Research and Health Utilization Around Conduct Problems Scott T. Ronis, Ph.D. Department of Psychology University of New Brunswick ________________________________________

Background to Disruptive Behaviour Problems Behaviours that violate the rights of others or that bring someone into conflict with societal norms Involves difficulties in emotional and behavioural regulation Several psychiatric disorders (based on DSM-5 and ICD-10) represent a range of disruptive behaviour problems –Intermittent Explosive Disorder –Oppositional Defiant Disorder –Conduct Disorder –Substance Use Disorders

Complexities in Identifying Behaviour Problems High comorbidity Unspecified or undiagnosed mental health problems may include behaviour problems In practice, diagnoses lack developmental context Time spent on defining problems do not necessarily equate to knowledge of handling problems

Ecological Models Society/Culture Neighborhood School Peers Child Family

Correlates of Youth with Behaviour Problems Research suggests that multiple risk factors are linked with serious behaviour problems in youth: Individual factors (e.g., externalizing and internalizing problems, difficulties with emotion regulation, intellectual deficits, neurobiological factors) Family factors (e.g., low warmth, high conflict, low monitoring, harsh or inconsistent parenting, large family size, instability) Parental problems (e.g., spousal violence, substance abuse, history of mental health problems, parental criminality) Peer relations (e.g., social isolation, immaturity, association with delinquent peers) Academic performance (e.g., low achievement, behavior problems, learning disabilities) Neighborhood factors (e.g., exposure to violence, limited resources) Cultural factors (e.g., norms for disruptive behaviour)

Defining Empirically-Based Practices (EBPs)  EBP movement in general began over 60 years ago  Child/youth psychotherapy research followed  There have been advances in distinguishing programs that work from those that do not work or do not have adequate support  Dealing with the real world: Moving from efficacy to effectiveness

EBP Resources  American Psychological Association’s Division 53:  Coalition for Evidence-Based Policy:  Blueprints for Healthy Youth Development:  SAMHSA:  OJJDP:  Office of Justice Programs:  National Child Traumatic Stress Network: practices practices

Continuum of Care  Universal Prevention  Secondary Intervention (Selective Prevention)  Tertiary Intervention

Model Universal Prevention EBPs ProgramsSettingCostsBenefitsPositive Impacts LifeSkills TrainingSchool for early adolescence $34 pp$1,290 pp*AOD use, Delinquency, Violence Positive ActionSchool for late childhood & early adolescence (& optional parenting classes) ~$400/classN/AAOD use, Academic problems, Delinquency, Internalizing problems, Violence Project Towards No Drug Abuse School for late adolescence $14 pp$123 pp*AOD use, Violent victimization Promoting Alternative Thinking Strategies School for late childhood $115 pp($19) pp*Aggression, Conduct problems, Emotion regulation, Internalizing problems *Washington State Institute for Public Policy

Model Secondary Intervention EBPs ProgramsSettingCostsBenefitsPositive Impacts Functional Family Therapy Families for early to late adolescence $3,262 pp$70,370 pp*Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence New Beginnings (Interventions for Children of Divorce) Parent training (and optional parent-child groups) for late childhood to late adolescence ~$595/ppN/AAOD use, Aggressive behaviour, Internalizing & externalizing problems, Mental health, Relationships with parents Nurse-Family Partnership Parent training from pregnancy to 2 years of age $9,600 pp$22,781 pp*AOD use, Child maltreatment, Delinquency, Employment, Mental health, Physical health & well-being Project Towards No Drug Abuse School for late adolescence $14 pp$123 pp*AOD use, Violent victimization *Washington State Institute for Public Policy

Model Tertiary Intervention EBPs ProgramsSettingCostsBenefitsPositive Impacts Functional Family Therapy Families for early to late adolescence $3,262 pp$70,370 pp*Delinquency, Illicit drug use, Internalizing problems, Relationship with parents, Violence Multidimensional Treatment Foster Care School for late childhood & early adolescence (& optional parenting classes) $7,922 pp$39,197 pp*Delinquency, Illicit drug use, Violence Multisystemic Therapy School for late adolescence $7,370 pp$32,121 pp*Delinquency, Illicit drug use, Internalizing & externalizing problems, Relationship with parents, Sexual violence *Washington State Institute for Public Policy

Journey Through Various Systems Historical context Collaborative Model of Response Action Plan for Mental Health in New Brunswick, 2011

Journey Through Various Systems

Looking Ahead at Utilization of Services in Atlantic Canada Addressing youth mental health needs is a moving target that needs continuous re-evaluation Identifying the needs of youth through administrative/survey data and qualitative interviews Who are the “providers”? What are they doing? Need to facilitate the use of effective interventions and services Need to keep an eye on costs and benefits as well as barriers/redundancy in services

There is no health without mental health (World Health Organization, 2010)