Table 2.
Reliability of observer ratings of goals and strategies in the child therapy process rating system (CTPRS)
| Goal/strategy | Child ICC | Caregiver ICC |
|---|---|---|
| Collect information about…’s mental health status, behavior, and/or functioning in one or more contexts (e.g., home, school, with peers); OR about family structure, such as: (a) who members of the family are and how individuals are related to one another, or (b) the strength of relationships that family members have with one another | .56 | .68 |
| Collect information about…’s current psychosocial stressors | na | .68 |
| Collect information about…’s strengths and/or supports | .30 | .58 |
| Gather information about high-risk issues and/or assess for the presence or extent of high-risk issues | .89§a | .01§b |
| Develop and/or facilitate the development of a safety plan or crisis plan to respond to high-risk issues | .89§a | .01§b |
| Provide an outline or agenda of goals during the session . The agenda could have been verbal or written | .60 | .60§c |
| Review the progress of the child/family toward meeting treatment goals | na | .60§c |
| Help the child receive appropriate medications . This could occur either by connecting the child/family with an appropriate individual, or by the therapist assessing needs or prescribing him/herself (when appropriate) | .79 | |
| Connect at least one individual with other informal/social supports, or strengthen relationships with other informal/social supports (e.g., friends, other parents, informal support groups, etc.) | .51§d | .61§e |
| Connect at least one individual with other formal services or strengthen their relationships with other formal services (e.g., Head Start, social services, respite care, legal services, alcohol and drug treatment services, etc.). DO NOT COUNT MEDICATION SERVICES HERE | .51§d | .61§e |
| Help at least one individual learn more about specific skills or abilities that the child is learning or improving | – | na |
| Help at least one individual to identify and/or counteract his/her cognitive distortions (e.g., irrational beliefs and/or thoughts) | .00 | .05 |
| Help at least one individual to improve his/her ability to understand and/or differentiate emotions from one another (e.g., This could involve: (a) recognizing specific emotions, (b) understanding the meaning of and verbal and nonverbal cues associated with specific emotions, etc.) | .63§f | – |
| Help at least one individual to improve his/her ability to identify his/her own signs or cues that signify specific emotions (e.g., feeling hot, muscular tension, self-denigrating thoughts, accusatory thoughts, might signify anger or sadness) | .63§f | – |
| Help at least one individual to improve his/her ability to use structured problem solving skills to handle difficult interpersonal situations (e.g., this could include skills such as: (a) recognizing and identifying the problem, (b) coming up with possible solutions, (c) evaluating possible consequences of different actions, (d) choosing an action to take, (e) rewarding oneself for problem solving, etc.) | .40 | – |
| Help at least one individual to improve his/her social and/or communication skills. For example, skills might include: (a) how to listen effectively, (b) how to reflect back what another person has said, (c) how to give equal time to participants in a conversation, (d) how to meet a new person, (e) how to start a conversation, etc | .51 | – |
| Help at least one individual to improve his/her ability to use relaxation skills or techniques. This could involve techniques such as: (a) meditation, (b) deep breathing strategies, (c) progressive muscle relaxation, (d) pleasant imagery, etc | .68§g | – |
| Help at least one individual to improve his/her ability to reduce own stress level. This could include: (a) relaxation or meditation skills, (b) finding time to take personal time outs, (c) taking part in more pleasant activities, (d) finding ways to anticipate and avoid stressful situations, etc | .68§g | na |
| Help at least one individual to improve his/her ability to understand another family member’s perspective and/or feelings | .54 | .52 |
| Help at least one individual to improve his/her ability to coordinate and be consistent with at least one other individual in how they interact with child (e.g., both respond to hitting in the same way). This could be caregivers with one another or caregiver(s) with teacher(s) | – | na |
| Help at least one individual to improve his/her ability to: (a) assume adaptive/appropriate parental or caregiver roles and/or responsibilities, or (b) eliminate or reduce inappropriate parental or caregiver roles and/or responsibilities (e.g., acting as the child’s parent, rather than their friend) | – | na |
| Help at least one individual to improve his/her ability to: (a) assume adaptive/appropriate child roles and/or responsibilities, or (b) eliminate or reduce inappropriate child roles and/or responsibilities (e.g., decrease child’s acting in a parental role or engagement in a coalition against another caregiver, etc.) | na | – |
| Help at least one individual to improve his/her ability to give effective commands. This could include helping the individual to: (a) state commands succinctly, (b) not repeat commands over and over, (c) use commands that ask the child to start doing something rather than stop doing something, (d) give the child choices in commands, etc | – | .42 |
| Help at least one individual to improve his/her ability to monitor or keep track of child behavior (either appropriate or inappropriate child behavior). For example, this might involve providing supervision of the child, or maintaining contact with teachers, babysitters, daycare providers, etc | – | .03 |
| Help at least one individual to improve his/her ability to respond effectively to inappropriate or negative child behavior. This could involve how to: (a) ignore inappropriate behavior, (b) be consistent over time in responses to behavior, (c) select natural or logical consequences, etc | – | .62§h |
| Help at least one individual to improve his/her ability to use Time Out | – | .62§h |
| Help at least one individual to improve his/her ability to respond effectively to appropriate or good child behavior. This could involve methods such as: (a) attending to and/or praising appropriate behavior, (b) looking for approximations of good behavior to praise, etc | – | .79§i |
| Help at least one individual to improve his/her ability to use reward systems with child. This could involve: (a) selecting behaviors to target, (b) selecting how to reward behaviors, (c) developing a reward chart, etc | – | .79§i |
| Help at least one individual to experience and/or express affect (especially emotions he/she may not have been able to release). These may be in response to events or circumstances in the past, present, or future | .64 | – |
Note Intraclass correlations (ICCs) were computed based on 258 double-coded therapy sessions from a larger sample of treatment sessions studied in the Child and Adolescent Treatment Strategies (CATS) study. Each goal and strategy has a more detailed accompanying definition that observers used to identify and code when therapists were pursuing specific goals or strategies. The checklist and definitions are both available directly from the first author. All ICCs greater than or equal to .30 are significant P < .05. § with a letter denotes a code that was combined with another code in the larger CATS study to reduce the total number of CTPRS codes. Goals and strategies with the same letter were combined. ICCs for the combined codes are reported here for each separate code individually. na, information not available about reliability in the broader CATS study because the goal or strategy was not measured as a separate or similar code. –, indicates that ratings were not made about a goal or strategy for a particular target (child or caregiver)