PHD, Kent State University, 2009, College of Education, Health and Human Services / School of Lifespan Development and Educational Sciences

The purpose of this study was to identify the thoughts, behaviors, and events that clinicians who work with adolescent male sexual offenders perceived as assisting the offenders in honest disclosure of sexual abuse. Honest disclosure is thought by some researchers to be a critical component of sexual offender treatment. The study using Q-methodology involved 35 (16 male and 19 female) clinicians who offered sexual offender treatment. Each was asked to sort 24 statements about specific thoughts, behaviors, and events that they thought aided adolescent males in making honest disclosure of sexual offenses on a continuum from most helpful (+3) to least helpful (-3). The 24 statements comprising the sort had been garnered from interviews with a panel of clinicians who shared ideas about what assisted adolescents in honestly disclosing sexual offenses. The sorts were then factor analyzed to disclose clinicians who sorted in similar ways. These sub-groupings of clinicians thus held a common perspective of what they thought was helpful in gaining honest disclosure. Three significant sub-groupings of clinician's perspectives were revealed. Factor 1 consisted of 7 participants and accounted for 20% of the variance. This group thought that the clinician's expression of non-judgmental respect was most important in assisting adolescent sexual offenders to make honest disclosure of their sexual offenses. Factor 2 consisted of a group of 6 clinicians whose responses accounted for 17% of the variance. Their responses stressed the importance of having a network of judges, lawyers, probation officers, clinicians, and family members who focused on the adolescent's honesty and accountability. Finally, a third factor was revealed consisting of 6 clinicians accounting for 17% of variance. Clinicians loading on this factor stressed the thoughts of adolescents. They thought those adolescents who assumed guilt for their offenses and thought they needed help were most likely to honestly di (open full item for complete abstract)

Committee: Donald Bubenzer PhD (Committee Co-Chair); John West EdD (Committee Co-Chair); Kele Ding PhD (Committee Member) Subjects: Educational Psychology; Mental Health; Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2025, Psychology

The present study sought to experimentally investigated the role of emotional numbing as a mediator in the relationship between posttraumatic stress symptoms and callous-unemotional traits in an adolescent sample seeking mental health or substance use treatment. Additionally, the relation of trauma exposure on treatment outcome and level of care referral was examined. Adolescents ages 11-19 (N = 119) who completed an intake for potential IOP treatment were enrolled in the study. Those who reported trauma were administered measures of posttraumatic stress, callous-unemotional traits, and emotional numbing during routine intake procedures. Referral decision, IOP substance abuse treatment outcome and duration were collected and their relation to trauma tested. Intended mediation analyses could not be conducted due to insufficient power. Trauma exposure was predictive of requiring intensive outpatient level of care or greater but was not associated with substance use disorder treatment outcome or days of treatment. More research is needed to better understand the role of trauma on treatment need and emotional numbing on developmental trajectories for youth with trauma history who develop callous-unemotional traits.

Committee: Susan Kenford (Advisor); Hannah Lubman (Committee Member); Stacey Raj (Committee Member) Subjects: Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2021, Psychology

Although adolescent substance experimentation is a relatively normative experience, there are significant risks associated with abusing substances during adolescence. Treatment programs have been designed to target and reduce substance abuse in adolescent populations; however, treatment retention remains a significant problem in adolescent populations. The current study aimed to examine the relationship between treatment motivation, substance abuse patterns, and session attendance in a sample of adolescents engaged in an intensive outpatient program (IOP). Using the measures administered during the intake interview, including the TCU ADOL MOTForm (a measure of treatment motivation), the SASSI-A2 (a commonly used measure to evaluate the need for treatment), and the ASAM PPC-2R (a clinician-rated form to determine the most appropriate level of care), the current study evaluated the relationship between scores from these measures and session attendance. There were no significant relationships between TCU scores, SASSI-A2 scores, or ratings on the ASAM PPC-2R and the number of sessions attended. Further, there were no significant differences between clients classified as high vs. low motivation and the number of sessions attended. There were significant correlations between scores on the TCU and some of the SASSI-A2 scores, suggesting that the SASSI-A2 may provide information related to treatment motivation. The current study suggests an ongoing need for adolescent treatment programs to continue to explore and identify factors that promote engagement and attendance in substance abuse treatment programs.

Committee: Kathleen Hart Ph.D., ABPP (Committee Chair); David Baum Psy.D., LICDC (Committee Member); Heather McCarren Ph.D. (Committee Member) Subjects: Behavioral Psychology; Clinical Psychology; Psychology

Master of Science (MS), Ohio University, 2009, Psychology (Arts and Sciences)

The current study examined predictors of Substance Abuse Severity in a sample of adolescents entering treatment for substance use disorders. Specific daily hassles and types of social support were assessed at treatment admission. Participants included 72 adolescents: 76.4% male, 91.7% Caucasian, and ranging in age from 13 to 18 years old (Mean=16.3 years). When daily hassles correlated with Substance Abuse Severity were forced entered into block 2 of a hierarchical regression, after gender was entered in block 1, the set of predictor variables explained a marginally significant proportion of variance in Substance Abuse Severity (R2=.29, Adjusted R2=.14, F(10,47)=1.96, p=.060, f2=.416), and no individual daily hassle accounted for a significant amount of unique variance. When provisions of social support correlated with Substance Abuse Severity were forced entered into a multiple regression, the set of predictor variables explained a marginally significant proportion of variance in Substance Abuse Severity (Adjusted R2=.09, F(2,57)=2.66, p=.078), and no individual provision of social support accounted for a significant amount of unique variance. Subsequent moderator analyses performed for each type of social support revealed a significant interaction between Reassurance of Worth and Total Stress. These results suggest that adaptive management of daily stressors should be addressed in youth substance use interventions. Additionally, there may be an important protective function in helping to increase adolescents' feelings of competence/ability.

Committee: Bernadette Heckman PhD (Committee Chair); Julie Owens PhD (Committee Member); Justin Weeks PhD (Committee Member) Subjects: Personal Relationships; Psychology

Doctor of Philosophy (PhD), Ohio University, 2007, Clinical Psychology (Arts and Sciences)

While motivation and therapeutic alliance have been found to be influential factors in the outcome of substance abuse treatment for adult populations, comparatively little is known about the potential impact of these variables on outcomes in adolescent substance abuse treatment. The present study examined the relationships between motivation and readiness for treatment, therapeutic alliance, treatment compliance, and outcome variables in a sample of adolescents in residential substance abuse treatment. Eighty-one adolescents participated in the study, in which they completed self-report measures of motivation and readiness prior to treatment, therapeutic alliance measures during treatment, and ratings of psychiatric problem severity and depressive symptomatology before and after their treatment episodes. Results indicated that initial alliance, as rated by clients or counselors on an adapted form of the Working Alliance Inventory (Horvath, 1981), was not associated with measures of treatment outcome, including discharge status, change in psychiatric symptoms, and clinician ratings of progress at discharge. Higher initial client-rated alliances were associated with fewer instances of severely inappropriate behavior over the course of treatment. However, positive counselor-rated alliance ratings obtained after session six of individual therapy significantly predicted greater progress in the treatment program and reductions in psychiatric problem severity as measured by the Ohio Youth Problem, Functioning, and Satisfaction Scale (Ogles, et al., 2000). Client-reported pre-treatment levels of problem recognition were negatively associated with client-rated alliance after session six of individual therapy, while high levels of treatment readiness predicted client ratings of the alliance at the same time point. In addition, high levels of problem recognition were associated with clients' poor compliance with program rules over the course of treatment. Despite mixed finding (open full item for complete abstract)

Committee: Timothy Anderson (Advisor) Subjects: Psychology, Clinical

Psy. D., Antioch University, 2010, Antioch Santa Barbara: Clinical Psychology

Background: The author pursued this area of interest due to having had a positive experience working as a therapist within a high cohesion treatment team in an in-home setting. This experience with a high cohesion team seemed to lead to more successful results than other teams that were deemed low cohesion, in the same format. This experience led to a general curiosity about why the team this author was on was more effective. Additional research allowed this author to determine the possible link between cohesion, success of treatment and reduced risk for burnout, defined as a response to chronic job related stressors (Maslach, 2003). This possible link paved the way for this research to be accomplished. The purpose of this study was to determine if treatment team cohesion is a factor in determining the success of in-home treatment for children and adolescents with emotional and behavioral diagnoses. The link between cohesion and treatment team success has not been specifically researched; however, cohesion has been related to the success of teams in various sports. It was hypothesized that a high cohesion treatment team would result in more successful in-home treatment than a low cohesion treatment team. Methods: A closed record review was completed on 26 participants, with 13 participants in each treatment team. The participants were assigned to a specific team by the Clinical Director of the family preservation services provider based upon the caseload of the clinicians at the time of assignment. The same licensed therapist completed the Work Environment Scale (WES) to determine which team had the higher level of cohesion. Demographic variables of gender, ethnicity, duration of treatment, and medication status were used, along with the CAFAS and GAF scores in two hierarchical linear regression analyses. Two hierarchical linear regressions were performed using SPSS. The first regression utilized the cohesion measure, demographic variables (gender, ethnicity, durat (open full item for complete abstract)

Committee: Steve Kadin PhD (Committee Chair); Cheryll Smith Ph.D. (Committee Member); Scott Musgrove Psy.D. (Committee Member); Michael Lindsay Ph.D. (Committee Member) Subjects: Behaviorial Sciences; Psychological Tests; Psychology; Psychotherapy; Statistics; Therapy

Psy. D., Antioch University, 2023, Antioch Santa Barbara: Clinical Psychology

The following dissertation presents a proposal for a program developed on theoretical concepts of the False Self and Persona. Integrative treatment approaches, such as Sensorimotor Psychotherapy, surfing, equine therapy, and wilderness therapy combined with individual and group psychotherapy, may be helpful in diminishing adolescent substance abuse by increasing connection to their internal resources and exposure to healthy external support. Although there are various programs that have proven to be effective in the treatment of substance abuse in adolescence, they tend to neglect the subjective experience of the individual and fail to address the why, behind the desire to self-negate in adolescence. Thus, the focus of this program is to move towards true self functioning by increasing subjective well-being and fostering a greater connection to self. This program proposal will discuss the underlying goals and proposed implementation of these integrative approaches in the treatment of adolescent substance abuse. This dissertation is available in open access at AURA, https://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu

Committee: Johanna Hays Psy.D (Committee Chair); Christopher Howard Psy.D (Committee Co-Chair); Bonnie Goldstein Ph.D (Committee Member) Subjects: Psychology; Psychotherapy; Spirituality

Doctor of Philosophy (PhD), Ohio University, 2022, Counselor Education (Education)

Substance use among adolescents has maintained historical consistency throughout several decades (Substance Abuse and Mental Health Services Administration, 2019), and hence it is imperative for the use of evidence-based practices that could be utilized to help adolescents with substance use disorders. The adolescents involved in substance use are increasingly becoming involved in the Juvenile Justice System and mental health services. This results in a larger population of legally mandated adolescents in residential facilities. Unfortunately, the research and literature for the domain of mandated treatment for adolescents involved in the juvenile justice system has not caught up with the increased need for information about treatment interventions and effective working alliance between adolescents and therapists. The researcher interviewed seven therapists about their work with legally mandated adolescents in a residential treatment center. The focus of the study qualitatively examined therapists' experience with legally mandated adolescents and strategies that are employed to develop positive working alliance between the therapists and legally mandated adolescent clients, as well as factors that impede the formation of working alliance. The therapists also provided information on the involvement of probation officers and clients' family members in treatment and how that impacts the formation of a positive working alliance. The study employed a qualitative case study design utilizing interview, direct observation and analysis of documents and artifacts that are used by the participants at the residential treatment center to foster the formation of a positive working alliance. The qualitative study addressed the research questions “what are the perceptions of mental health therapists regarding their working alliance with legally mandated substance abuse adolescent clients?” “What strategies contribute to a positive working alliance with legally mandated adoles (open full item for complete abstract)

Committee: Yegan Pillay (Advisor); Krisanna Machtmes (Committee Member); Bilal Urkmez (Committee Member); Foreman Tamarine (Committee Member) Subjects: Behavioral Psychology; Clinical Psychology; Counseling Education; Counseling Psychology; Psychology; Psychotherapy; Rehabilitation; Social Work

Psy. D., Antioch University, 2019, Antioch New England: Clinical Psychology

This qualitative study explores therapist views of the therapeutic relationship in adolescent residential treatment from an attachment perspective. The therapeutic relationship is a strong predictor of outcomes in adult psychotherapy and a significant body of research has relied on the attachment literature to understand its importance. Research yields comparable results when examining the significance of the therapeutic relationship with children and adolescents; however, there is virtually no literature exploring it from the attachment lens. This is particularly notable for children and adolescents in residential treatment. As treatment intensity increases from outpatient to inpatient to residential, challenges and opportunities within the therapeutic relationship increase, too: therapists form uniquely intense and intimate connections with children and adolescents they may see every day. This study employed constructivist grounded theory data analysis of semi-structured interviews with residential therapists exploring their views of the role of attachment in the therapeutic relationship with their adolescent clients. Key findings include role differences in therapists in adolescent residential treatment; the importance of affect management, attunement, and self-awareness within the therapeutic relationship in adolescent residential treatment; the healing nature of relationship, connection, and feelings of safety with adolescents in residential treatment; and the concept of attachment as fundamental in adolescent residential treatment. Implications for practice and training, limitations, and suggestions for future inquiry are also discussed.

Committee: Martha Straus PhD (Committee Chair); Gina Pasquale PsyD (Committee Member); Cara Bonuso PsyD (Committee Member) Subjects: Clinical Psychology

MPH, University of Cincinnati, 2017, Medicine: Epidemiology

BACKGROUND: Asthma morbidity is most prevalent among children living in under-resourced, urban environments. Additionally, children living in economically depressed regions tend to experience many barriers to accessing medical care. This study investigates the effects of combining school-based asthma care and health technology to increase access to asthma care among minority students in Cincinnati, Ohio from the perspectives of multiple stakeholders. METHODS: Patients in this study participated in the Asthma Free Schools pilot program (AFS) which engaged youth with poorly controlled asthma in six telehealth appointments with an asthma specialist and six telehealth appointments with an adherence specialist. Descriptive, secondary analysis of inter and post-intervention surveys revealed how well the AFS program met stakeholders' expectations. Survey questions focused on the interaction between participants and the study staff, ease of technology use and participants' opinion of the value of telehealth appointments. RESULTS: Across surveys and stakeholder groups, results revealed high satisfaction with the AFS program. All guardians and nurses believed the telehealth visits met their child's healthcare needs. The AFS program drastically increased access to care among minority youth; 85% (n=11) patients reported that without telehealth, they would not have seen an asthma or adherence specialist. Finally, according to school administrators, participation in the AFS program proved a positive experience for school staff, students and families. DISCUSSION: The AFS program successfully combined school-based healthcare and health technology to increase access to patient-centered, asthma care among patients with uncontrolled asthma living in lower-income, minority communities. All stakeholders were pleased with the intervention, which was likely due to the rapport among researchers, school staff, and families. As school-based health centers become more prevalent, (open full item for complete abstract)

Committee: Liza Murrison Ph.D MPH (Committee Chair); Kevin Hommel Ph.D. (Committee Member); Rachelle Ramsey Ph.D. (Committee Member) Subjects: Public Health

Doctor of Philosophy, The Ohio State University, 1987, Graduate School

Committee: Not Provided (Other) Subjects: Education

Doctor of Psychology (Psy.D.), Xavier University, 2016, Psychology

Adolescent substance misuse is a public health problem that results in substantial costs to society. Teenagers who move beyond normative use and require treatment often do not improve due to poor treatment initiation, retention, and completion. As such, efforts are needed to improve adolescent-focused substance use treatment. One potential avenue for strengthening outcomes is increasing parental engagement, as parents are central for adolescent treatment progress. The present study sought to increase treatment initiation, adherence and completion by targeting parental ambivalence about treatment using a brief motivational enhancement (ME) intervention. Using random assignment, the ME was compared to a time-matched psychoeducation (PE) control intervention and a standard care control (SCC) condition. Results from the study indicated no differences in outcome across conditions. Participants who received the ME were not significantly more likely to follow through with treatment recommendations, attend more sessions of treatment, or complete the program with greater frequency. Overall findings suggest that motivational enhancement does not provide added value to a private-pay, traditional adolescent substance use assessment. The present findings underscore the need to consider context when using motivational interviewing as extant findings may inflate its relative efficacy.

Committee: Susan Kenford Ph.D. (Committee Chair); Kathleen Hart Ph.D. (Committee Member); Gibson Jennifer Ph.D. (Committee Member) Subjects: Psychology

Master of Arts, Ursuline College, 2008, Art Therapy and Counseling

The current research regarding the usefulness of art therapy interventions with bipolar disordered adolescents is limited. This case study examines the efficacy of art therapy interventions with a 13-year-old African American male client. At the time the case study was conducted, the subject was a client in a residential treatment facility for emotionally and behaviorally troubled adolescents. The results of the case study indicated that art therapy enabled this particular client, who was normally treatment resistant, to cultivate a therapeutic relationship with the art therapist and visually explore his feelings even when he was unable to verbalize them. The art therapy sessions also allowed the art therapist to identify oncoming cycles of mania through the client's responses to both the art therapist and the the various art interventions. Finally, the art therapist also discovered that this client became engaged towards therapeutic art tasks that reflected his hobbies and interests.

Committee: Gail Rule-Hoffman M.Ed (Committee Chair) Subjects: Mental Health; Psychology; Psychotherapy; Therapy

Master of Arts, Ursuline College, 2008, Art Therapy and Counseling

The trauma endured by children entering foster care can be horrific. The child often works diligently to recover from the abuse and neglect that he or she has endured. The pain that the child experiences through the healing process may hamper the recovery. The child may resolve or identify issues by using art to lessen the burden and pain he may hold within himself. Art therapy as part of a treatment team approach with a child who has many needs, such as a foster child, is usually welcomed by the child, and can be very effective as part of an overall treatment plan.

Committee: Cecile Brennan (Advisor); Gail Rule-Hoffman (Advisor); Diane Merros (Advisor); Valerie Treisch-Chirdon (Other) Subjects: Art Education; Behaviorial Sciences; Mental Health; Physiological Psychology; Psychology; Social Psychology; Therapy

MA, University of Cincinnati, 2011, Arts and Sciences: Psychology

This study examined the relation of race/ethnic-matching (i.e., matching therapist and client based on self-reported race/ethnicity [REM]) to the treatment outcomes of 471 Hispanic, African American, and White adolescents in substance abuse treatment. Additionally, exploratory analyses were conducted to examine family functioning as a moderator variable between racial/ethnic match and treatment outcomes. Logistic and multiple regression analyses revealed that REM, alone, did not significantly predict the treatment outcomes of the African American and White adolescents. However, REM predicted an increase in the externalizing behaviors (e.g., non-compliance, aggression, hyperactivity) and substance use of Hispanic adolescents 12 months post baseline assessment. Family functioning moderated the relationship between REM and treatment engagement for African American adolescents. As family functioning worsened, African American adolescents who were matched had a higher likelihood of treatment engagement. Implications for substance abuse treatment with ethnic minority adolescents and future race/ethnic-matching research are provided.

Committee: Ann Kathleen Hoard Burlew PhD (Committee Chair); Farrah Jacquez PhD (Committee Member); Bridgette Peteet PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2005, Social Work

Within the complexities of the therapeutic milieu often times the youth workers interacting most directly with the youth encounter situations which lend themselves to pushing the boundaries. Entwined in the youth worker and teen encounter, the youth may find themselves grappling with thoughts, feelings, and behaviors in direct response to issues of professional boundaries. Distinguished from the specific roles of social workers, psychologists, and psychiatrists, the youth workers comprise the women and men that provide the day to day care of the teens in treatment. To date, there is a scant amount of literature addressing the topic of professional boundaries with teenagers in residential treatment programs. Further, lacking in the literature are studies that address the topic from the perspective of adolescents. Because the gap in the literature has left many unanswered questions, as a result, a qualitative case study was conducted in order to gain a more thorough understanding of professional boundaries as they relate to adolescent females placed in residential treatment for emotional and behavioral difficulties. Findings from the interviews with teens revealed three categories: 1) Physical Presence, 2) Staff and Teen Emotional Connection, and 3) Teen's Mindful Awareness of their Current Emotional Living Environment. The young women highlighted how they are able to navigate the rules and limits set upon them in residential treatment. However, the teens articulately expressed their desire to have a physical (nonsexual) and emotional relationship with both their peers and staff members. The young women at TT expressed wanting staff to set limits so that boundary violations could and would not occur. However, within the daily living environment teens expressed a desire to have the confines of boundary crossing situations to be more relaxed. Based on the findings, implications for practice at the micro and macro levels are suggested.

Committee: Susan Saltzburg (Advisor) Subjects: Social Work

Doctor of Philosophy, The Ohio State University, 2002, Educational Services and Research

This study was designed to address multiple questions surrounding the broad topic of adolescent depression in magnet school adolescents. All participants in this study were drawn from a magnet high school for academics/talented arts in a metropolitan Louisiana city. This study therefore adds to the limited base of literature which addresses the prevelance of depressive symptoms in this population. The relationship between depression and numerous factors was examined as well, including locus of control, grade point average, race, gender, socioeconomic status, and school attendance. In addition, the study investigated the degree to which adolescent self-reports and teacher ratings agree in this population, while also looking at personal and professional characteristics that may have influenced teacher ratings. Results from this investigation revealed high rates of depressive symptoms in this population, with 29% of student self-reports and 24% of teacher reports suggesting significant levels of depression. Levels of agreement between the student and teacher forms were low. The relationship between depression assessments and scholastic correlates (attendance, G.P.A.) failed to meet the criteria selected for statistical significance (alpha=.01). Stronger correlations were observed between depression self-assessments and psycho-social factors (stressful life events and locus of control). An analysis of teacher assessments indicated that significant between-group variations existed when teacher rating forms, divided by gender and attitude regarding adolescent depression, were compared. Finally, in addition to addressing the primary research considerations noted here, the results section of this study presents findings which suggest that short term, school-based counseling may be an effective means for reducing symptoms of depression in adolescents.

Committee: Antoinette Miranda (Advisor) Subjects:

Doctor of Philosophy (PhD), Ohio University, 2009, Psychology (Arts and Sciences)

This study explores relationships between treatment outcomes, parent involvement, and family variables in an adolescent residential substance use treatment program. Adolescents (N = 165), ages 13 to 18 (61% male), and their parents or guardians participated in this study. Statistically significant changes between pre- and post-treatment adolescent attitudes toward drugs, psychological symptom severity, and stage of change were found. Abstinence rates at 7-day and 30-day follow-up were 83.9% and 75.6% respectively. Increased parent contact was associated with reduced 7-day abstinence rates. Increased family conflict predicted increased parent contact. Increased levels of parent precontemplation and maintenance predicted decreased parent contact. Findings suggest residential treatment remains a viable treatment option for substance-using adolescents. Parent and family factors appear to impact parent contact, and parent contact appears to impact treatment outcome, though the effects remain unclear. Further exploration of the construct of parent involvement is warranted.

Committee: John P. Garske PhD (Committee Chair); Bruce Carlson PhD (Committee Member); Benjamin Ogles PhD (Committee Member); Julie Owens PhD (Committee Member); Karen Carlson PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy in Urban Education, Cleveland State University, 2009, College of Education and Human Services

This study investigated student outcomes by analyzing archival PEP client data from the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 2000). Participants were students with severe emotional and behavioral problems, being served by the Positive Education Program's (PEP) Day Treatment Centers in a midwestern urban center. The CAFAS is a multidimensional rating scale that measures degree of behavioral and emotional impairment across domains in children and adolescents. In addition to subscale and total score analysis, the CAFAS permits analysis of subscale score results in terms of CAFAS Tiers that represent different client types (Hodges, 2004). Hodges (2004) indicated that CAFAS Tiers are a research-based way of assigning clients to diagnostic groups based on the level of impairment in their functioning. CAFAS Tiers have multiple potential utilities which include screening clients for serious problems (i.e., self-harm potential), linking research-based treatments to specific client needs, and assisting agencies with staff training needs and cost allocation decisions (Hodges, 2003a, 2004). This study investigated the utility of the CAFAS in identifying outcomes for PEP students (aka: children, clients, youths) as a function of their CAFAS Tier type. PEP clients' CAFAS Tier type and change in CAFAS scores were compared over a one year period. Results showed that four out of five Tier types demonstrated significant score reduction between first and last CAFAS. Tier groups with highest impairment (i.e., highest overall CAFAS scores at intake) showed the greatest amount of score reduction from first to last CAFAS. The Thought Problems and Delinquency Tiers remained significantly impaired on the Thinking and Community subscales. Lastly, the membership in the severe Tiers' groups at intake decreased by last CAFAS - except for the Thought Problems Tier. Potential benefits of this study include (a) a means to more closely analyze PEP students' outcomes, ( (open full item for complete abstract)

Committee: Kathryn MacCluskie EdD (Committee Chair); Ann Bauer PhD (Committee Member); Ronald Beebe PhD (Committee Member); Kathleen McNamara PhD (Committee Member); Sarah Toman PhD (Committee Member) Subjects: Education; Psychology

Doctor of Philosophy in Urban Education, Cleveland State University, 2009, College of Education and Human Services

One in five children and adolescents meet the criteria for psychiatric disorders each year. Of those who meet the criteria and are referred for treatment, forty to sixty percent will terminate prematurely (Nock and Kazdin, 2001). While some researchers studying this phenomenon have focused on how a client progresses through treatment and others look at dropout risk factors, no one has explored the relationship between the two. The specific purpose of this study is to provide information to the existing pool of research focusing on treatment effectiveness and completion to help provide better services to the mentally ill adolescent population already being seriously underserved in this country. A client's readiness to change a behavior in treatment, as studied by James Prochaska (1993), and barriers one faces throughout treatment, as researched by Alan Kazdin (1997) are two variables that have been developed for the purpose of understanding the dynamics of change in the therapeutic setting. Specifically, Prochaska has developed the Transtheoretical Model of Change including five stages (Precontemplation, Contemplation, Preparation, Action and Maintenance) through which one progresses while in treatment, from a lack of intention to change, to the recognition of a problem but an unwillingness to do anything about it, to a decision and commitment to change. Prochaska believes that change must occur for individual development and that his Transtheoretical Model provides a balance of empiricism and theory for utility among various populations (Petrocelli, 2002). Kazdin (1997) has found that child and adolescent dropouts in treatment showed higher levels of barriers than did completers based on parent and therapist total barriers scores. His term “barriers to participation in treatment” explore factors that might impact a client's ability to successfully complete a treatment program, including socioeconomic disadvantage, family stress and life events. Data for this study (open full item for complete abstract)

Committee: Elizabeth Welfel PhD (Committee Chair); Donna Schultheiss PhD (Committee Member); Kathryn MacCluskie PhD (Committee Member); Sarah Toman PhD (Committee Member); Constance Hollinger PhD (Committee Member) Subjects: Developmental Psychology; Psychology; Psychotherapy; Social Psychology