One Year Follow up Efficacy of the Coping Power Universal and Its Relations with Teachers’ Occupational Stress

The coping power universal (CPU) is an evidence-based universal prevention program delivered by teachers, and completely integrated into the school agenda. Previous studies have shown its positive effects, though little is known about its longer-term effects, and no previous study has explored whether teachers’ occupational stress could influence the CPU efficacy. The current study aimed to explore the 1 year follow up of the CPU on students’ externalizing and internalizing problems and prosocial behavior, and the influence of baseline levels of teachers’ stress in a sample of 316 3rd graders and their teachers (N = 32). Results showed that the CPU led to positive effects, not attainable with the standard curriculum. Additionally, improvements in prosocial behavior persisted even one year after the conclusion of the program. However, improvements in internalizing and externalizing problems were not maintained at the follow up, highlighting the need to understand the factors influencing the CPU efficacy. In this regard, our findings showed that high levels of teachers’ occupational stress predicted poorer improvements following the CPU, and an increase in students’ difficulties at the follow-up assessment. Addressing teachers’ stress as part of prevention programs for students could boost their efficacy and yield more lasting results.

Mindful Coping Power: Comparative Effects on Children’s Reactive Aggression and Self-Regulation

Coping Power (CP) is an evidence-based preventive intervention for youth with disruptive behavior problems. This study examined whether Mindful Coping Power (MCP), a novel adaptation which integrates mindfulness into CP, enhances program effects on children’s reactive aggression and self-regulation. A pilot randomized design was utilized to estimate the effect sizes for MCP versus CP in a sample of 102 child participants (fifth grade students, predominantly low-middle income, 87% Black). MCP produced significantly greater improvement in children’s self-reported dysregulation (emotional, behavioral, cognitive) than CP, including children’s perceived anger modulation. Small to moderate effects favoring MCP were also observed for improvements in child-reported inhibitory control and breath awareness and parent-reported child attentional capacity and social skills. MCP did not yield a differential effect on teacher-rated reactive aggression. CP produced a stronger effect than MCP on parent-reported externalizing behavior problems. Although MCP did not enhance program effects on children’s reactive aggression as expected, it did have enhancing effects on children’s internal, embodied experiences (self-regulation, anger modulation, breath awareness). Future studies are needed to compare MCP and CP in a large scale, controlled efficacy trial and to examine whether MCP-produced improvements in children’s internal experiences lead to improvements in their observable behavior over time.

Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement

Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents’ inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children’s self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children’s level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children’s positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.

The Coping Power Program for Children with Aggressive Behavior Problems

Flexible adaptations of the Coping Power Program have been made for the delivery of the program. Coping Power is a structured, manualized cognitive-behavioral program, with components for children and parents designed to alter targeted mechanisms that contribute to children’s aggressive behavior problems. The program originated as a targeted prevention program, delivered in school settings, but also has been applied and tested in clinical settings. The contextual social-cognitive model is described, followed by a brief description of program components, of fidelity assessment, and of results from several initial randomized controlled efficacy studies. The bulk of the chapter describes two types of adaptations of the program. The first adaptation is evident in a field trial study of real-world school counselors’ use of the program, and was affected by the intensity of training that counselors received and by their own characteristics and the characteristics of their work setting. Appropriate and inappropriate adaptions were observed, with appropriate adaptations illustrating the concept of flexibility within fidelity. The second type of adaptation involves efforts to optimize the program and to test planned changes. The chapter describes evaluations of planned adaptations to the length of the program (including Internet components), to program targets through inclusion of mindfulness training, to delivery of the program in group versus individual formats, and to a variety of changes made in the structure and cultural relevance of the program in international adaptations.

Coping Power in the City: Promoting Coping in African American Male Students

This article describes efforts to adapt an adolescent version of the Coping Power program, called Coping Power in the City, for use with high school students attending an urban school district with high concentrations of students exposed to community violence and challenges related to elevated tensions between youth and police. The goal of this group-based preventive intervention is to provide a comprehensive, school-based approach to stem rates of violence, discipline problems, and related mental health concerns for adolescents. A novel feature is the integration of a school police component into the intervention model with concurrent supports for students, parents, and teachers to supplement school counseling efforts. We present an overview of the program and a rationale for its adaptation to meet the needs of African American males in urban high schools. We summarize baseline data for 514 ninth graders (46% African American males) across 10 urban high schools participating in a randomized controlled trial. We also address lessons learned and implications for school-based counseling practices for African American male students and engagement of school police officers in urban high schools.

Examining for the Protective Effects of Therapeutic Engagement on Child Aggression

Therapeutic alliance is associated with treatment outcomes across a diverse range of intervention models and clinical populations. Likewise, the perceived quality of working alliance in adult psychotherapy has been a consistent predictor of engagement, while research with children is limited. This study draws from a sample of 180 children who were involved in a study of the Coping Power preventive intervention for elementary students with aggressive behavior. Approximately 1,080 individual intervention sessions were coded using the Therapeutic Process Observational Coding System (TPOCS-A). Results suggest that bonding, in the early sessions of Coping Power, predicted a reduction in teacher-reported externalizing behaviors. In addition, data analyses revealed that bonding interacted with children’s gender in the latter portions of Coping Power. Higher bonding for girls in later sessions predicted lower teacher-rated externalizing behaviors at 1-year follow-up. Finally, initial levels of aggression moderated the relationship between bond and parent-rated externalizing behaviors during the early and late sessions of Coping Power, with stronger effects for moderately aggressive children. Task orientation, a component of therapeutic alliance, in late sessions had counter-intuitive effect on parent-rated externalizing behaviors, possibly due to therapists’ efforts to impose more structure with children who were not progressing well.

Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for children with disruptive behaviour disorders

Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015