A multiple baseline investigation of Conjoint Behavioral Consultation (CBC) facilitated by a pediatric mental health consultant

Abstract

Behavior problems are the most common reason that young children are referred for mental health services (Offord et al., 1991). While effective intervention and treatment become a top priority for parents and educators alike, the resources mobilized to address these behavioral concerns vary depending on role and setting. A plethora of literature suggests that collaborative partnerships between families, educators and outside services providers are necessary and beneficial to address these issues, but there continues to be a lack of coordination between service providers, educational professionals and parents (Blue-Banning, Summers, Frankland, Nelson & Beegle, 2004; Power, DuPaul, Shapiro & Kazak, 2003). Conjoint behavioral consultation (CBC; Sheridan & Kratochwill, 1992) is a model that has the potential to address barriers, improve communication, build partnerships and increase collaboration between educators, families and healthcare providers (Burt et al., 2008; Power, 2003; Sheridan et al., 2009). Developed for use in the school setting to build problem-solving partnerships between teachers and parents, the traditional CBC model has a formidable body of empirical evidence to support its effectiveness for a plethora of mental health, educational and behavioral issues (Sheridan, Eagle, Cowen and Mickelson, 2001; Wilkinson, 2005). While CBC has been recommended as "best practice" for use in pediatric settings (Power, 2003), this study is among the first to experimentally evaluate its effectiveness when facilitated by a pediatric mental health clinician. In the current study, a pediatric mental health clinician used Conjoint Behavioral Consultation to facilitate the development and implementation of a collaborative behavior intervention plan. Parents, teachers and an outside mental health provider worked together to create and support a behavioral intervention that was used at home and school. Behavioral outcomes and collaboration indicators were measured throughout the study. Direct observations were conducted to monitor the percentage of expectations and commands that each participant complied with during specific problematic routines at home and school. Using a multiple baseline design across three participants, the researcher evaluated the effectiveness of collaborative interventions developed and implemented through CBC as means to improve behavioral outcomes at home and school. Data was evaluated for variability, trend, level, and percentage of overlapping data points. Effect sizes independent samples t-tests were also calculated for each participant. Perceptions of goal attainment, collaboration and parent-teacher relationship are qualitatively discussed. Results indicate that collaborative interventions developed by parents, teachers and a pediatric mental health clinician through the CBC process can be an effective way to improve behavior during problematic routines at home and school. Implications, limitations and future research directions are discussed.