially mediate the estimated impact of mentoring on both types of child behavior problems, meaning mentoring impacted children’s behavior problems by reducing the stress of parents. There was no evidence of mediation found for the other two measures.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Jent, Jason F., and Larissa N. Niec. 2006. “Mentoring Youth with Psychiatric Disorders: The Impact on Child and Parent Functioning.” Child & Family Behavior Therapy 28:43–58.

http://dx.doi.org/10.1300/J019v28n03_03
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Additional References

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These sources were used in the development of the program profile:

Bandura, Albert. 1977. Social Learning Theory. Englewood Cliffs, N.J.: Prentice-Hall.


Bronfenbrenner, Urie. 1979. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Mass.: Harvard University Press.


Bronfenbrenner, Urie. 1986. “Ecology of the Family as a Context for Human Development: Research Perspectives.” Developmental Psychology 22:723–42.

http://dx.doi.org/10.1037/0012-1649.22.6.723
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Mentoring
This practice provides at-risk youth with positive and consistent adult or older peer contact to promote healthy development and functioning by reducing risk factors. The practice is rated Effective in reducing delinquency outcomes; and Promising in reducing the use of alcohol and drugs; improving school attendance, grades, academic achievement test scores, social skills and peer relationships.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - More than one Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Education - Multiple education outcomes
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
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Program Snapshot

Age: 8 - 12

Gender: Both

Race/Ethnicity: Hispanic, White

Geography: Rural

Setting (Delivery): Other Community Setting

Program Type: Cognitive Behavioral Treatment, Mentoring

Current Program Status: Not Active

Listed by Other Directories: Model Programs Guide

Researcher:
Jason F. Jent
Assistant Professor of Clinical Pediatrics
Miller School of Medicine, University of Miami
1601 NW 12th Street
Miami FL 33136
Phone: 305.243.6857
Email