«A Final Report Submitted to the Provincial Centre of Excellence for Child and Youth Mental Health at CHEO EIG # 1196 Dr. Yona Lunsky†, Ph.D., C. ...»
Evaluating the CAMH Social Skills Program for Youth with Asperger Syndrome and Their
A Final Report Submitted to the Provincial Centre of Excellence for Child and Youth Mental
Health at CHEO
EIG # 1196
Dr. Yona Lunsky†, Ph.D., C. Psych.
Dr. Jonathan Weiss*, Ph.D., C. Psych
Michelle Viecili*, B.A.
University of Toronto†, York University*
Dual Diagnosis Program
Centre for Addiction and Mental Health
Toronto, Ontario, CANADA
Table of Contents
Overview of the program
The current study’s purpose
Review of related research
Literature review tables for SSTGs
Child group outcomes
Parent group outcomes
Conclusions & Discussion
Limitations of the study
Challenges and successes
Knowledge Exchange Plan
Building a community of practice
End of project knowledge translation
Appendix A: Logic model
Appendix B: Consent and assent forms
Appendix C: Measures
Appendix D: Weekly measures
Appendix E: Evaluation summaries
Appendix F: Kerry’s Place feedback meeting handout
Appendix G: Teleconference feedback survey
Appendix H: Breakdown of recruited participants
The CAMH social skills program is a 10-week social skills training group for youth between 8 and 14 with Asperger Syndrome and their parents. The social skills program aims to increase youth interpersonal skills for interacting in social situations appropriately and enhance their confidence in using these new skills. At least one parent is required to attend a concurrent parent group. Parent sessions combine psychoeducation on specific topics (e.g., parenting strategies, school problems, medication, and development of social skills) with a review of the skills being taught to their youth, and time for unstructured parent discussion.
Our program evaluation, funded by the Provincial Centre of Excellence for Child and Youth
Mental Health at CHEO, had 3 foci:
1) Child outcomes: The study considered whether children improve in interpersonal skills, in self-esteem, in making friends, and in reduced maladaptive behaviour, from the child and parent perspective. It also examined child and staff satisfaction with the social skills group.
2) Parent outcomes: The study considered whether parents reported improvement in their use of appropriate parenting skills, in feelings of empowerment, and a decrease in feelings of anxiety, depression and stress. It also evaluated parent satisfaction.
3) Capacity building and knowledge exchange: Findings from the study, including lessons learned on how to conduct this type of program evaluation, were shared with parents, clinical staff, policy makers, community partners, and other organizations that provide services to youth with autism spectrum disorders. In addition, a provincial community of practice was created.
Forty families participated in this program evaluation. Parents and youth completed information about themselves prior to and following the 10-week group.
A major contribution of this project was the capacity building that occurred by working closely with stakeholders to conduct the study and share study findings.
• Through videoconference, our project was combined with the Lake Ridge Community Support Services project, and was shared with over 40 agencies across Ontario, as well as policy makers from 3 government ministries.
• A presentation was given and discussion was held with parents from across Ontario at the Autism Ontario Annual General Meeting
• Participants in the project and project clinicians were also briefed about the project and its findings midway and when the study was completed
• A major outcome of these knowledge exchange efforts was the establishment of a community of practice through an email listserv run by Lake Ridge Community Services
• We are continuing to present results from the project and screen our DVD demonstrating how the group works, and its impact on youth and their parents.
The CAMH social skills program is important in several ways. An important aspect of taking part in a social skills group is that children have the opportunity to develop friendships.
Another important benefit of the CAMH group is the opportunity it presents to parents to learn more about Asperger Syndrome, and to learn from other families. The CAMH program is now making adjustments to its program, based on this program evaluation, which will hopefully make it an even stronger program in the future. As well, staff from the program are committed to continue with ongoing program evaluation, and now have some simple tools to help them do so.
Overview of the program The CAMH social skills program is a social skills training group (SSTG) that includes both a child and parent component running simultaneously. The program developed through a collaboration between the Asperger Society of Ontario (community organization) and the Centre for Addiction and Mental Health (CAMH; Hospital), and has been operating for the past 6 years.
In 2009 Kerry’s Place began a partnership with CAMH to deliver this program. Eligible youth are between 8 to 14 years of age, with a diagnosis of Asperger syndrome (AS). Youth are split into two age groups: 8 – 11 and 12 – 14. The size of child groups is limited to 6 – 9 children to ensure a high staff to youth ratio, ranging from 1:3 to 1:1 depending on the needs within the group. At least one caregiver is required to attend a concurrent parent group. Needs of the children and their families are determined by interviews during screening sessions. The SSTG program consists of 10 weekly 1.25-hour sessions. In the 2009/2010 year, the group ran in the Fall (October to December) and in the Winter (February to April). Families had the option of enrolling in the group for one term, or enrolling for both terms.
Child Group The short-term goals of the child sessions are to increase appropriate interpersonal skills and strategies for interacting in social situations, increase confidence in using these new skills, increase perspective taking skills, and generalize learned skills to environments outside of group sessions. Longer term goals are to establish friendships within the groups, increase the quantity and quality of peer networks outside the group, reduce incidents of inappropriate social behaviour, improve self esteem, and decrease levels of anxiety and depression in the child.
Consistent with other models (e.g. Tse, Strulovitch, Tagalakis, Meng, & Fombonne, 2007), the overall program focuses on: (1) Getting acquainted, (2) Friendship skills, (3) Conversation skills, (4) Social problem solving skills, and (5) Dealing with emotions. Each child group session is comprised of (1) Individual and group goal setting, (2) Brief ‘check- in’ circle
the skill, and (5) Informal and unstructured time (including snack). Some examples of the main social skill topics covered for children include Conversation Skills (e.g. turn taking), Friendship Skills (e.g. giving compliments) and dealing with emotions. Homework is periodically assigned to encourage the children to practice the skills learned at home (e.g. having to call another child from the group to practice conversation skills).
Parent Group Each parent group is led by two facilitators and one volunteer, and consists of approximately 20 parents. The sessions combine psychoeducation on specific topics (e.g.
parenting strategies, school problems, medication, and development of social skills) with a review of the skills being taught to their youth, and time for unstructured parent discussion.
Content of the psychoeducational material is determined based on parent needs identified at intake. The educational experience itself is carried out through presentations and group discussions structured by the group facilitators. Group leaders also update parents on what occurs during the child group at the end of the session.
The short-term goals of parent sessions are to increase group cohesion and participation within the group, and increase knowledge regarding AS and the skills that reduce parent/youth conflict. Intermediate goals for parents are to help their children maintain social skills and to expand the effects of the intervention beyond group sessions into the home and school environment. Another goal is to teach parenting skills that fit with the needs of the youth and consequently increase parent empowerment and sense of self-efficacy.
Staff Training A clinical group leader is responsible for the overall supervision of the child program and leads group activities each week. Group leaders are chosen based on their experience with the AS population and come with backgrounds in education, behaviour therapy, speech and language, or psychology. All staff attend an information and training session, prior to the first
the structure, themes, and activities of the group.
The current study’s purpose The social skills program has attempted to evaluate its effectiveness in the past, but has experienced a number of challenges. The program was confronted with organizational and resource limitations, including a lack of staff responsible for the administration of the evaluation measures and lack of a standard process of evaluation. This resulted in missing up to a third of client data either at pre or post intervention. Our evaluation funded one research assistant whose specific responsibility included ensuring that the measures were completed at pre and post evaluation. Program attempts at evaluation were also limited by a lack of a scientific perspective, and measures were selected without attention to reliability and validity, and without matching measures to hypothesized areas of change. As well, once the measures had been collected the program did not have the capacity to complete data analyses to address concerns.
The current evaluation was able to allocate time for the research assistant to interview youth, parents, and clinicians, and attempted to elicit information through teacher report. The scientific team could select appropriate measures and carry out analyses in a timely fashion.
The evaluation examined a number of process and outcome questions (see Appendix A for
logic model) that were formulated based on discussions with project partners and parents:
1) Do children improve in interpersonal skills, in self-esteem, in making friends, and do they have reduced maladaptive behaviour? Do they enjoy how the group is delivered? What do they enjoy most, and what can be improved according to children?
2) Do parents experience improvement in their use of appropriate parenting skills, in feelings of empowerment, and experience reduced anxiety, depression and stress? Do they
parents rate the quality of the parenting group?
3) A third goal of the project is capacity building and knowledge sharing. Findings from the study were shared with parents, clinical staff, decision and policy makers, community partners, and other organizations that provide services to youth with Autism Spectrum Disorders (ASD) in Ontario and internationally.
Review of related research Social skills intervention groups for ASD have traditionally focused exclusively on the child (e.g. see Rao, Beidel, & Murray, 2008; White, Keonig, & Scahill, 2007, for review), and usually present mixed results for child outcomes with little attention to parent outcomes.
Cappadocia and Weiss (2010) recently conducted an extensive literature review on SSTGs for children with AS or high functioning ASD, and categorized programs as traditional child focused SSTG, cognitive behaviour SSTG, or parent component SSTG.
Traditional child-focused social skills training groups. Traditional SSTGs are the foundation for other SSTGs with additional cognitive-behavioural and parent components.
Unlike parent component groups, in traditional SSTGs there is no parent group per se, but it is assumed that parents facilitate or support change in their children at home. Parents are an important part of the learning process because they enforce lessons learned from group in the home environment, and without this continuity of instruction, children do not effectively retain skills or transfer them to outside environments.
Instruction and training is usually geared towards improving a particular set of social skills. Topics vary widely between reading verbal and non-verbal social cues and facilitating social interaction. Examples may include facial expression recognition, reading body language and tone of voice, conflict resolution and social problem solving, conversational skills, or anxiety
after treatment. Typically, SSTGs will measure social skills by direct observation/clinician assessment, parent report, child self-report, or teacher report. Lack of consistency may be an issue when more than one type of measure is used, as was the case for Lopata, Thomeer, Voker, & Nida (2006), but different viewpoints are important to examine for what they tell us in how social skills transfer or fail to transfer across different environments. For most studies included in the Cappadocia & Weiss review (2010), the majority of outcome measures were parent-report. The CAMH SSTG initiative attempted to incorporate more than one perspective (child, parent, & teacher) to gain a more encompassing representation of the child’s outcomes, as well as the parent’s own outcomes.