Adapting Dialectical Behavior Therapy for Children in Residential Care

Specific Aim 1: Examine feasibility of DBT-C by evaluating response rate in treatment attendance, treatment satisfaction, and any differences in these rates by groups.

Hypothesis 1: DBT-C will be equivalent to TAU in attendance rate and will have significantly greater treatment satisfaction rating by subjects, as well as by therapists and milieu staff.

Specific Aim 2: Examine efficacy of DBT-C as compared to TAU in reducing internalizing and externalizing symptoms.

Hypothesis 2: Children in DBT-C condition as compared to TAU will have significantly fewer internalizing and externalizing symptoms.

Specific Aim 3: Examine efficacy of DBT-C in improving adaptive coping, emotion regulation, risk taking, and social skills, and reducing depression.

Hypothesis 3: Children in DBT-C Training condition as compared to TAU will have significantly greater improvement in adaptive coping skills, emotion regulation, risk taking and impulsivity and social skills, and reducing depressive symptoms.

Specific Aim 4: Examine efficacy of DBT-C in reducing the frequency of critical incidents.

Hypothesis 4: Children in DBT-C condition as compared to TAU will have significantly fewer critical incidents, including psychiatric hospitalization, emergency room visits, total number of days inpatient, suicidal ideations and attempts, self-harm behaviors, sexual acting out, running away, stealing, police involvement, etc.

• DBT for children (Behavioral), also known as Dialectical Behavior Therapy adapted for Children: intervention consists of weekly individual 45 min. sessions, twice per week 60 min. group sessions, and every other week 90 min. sessions with parents
• Enhanced Supportive-Educational therapy (Behavioral), also known as Enhansed TAU: weekly individual 45 min sessions, twice per week 60 min. group sessions and every other week parent sessions.

Primary outcomes

• Attendance Form [post-treatment at 30 weeks]

Secondary outcomes

• Balloon Analog Risk Task [pre-treatment, week 6, 12, 18, 24, 30 of treatment and at 3 and 6 months follow-up]
• Mood and Feelings Questionnaire [pre-treatment, weeks 6, 12, 18, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Emotion Regulation Checklist [pre-treatment, weeks 12, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Children's Coping Strategies Checklist [pre-treatment, weeks 12, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Pleasure Scale for Children [pre-treatment, weeks 12, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Social Skills Rating Scale [pre-treatment, weeks 12, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Therapy Satisfaction Questionnaire [week 30]
• Therapist Satisfaction Scale [week 30]
• Milieu Staff Satisfaction Questionnaire [every 6 months]
• Incident Report [pre-treatment, weeks 6, 12, 18, 24 and 30 of treatment at at 3 and 6 months follow-up]
• Psychosocial Treatment Compliance Scale [week 30]
• Child Behavior Checklist [at pre-treatment, 6, 12, 18, 24, 30 weeks of treatment, and at 3 and 6 months follow-up]
• Difficulty with Emotion Regulation Scale [pre-treatment]

Sex: Male, ages: 6 Years to 12 Years

Inclusion Criteria:

* age between 6 years 0 months and 12 years 11 months;
* male;
* in residential care at Green Chimneys;
* projected length of stay is at least 8 months.

Exclusion Criteria:

* pervasive developmental disorder;
* psychotic disorder;
* mental retardation; (all as per psychiatric evaluation at Green Chimneys);
* in care or custody of the Department of Social Services (DSS);
* caregivers do not speak English.

• Francheska Perepletchikova, Ph.D., Principal investigator, Weill Medical College of Cornell University