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

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 statistically significant differences between the intervention and control groups on measures of child behavior, parenting stress, perceived social support, and attachment to parents.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

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).

Study

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.

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.

Additional Outcomes

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.

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

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

Following are CrimeSolutions-rated programs that are related to this practice:

Mentoring for Youth Development

This practice provides youth with a positive and consistent adult or older youth relationship to promote healthy youth development and social functioning and to reduce risk factors. The practice is rated Effective in reducing delinquency and improving educational outcomes; Promising in improving psychological outcomes and cognitive functioning; and Ineffective in reducing substance use.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Education - Multiple education outcomes
	Mental Health & Behavioral Health - Psychological functioning
	Mental Health & Behavioral Health - Cognitive functioning
	Mental Health & Behavioral Health - Social functioning
	Drugs & Substance Abuse - Multiple substances

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?