Thursday, August 2, 2018

Coping Power Program

Basic Info

The Coping Power program was "designed to address aggression in preadolescent children at the end of elementary school, to prepare them for the enhanced risks they will experience during their transition into middle school and adolescent years" (Lochman et al. 2012).

The Coping Power Child Component "is a 34-session program designed to take place across two school years within the fourth to sixth grade period. The program was designed for delivery to small groups of 5 to 7 students, with meetings taking place for about 1 hour each week during the school day. Typically, two clinicians lead the sessions, with one leader taking responsibility for delivering the program content while the other coleader monitors and manages group behavior. In addition to the weekly groups, Coping Power leaders hold monthly individual meetings with students to build rapport, assess and ensure comprehension of material, and individualize the program as needed" (Lochman et al. 2012).

The Coping Power Parent Component "includes 16, 90-minute meetings that take place separately from the child sessions, but during the same 16-to 18-month period. Parent meetings can include up to 12 parents or parent dyads, and are typically led by the same two clinicians who lead the child groups. Main content areas for the Coping Power parent sessions include positive parenting skills, family cohesion and fostering communication, family problem-solving, involvement in children’s academic programs, and behavior man-agement (e.g., ignoring, time out, effective consequences for mis-behavior). Parents are also taught to reinforce the skills their children are learning in their groups" (Lochman et al. 2012).

Theoretical Foundation

The theoretical foundation of the Coping Power Program rests on the contextual social-cognitive model. This model postulates two causes for aggression in children: ineffective parenting and impaired social-cognitive processing. This model also holds that children's aggressive behavior is a risk factor for later negative adolescent problems, including school problems, delinquency, and substance abuse.

Ineffective parenting. Lochman & Wells (2002a) write that innate factors and non-shared environmental factors also contribute to aggression, but their focus is on parental factors. They write that "child aggressive behavior arises most fundamentally out of early contextual experiences with parents who provide harsh or irritable discipline, poor problem solving, vague commands, and poor monitoring of children's behavior."

Impaired social-cognitive processing. Research shows:
  • "Aggressive children have cognitive distortions at the appraisal stage of social-cognitive processing b/c of difficulties in encoding incoming social information and in accurately interpreting social events and others' intentions." In other words, aggressive children tend to be bad at interpreting social events: they base their interpretations of events on fewer cues than their peers; they focus their attention on hostile cues, ignoring neutral cues; they're more likely to believe that others are behaving with hostility. 
  • Aggressive children "have cognitive deficiencies at the problem solution stage of social-cognitive processing, generating maladaptive solutions for perceived problems and having nonnormative expectations for the usefulness of aggressive and nonaggressive solutions to their social problems." In other words, such children are not good at offering verbal solutions, being assertive, finding compromise. They believe that aggressive behavior will yield positive results. 

Lochman et al. (2001). From CEBC: "Students identified as having moderate to severe aggressive behavior problems by teachers and dormitory staff were randomly assigned to receive the intervention in year one or to receive it in year two (waitlist control). The Coping Power Program for this study consisted of 33 group sessions. Behavioral outcomes were assessed using the Behavioral Assessment System for Children (BASC) and the Behavioral Improvement Rating. Social and emotional factors that were hypothesized to be related to aggressive behavioral outcomes were also assessed using the Language Independent Measure of Communicative Confidence (LIMCC), Meadow-Kendall Social-Emotional Assessment Inventory, Piers Harris Self-Concept Scale, Problem-Solving Measure for Conflict (PSM-C). Results showed that children in the intervention condition showed improvement on BASC scores for improvement in behavior, social problem-solving skills, and communication abilities. Limitations include a small sample size and lack of long-term follow-up."

Lochman & Wells (2002a). Study: Fourth and fifth grade boys, 15-month program, assessed pretest, posttest, and one year after intervention ended. Boys selected based on teacher screening scores, 183 boys with most aggressive and disruptive behaviors chosen. Boys randomly assigned to (a) Child Intervention only, (b) Child + Parent Intervention, (c) control group. (See later studies for intervention details.) CEBC: "The report combines the two intervention conditions in the analyses. Outcome measures included self-reports of delinquency using the National Youth Survey, parents’ reports of youth substance abuse, and behavioral improvement ratings made by teachers who were not aware of the boys’ treatment conditions. Coping Power’s effect on delinquency, substance use, and school behavior outcomes was at least partially mediated through intervention-produced changes in child and parent variables that were targets for the intervention. Analysis suggested that the strongest effects on later delinquent behavior were found on two traits: consistency of discipline and anger resulting from hostile attributions for others’ behavior."

Lochman & Wells (2002b). Fourth grade teachers in 17 schools asked to complete screener assessing student aggression. Researchers selected most aggressive children, 245 received parental permission to participate in intervention. The following year, the students were randomly assigned to one of four conditions: 
  1. Coping with Middle School Transitions (CMST): five 2-hour teacher meetings with Coping Power Staff and four parent meetings.
  2. Coping Power Child Component: 22 sessions in fifth grade, 12 sessions in sixth grade (40-50 min. each) + 30 min individual session every other month. Five-eight students per group, led by Coping Power staff member and school counselor. 
  3. Coping Power Parent Component: 16 sessions. Parents taught basic behavior management as well as CBT problem-solving model. 
Each school had at least one intervention and one control classroom. Measures: child self-report for substance use, child self-report for self-regulation, parent rating for aggression, teacher rating for aggression, teacher rating for social competence. Four groups: (a) CMST + CP Program, (b) CMST only, (c) CP Program only, (d) control (school as usual). Findings: 
  1. All three intervention cells had produced a lower rate of substance use than the control group. 
  2. CMST + CP Program: "Children who received both interventions displayed improvements in their perceptions of their social competence with their peers, and their teachers rated these children as having the greatest increases in problem-solving and anger-coping skills. These children receiving both interventions also tended, in comparison with children in the other three cells, to display less pronounced increases in anger in response to vignettes about provocative and frustrating social problems with peers and parents, and they tended to have more marked decreases in teacher-rated aggressive behavior over time."
  3. CP Program only: "Children of families receiving the Coping Power child and parent components had significant reductions in parent-rated proactive aggressive behavior, and teacher-rated proactive aggressive behavior also tended to be reduced. Teachers also reported significant increases in overall behavioral improvement for the Coping Power children by the end of intervention." These children did not improve in the area of reactive aggressive behavior, "indicating that this form of intervention has less impact on impulsive aggression." "Teachers’ ratings of the specific types of social skills targeted by the Coping Power indicated that the program had enhanced these children’s abilities to express emotions, to handle disagreements in produc-tive ways, and to work and play with peers in more cooperative ways." 

Lochman & Wells (2003). Abstract only. CEBC: Children from Lochman & Wells (2002) one year after intervention. Children in CP Program only showed reduced rates of self-reported delinquency, compared to control group. Children in CMST + CP Program showed reduced rates of delinquency and also reduced rates in teacher-rated aggression, compared to control group.

Lochman & Wells (2004). 183 fourth and fifth grade boys in 11 schools identified by screening given to teachers as high-risk for aggression. Intervention began in spring when boys were in fourth or fifth grade; intervention lasted 15 months; follow-up assessment conducted one year after intervention ended. Boys randomly assigned to one of three groups: (a) Child Intervention only (CI) (Coping Power child component, 33 sessions 40-60 min., co-lead by specialist and school counselor), (b) Child + Parent Intervention (CPI) (16 parent sessions), control condition (C) (school as usual). Students 47% black, 53% white. Results: 
  1. CPI boys had lower rates of self-reported covert delinquency (theft, fraud, property damage), although no intervention effects on overt delinquency (e.g., robbery or assault). 
  2. CPI boys: parents reported decreased substance use, although boys themselves did not.
  3. Both CI and CPI: teachers reported improvements in school behavioral problems, "suggesting that intervention-produced changes in children’s abilities to cope effectively with difficult peer and adult conflicts had continued to grow in the year following intervention." The teachers who rated the boys at 1-year follow-up were seemingly blinded as intervention concluded year before. 

Van de Wiel et al. (2007). From CEBC: "Children meeting a DSM-IV diagnosis of disruptive behavior disorder were randomly assigned to receive a version of the Coping Power Program aimed at severely disturbed children or to care as usual. The authors further categorized care as usual into family therapy or behavior therapy for the comparison. Problem behaviors were measured using the Parent Daily Report (PDR) and the Child Behavior Checklist (CBCL). The CBCL was completed by both parents and teachers. Behavior scores were significantly improved, post-treatment, for the Coping Power Program group in comparison with the family therapy group, but not in comparison with the behavior therapy group. Limitations include differences in the number of therapy sessions across groups and small sample sizes, particularly for the comparison groups."

Zonnevylle-Bender, Matthys, van de Wiel, & Lochman (2007). From CEBC: "This study uses the same sample describe in van de Wiel, et al. (2007). Participants were randomly assigned to receive either the Coping Power Program or care as usual (CU). An additional, non-randomized, comparison group of non-treated youth was recruited from high schools to complete the measures (referred to as the HC group). The youths’ self-reported attitudes towards drugs and alcohol and their use of them were measured with the CSAP Student Survey. Delinquent behavior was measured with the Delinquency Scales of the National Youth Survey. Results showed that both the Coping Power Program and CU group were comparable in rates of substance abuse and delinquency to the HC group. The Coping Power Program group also reported lower rates of smoking than the CU group. Limitations include the use of self-report measures of substance use."

Jurecska, Hamilton, & Peterson (2011). From CEBC: "This study discusses the effectiveness of the Coping Power Program. Students were randomized to an intervention group of Coping Power Program or to a control group. Measures utilized were the Behavior Assessment Scale for Children-2 (BASC-2 SRP) and the BASC-2 TR. A subset of students from the Coping Power Program group was identified as significantly improved. A pre-intervention and postintervention measure showed that students with clinically significant hyperactivity and behavioral difficulties scores were the most sensitive to the Coping Power Program intervention. Limitations include small sample size and possible differences between the group leaders."

Muratori et al. (2015). Abstract only. Group randomized trial to see if Coping Power Program can be effective as universal classroom-based prevention intervention. "Nine classes (five first grade and four second grade) were randomly assigned to intervention or control conditions. Findings showed a significant reduction in overall problematic behaviors and in inattention–hyperactivity problems for the intervention classes compared to the control classes. Students who received Coping Power Program intervention also showed more pro-social behaviors at postintervention."

Lochman, Wells, Qu, & Chen (2013). From CEBC: "This study uses the same sample as Lochman & Wells (2002b). This study examined children who had been assigned to the Coping Power Program or to a care-as-usual comparison condition during the fifth and sixth grade years, at the time of transition to middle school. Measures utilized were the Behavior Assessment System for Children – Teacher Rating Scale (BASC-TRS), the Teacher Report of Reactive and Proactive Aggression, and the Antisocial Process Screening Device – Teacher Form (APSD-T). Results indicated indicate that the Coping Power Program had effects through the 3 years after the end of intervention on reductions in children’s aggressive behavior and academic behavior problems, children’s expectations that aggression would lead to positive outcomes, and parents’ lack of supportiveness with their children. There was limited support for the hypothesis that intervention effects would be greater in less problematic neighborhoods. Limitations include generalizability due to the limited population and that the analyses conducted test patterns of change in outcome variables across time, and does not test whether the intervention and control groups significantly differ at each specific time period after the intervention."

Lochman et al. (2012). The program can be successfully adapted. Of special interest to me: The program was efficacious when taught over 9-month period.

* * * * *

Jurecska, D. D., Hamilton, E. B., & Peterson, M. A. (2011). Effectiveness of the Coping Power Program in middle-school children with disruptive behaviors and hyperactivity difficulties. Support for Learning, 26, 168-172.

Lochmann, J. E., FitzGerald, D. P., Gage, S. M., Kanaly, M. K., Whidby, J. M., Barry, T. D., ... McElroy, H. (2001). Effects of a social-cognitive intervention for aggressive deaf children: The Coping Power Program. Journal of the American Deafness and Rehabilitation Association, 35(2), 39-61.

Lochman, J. E., Powell, N., Boxmeyer, C., Andrade, B., Stromeyer, S. L., & Jimenez-Camargo, L. A. (2012). Adaptations to the coping power program's structure, delivery settings, and clinician training. Psychotherapy, 49(2), 135.

Lochman, J. E., & Wells, K. C. (2002a). Contextual social–cognitive mediators and child outcome: A test of the theoretical model in the Coping Power program. Development and psychopathology, 14(4), 945-967.

Lochman, J. E., & Wells, K. C. (2002b). The Coping Power program at the middle-school transition: Universal and indicated prevention effects. Psychology of Addictive Behaviors, 16(4S), S40.

Lochman, J.E., & Wells, K.C. (2003). Effectiveness of the Coping Power Program and of classroom intervention with aggressive children: Outcomes at a 1-year follow-up. Behavior Therapy, 34, 493-515. Abstract only.

Lochman, J.E., & Wells, K.C. (2004). The Coping Power Program for preadolescent aggressive boys and their parents: Outcome effects at the 1-year follow-up. Journal of Consulting and Clinical Psychology, 72(4), 571-578.

Lochmann, J. E., FitzGerald, D. P., Gage, S. M., Kanaly, M. K., Whidby, J. M., Barry, T. D., ... & McElroy, H. (2001). Effects of a social-cognitive intervention for aggressive deaf children: The Coping Power Program. JADARA-ROCHESTER NY-, 35(2), 39-61. CEBC only.

Lochman, J. E., Powell, N., Boxmeyer, C., Andrade, B., Stromeyer, S. L., & Jimenez-Camargo, L. A. (2012). Adaptations to the coping power program's structure, delivery settings, and clinician training. Psychotherapy, 49(2), 135.

Lochman, J. E., Wells, K. C., Qu, L., & Chen, L. (2013). Three year follow-up of Coping Power intervention effects: Evidence of neighborhood moderation? Prevention Science, 14(4), 364-376.

Muratori, P., Bertacchi, I., Giuli, C., Lombardi, L., Bonetti, S., Nocentini, A., ... & Lochman, J. E. (2015). First adaptation of Coping Power program as a classroom-based prevention intervention on aggressive behaviors among elementary school children. Prevention science, 16(3), 432-439. Abstract only.

Van de Wiel, N. M. H., Matthys, W., Cohen-Kettenis, P. T., Maassen, G. H., Lochman, J. E., & van Engeland, H. (2007). The effectiveness of an experimental treatment when compared to care as usual depends on the type of care as usual. Behavior Modification, 31, 298-312.

Zonnevylle-Bender, M., Matthys, W., van de Wiel, N. M. H., & Lochman, J. E. (2007). Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 46(1), 33-39.

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