Ph.D. - Psychology

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https://hdl.handle.net/10125/2145

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    STRENGTH-FOCUSED TREATMENT AND CLINICAL OUTCOMES FOR YOUTH IN PUBLIC MENTAL HEALTH CARE
    (2024) Turner, Emilee; Mueller, Charles W.; Psychology
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    Gifts for the Dead: Maya Children's Developing Theory of Mind and Their Participation in Día de los Muertos
    (2024) Bowen, Kristy Elizabeth Jo; Maynard, Ashley; Psychology
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    An Examination of Parental Behavioral Intentions to Use Youth Evidence-Based Services
    (2023) Choy, Spencer; Nakamura, Brad J.; Psychology
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    Treatment Focus Diffusion And Client Outcomes In Public Mental Health Care For Youth
    (University of Hawaii at Manoa, 2023) Holmes, Kalyn; Mueller, Charles W.; Psychology
    Research conducted in public mental health care (PMHC) suggests that therapists often divide treatment focus across several co-occurring issues (both diagnostic and non-diagnostic) over the course of treatment. This spreading of treatment focus across multiple concerns is referred to as treatment focus diffusion (TFD). There is emerging evidence that maintaining a central focus in treatment is an important element of effective services and that higher levels of TFD are associated with poorer client outcomes. Additional research is needed in order to determine the robustness and generalizability of TFD as a predictor of clinical and system outcomes. The program of research described in this dissertation aims to investigate the extent of TFD as it occurs in different service formats in PMHC settings (e.g., standards-based in- and out-of-home services and implemented evidence-based therapies) and its association with relevant outcomes. Data collected as part of routine quality assurance initiatives in a local state-wide child and adolescent mental health care system were examined using multi-level linear and logistic regression analyses including statistical controls for potential covariates.The following dissertation includes an introductory chapter to orient the reader to the theoretical and empirical background relevant to all four subsequent studies. Chapters two through five include four separate studies in manuscript submission format. The first study showed that in implemented Multisystemic Therapy (MST), an evidence-based treatment package, therapists reported a significantly lower average TFD level than those in a standards-based intensive in-home (SB-IIH) service format when accounting for other indicators of case complexity. The first, second, and third studies found that higher TFD was related to poorer outcomes in these two service formats, whether measured by therapist reported progress ratings, change in functional impairment, or longer-term subjective indicators of return to services and cost to the system. Across all three of these studies, the relationship between higher TFD and poorer outcomes tended to be stronger in the implemented MST service format than in the SB-IIH format. In the final study (Chapter 5) we examined TFD’s relationship to all previously identified outcomes in an out-of-home, community-based residential (CBR) service and in Functional Family Therapy (FFT), another implemented evidence-based treatment. This study found that CBR therapists reported relatively high levels of TFD while FFT therapists reported relatively low TFD. Second, more TFD was significantly related to poorer immediate outcomes (monthly average progress ratings and functional improvement over the course of the study episode) in the CBR service format. In FFT, higher TFD was significantly related to higher odds of returning to services. Across all four service formats, all but one of the TFD/outcomes relationships were in the expected direction. These results suggest that TFD might be a useful early indicator of later treatment success in PMHC. These services generally have a high rate of use and are often utilized by historically underserved clientele. Thus, it is important to deepen our understanding of treatment elements related to clinical outcomes in PMHC that might be amenable to improvement such as TFD.
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    Parents’ Marital Context And Adjustment In Children With Intellectual Disabilities
    (University of Hawaii at Manoa, 2023) Conover, Olivia; Floyd, Frank J.; Psychology
    Parents’ marital context, or the quality of their marital relationships and marital transitions across time, appears to affect emotional adjustment for typically developing children. However, little research has examined the impact of both marital quality and marital transitions on children’s development of adaptive skills, especially for children with intellectual disabilities. The current study examined how parents’ marital quality, status, and transitions over a 14-year period were related to behavior problems and adaptive behavior in children (n = 153, age 6 to 18 at the first wave of measurement) with mild or moderate intellectual disability, using parent reports at four time points. Parent’s marital quality, status, and experience of divorce or remarriage were considered at the start and the end of the study period. It was predicted that being happily married, as opposed to being unhappily married or single, would predict children’s concurrent and future lower levels of behavior problems and greater adaptive behavior. The experience of marital transitions was hypothesized to predict greater behavior problems and lower adaptive behavior skills at the final wave of measurement. Being unhappily married, single, or experiencing a marital transition was also hypothesized to predict greater growth in behavior problems and less growth in adaptive behavior over the course of the study. Multiple linear regression and multi-level modeling analyses were used. Being in a happily married family predicted children’s concurrent and future lower levels of behavior problems and greater adaptive behavior skills. Marital satisfaction was inconsistently related to rate of change in outcomes, but children in happily married families generally showed better adjustment across all time points. Marital transitions were not associated with behavior problems, but were associated with some aspects of adaptive behavior. These results provide evidence for the likely importance of parents’ marital context for the long-term adjustment of children with intellectual disabilities.