ACCEPTANCE & COMMITMENT

THERAPY PROGRAM EVALUATION

CORIN
MARSHALL

Agenda
Agency Overview
Mission
Background
Agency culture, policies, research
Programs offered

Stages of Project
Intro
Engagement/assessment
Implementation
Evaluation
Discussion

OVERVIEW OF AGENCY

Agency Mission:
IPC Pediatric Clinics
Geisingers IPC Clinics Mission:
1.

Provide high-quality, evidence-based practice in primary care

2.

Partner with PCPs and improve their care of behavioral health

concerns

3.

Invest in trainees committed to primary behavioral care health and

prepare them for independent practice

4.

Construct program evaluation and research on PCBH and

disseminate results

5.

Expand our program to offer care to patients/care across the system

Agency Background:
IPC Pediatric Clinics
Started out with 3 pilot clinics
Bloomsburg, Selinsgrove, & Pottsville
Integrated for 4.5 years
1 psychologist
1-2 psychology fellows
Social work intern
Not a social worker on site yet

Agency Culture
Team approach (integrated primary care)
Policies
Broader polices include: confidentiality, treating a minor, suicide policy,
mandated reporting
Specific polices to clinic: referrals only from PCPs, sharing information
with PCPs

Research
Only use evidence-based interventions
Treatment is short-term and problem-focused

Programs Offered
Evidence-based, problem-focused interventions
Crisis evaluations
Same-day evaluations
Psychological evaluations
Individual psychotherapy and family therapy
Treatment and support groups
Bloomsburg: Disruptive Behavior Clinic & ACT Adolescent Group

ACCEPTANCE & COMMITMENT

THERARPY (ACT)

Introduction of ACT
(Hayes & Wilson, 1994)

Evidence-based treatment
Provides skills to handle uncomfortable personal
experiences
Accepting what is out of your control and committing to
act in ways that improve your life
Values guide behaviors

Acceptan
cehoosin
C
gTaking
Action

Goal of ACT group: live a

meaningful life however you
want to live it.

Project Overview
Goal of project: develop pilot study to evaluate
effectiveness of ACT group for adolescents
Concentration: macro level practice (program level)
Reviewed outcomes ACT group program through preand post-measures
Bloomsburg and Selinsgrove clinics

Project Overview
continued

Why evaluate ACT?

Clinical need
Proven in adults, less evidence in adolescents

Why did I choose this?

Give back to the agency and contribute to clinical work and research

ENGAGEMENT/ASSESSMENT
(METHODS)

Participation
Recruitment & Assessment for Group
Step 1: Potential group members evaluated for appropriateness
PCPs refer patient to psychologist
60 minute evaluation with psychologist or postdoctoral fellow
Anxiety, depression, or adjustment disorder
Maturity level and severity
Treatment induction (whats involved and if they are interested)
If the adolescent could commit to group date and time
Step 2: Measures used to track clients progress

Measure Selection
Literature search
Collaborative process
Considerations
Length
Free
Reliability and validity
What does it assess?
Was it used with adolescents?

Revised Avoidance & Fusion

Questionnaire (AFQ-Y 17)
(Greco, Murrell, & Coyne, 2005)

ACT Process Measure

17-item questionnaire
Child self-report that assesses psychological inflexibility
5-point Likert scale
0 (not true at all) to 4 (very true)

Grades 5-10
Used pre- and post-treatment
Single factor analysis high scores indicate psychological
inflexibility

Revised Childrens Anxiety and

Depression Scale (RCADS)
(Chorpita et al., 2000)
Symptoms Measure
47-item questionnaire
Child self-report of symptoms of depression and/or anxiety
6 subscales (separation anxiety, generalized anxiety, panic, social phobia,
obsessions/compulsions, and depression)
Yields a total anxiety and total anxiety & depression score

4-point Likert scale

0 (never) to 3 (always)

Grades 3-12
Used pre- and post-treatment
T scores of 65-69 are at the borderline clinical threshold
T scores of 70 or higher are above the clinical threshold

Youth Top Problems (TP)

(Weisz et al., 2011)

Impairment Measure
3-item method
Identify top 3 problems disrupting their life
Then rate the severity on a scale of 0 to 10 of how big a problem it
is, where 0 is not at all and 10 is very, very much

Provides updates on the adolescents response to

treatment
Used weekly

Barkley Functional Impairment Scale

(Barkley, 2011)

Impairment Measure
Total of 23 items
1st part: 15-item Likert scale format
2nd part: 8-item Q&A format

Parent report that measures psychosocial impairments

Home-school
Community

Ages 6-17
Used pre- and post treatment

Homework & Attendance

Tracking Sheet
Treatment Integrity
Developed by Dr. Shelley Hosterman
Used to monitor attendance, completion of homework,
and self-rating of homework completion
Used weekly

IMPLEMENTATION
(INTERVENTION)

Structure of Group Meetings

Selinsgrove: 2 facilitators (psychologist and post-doc)
Bloomsburg: 3 facilitators (psychologist, post-doc, and extern)
75 minute sessions
9 total sessions
Weekly for 7
Last 2 sessions 2 weeks apart

Topics Covered
Week 1: Intro to ACT

Week 6: Noticing

Week 2: Noticing & Defusion

Week 7: Self-As-Context

Week 3: Dropping the Rope

Week 8: Moving Forward

Week 4: Self-Compassion

Week 9: Strategies for

Week 5: Willingness

Maintenance & Graduation

EVALUATION

Evaluation of Implementation
Assessment and intervention plan
Feasibility
Was what we planned realistic?

Integrity of implementation
Did we execute what we planned?

Evaluation of Outcomes
How effective was the program?
Pre and post data of the:
AFQ-Y 17
RCADS
Youth Top Problems
Barkley Functional Impairment Scale
Homework & Attendance Tracking Sheet

Participant Demographics
Patient 1:
Female, 14 years-old
Diagnosis: adjustment disorder with depressed mood
Level of treatment based on homework & attendance tracking:
- Attendance: 100%
- Completed homework: 62.5%
- Rated homework completion:
-4 out of the 6 times as every day or opportunity
-1 out of the 6 times as a couple of times
-1 out of the 6 times did not rate homework completion, left blank

Participant
Demographics
continued
Patient 2:
Male, 16 years-old
Diagnosis: adjustment disorder with depressed mood
Level of treatment based on homework & attendance tracking:
-Did not complete

AFQ-Y 17

AFQ-Y 17

RCADS-Child

RCADS-Child

Youth Top Problems

Barkley Functional Impairment Scale

0 people completed/returned the scale
No data to report
Procedure for this take-home measure not great
Change the way it is administered

DISCUSSION

Conclusions
Implementation/Feasibility
AFQ-Y was feasible and provided important ACT specific information
RCADS was lengthy, but feasible and worth it
Youth Top Problems was feasible after instructions were altered, but
needs to be implemented better and more consistently
Dont entirely know if Barkley Functional Impairment Scale was feasible
Homework & Attendance Tracking Sheet is realistic, but implementation
needs to be more consistent

Conclusions
continued
Effectiveness as Measured by Symptoms (RCADS)
Based on the limited data we found:
Total scores for symptoms of anxiety and depression stayed the same
for both patients
For patient 2, separation anxiety went from average range at the
beginning, to clinical at the end of the group
One possible reason: we are getting them to approach difficult thoughts
and feelings

ACT does target symptom reduction directly

Conclusions
continued
Effectiveness as Measured by Process (AFQ-Y 17)
Based on limited data we found:
Their levels of psychological inflexibility minimally changed

Conclusions
continued
Effectiveness as Measured by Impairment (TP)
Impairment decreased for all three problems for patient 1
By the end of group, identified problems were not as intrusive as the
start of group

Challenges &
Limitations
Timeline
Actual completion of measures
Sample size
Attendance
Events out of our control

My own research background

Future Directions
Continue utilizing the AFQ-Y, RCADS, Youth Top
Problems, and Homework & Attendance Tracking Sheet
Change the procedure to administer the Barkley
Functional Impairment Scale
For weekly scales implementation more consistent
Pilot across all 3 clinics to get a larger sample size

Relation to Social
Work
NASW Code of Ethics
Service
Dignity and worth of the person
Integrity
Competence

ANY QUESTIONS?

References
Barkley, R. A. (2011). Barkley functional impairment scaleChildren and adolescents (BFIS-CA). New York, NY.
Guildford Publications, Inc.
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression
Scale in a clinical sample. Behaviour Research And Therapy, 43309-322.
doi:10.1016/j.brat.2004.02.004
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV
anxiety
and depression in children: a revised child anxiety and depression scale. Behaviour Research And Therapy, 38835-855.
doi:10.1016/S0005-7967(99)00130-8
Greco, L. A., Ball, S. M., Dew, S. E., Lambert, W. & Baer, R. A. Psychological inflexibility in childhood and adolescence:
Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Manuscript under review.
Hayes, S. C., & Wilson, K. G. (1994). Acceptance and commitment therapy: Altering the verbal support for experiential
avoidance.
Weisz, J. R., Frye, A., Bearman, S. K., Ugueto, A. M., Langer, D. A., Chorpita, B. F., & ... Hoagwood, K. E. (2011). Youth
top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during
psychotherapy. Journal Of Consulting And Clinical Psychology, (3), 369. doi:10.1037/a0023307