Coping Power/Utrecht Coping Power (CPP) - an indicated programme for children with disruptive behaviour
At a glance
Country of origin
- USA
Level(s) of intervention
- Indicated prevention,
- Targeted intervention,
- Universal prevention
The Utrecht Coping Power Programme (UCPP) was adapted from the Coping Power Programme (CPP), which was originally developed as a prevention programme for at-risk children. The programme was then adapted to everyday clinical practice for children diagnosed with DBD. It includes all of the essential elements of the CPP. The UCPP combines a cognitive behavioural intervention for the child with a behavioural parental intervention. There are 23 weekly sessions of 1.25 hours with groups of four children.
There are 15 parents’ sessions, which occur every other week, lasting 1.5 hours each. During the children’s sessions, there is recognition of feelings and emotions, social problem solving takes place, and communication skills are discussed and practised. The parents’ sessions focus on parenting skills, stress management and problem solving. The two components (parent and child) are integrated during the parents’ sessions by showing them videos of the children. The sessions take place in a clinical setting.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Dr Walter Matthys
Rudolf Magnus Institute of Neuroscience
University Medical Centre,
Department of Child and Adolescent Psychiatry
Utrecht 85500, 3508 GA
Utrecht, the Netherlands
Email: W.Matthys[a]umcutrecht.nl
Website: www.copingpower.com
Overview of results from the European studies
Studies overview
The programme has been evaluated in: one randomised controlled trial (RCT) in the Netherlands involving children aged 8-13 years with disruptive behaviour disorder; one quasi-experimental study in Italy involving children aged 8-9 years with disruptive behaviour disorders and comparing Coping Power to, respectively, no treatment and a multi-component programme based on cognitive-behavioural therapy; and three cluster RCTs in Italy, evaluating the programme in a classroom-based format – one with children aged approximately 7-8 years, one with children aged approximately nine years, and one with children aged four years.
In the Dutch RCT, there was a statistically significant effect favouring the intervention at post-test on parent-reported child aggression but not on parent-reported oppositional behaviour or teacher-reported externalising behaviour. About four years after the programme ended, there was a statistically significant effect favouring the intervention on self-reported use of cigarettes in the last month, but not on the use of alcohol or marijuana. However, there was a statistically significant effect favouring the intervention on self-reported lifetime use of marijuana (although not on alcohol or cigarettes). About four years after the programme ended, there was no difference between intervention and control conditions in self-reported delinquency.
In the Italian quasi-experimental study evaluating the targeted version of the programme, assessments were conducted at post-test and one year after the intervention ended but they were analysed together as longitudinal data. There was a statistically significant effect favouring Coping Power (compared to both the control and alternative intervention conditions) on parent-reported child aggressive behaviour and parent- and self-reported child callous traits, but not on parent-reported child rule-breaking behaviour. In terms of parent outcomes, there was a statistically significant effect on positive parenting and inconsistent discipline, but not on harsh discipline or involvement (parent-reported, compared to the other intervention).
In the Italian study with 7-8 year olds (in a universal version of the programme), there were statistically significant effects at post-test and 12 months after the programme ended on three of six teacher-reported child behaviours – prosocial behaviour, hyperactivity and total difficulties – but not on conduct problems, emotional symptoms or peer problems. At the follow-up, academic grades were also analysed, showing a statistically significant effect favouring the intervention.
In the Italian study with 4 year olds (in a universal version of the programme), there were statistically significant effects favouring the intervention at post-test on teacher-reported child conduct problems, prosocial behaviour and total difficulties (but not on emotional symptoms, hyperactivity or peer problems). Considering parent-reported measures, there was a statistically significant effect favouring the intervention at post-test for conduct problems only.
In the Italian study with 9-10 year olds, there was a statistically significant effect on all child outcomes measured, namely teacher-reported emotional symptoms, conduct problems and hyperactivity at post-test.
The programme has been rated as Promising by Blueprints for Healthy Youth Development database based on a review of studies conducted world-wide.
Countries where evaluated
- Italy,
- Netherlands
Characteristics
Protective factor(s) addressed
- Family: opportunities/rewards for prosocial involvement with parents
- Individual and peers: clear morals and standards of behaviour
- Individual and peers: interaction with prosocial peers
- Individual and peers: Problem solving skills
- Individual and peers: refusal skills and decision making
- Individual and peers: skills for social interaction
Risk factor(s) addressed
- Family: family management problems
- Individual and peers: anti-social behaviour
- Individual and peers: favourable attitude towards alcohol/drug use
- Individual and peers: favourable attitudes towards anti-social behaviour
- Individual and peers: interaction with antisocial peers
- Individual and peers: peers alcohol/drug use
- Individual and peers: rebelliousness and alienation
- School and work: low commitment/attachment to school/workplace
Outcomes targeted
- Relations with parents
- Alcohol use
- Use of illicit drugs
- Smoking (tobacco)
- Crime
- Other behaviour outcomes
- Social behaviour (including conduct problems)
Description of programme
The Utrecht Coping Power Programme (UCPP) was adapted from the Coping Power Programme (CPP), which was originally developed as a prevention programme for at-risk children. The programme was then adapted to everyday clinical practice for children diagnosed with DBD. It includes all of the essential elements of the CPP. The UCPP combines a cognitive behavioural intervention for the child with a behavioural parental intervention. There are 23 weekly sessions of 1.25 hours with groups of four children. This is in contrast to the CPP where there are 33 sessions which last 50 minute each. There are 15 parents’ sessions, which occur every other week, lasting 1.5 hours each.
During the children’s sessions, there is recognition of feelings and emotions, social problem solving takes place, and communication skills are discussed and practised. The children are introduced to the five steps of social problem solving: what is the problem, what are the solutions, what are the consequences, choosing the best solution and acting on this. The parents’ sessions focus on parenting skills, stress management and problem solving. The two components (parent and child) are integrated during the parents’ sessions by showing them videos of the children. There are detailed manuals for both components and randomly selected videotaped sessions are reviewed to check they are adhered to. The sessions take place in a clinical setting.
Implementation Experiences
Contact details
Pietro Muratori
pmuratori[a]fsm.unipi.it
Main obstacles
With respect to individual professionals
In the universal prevention version of Coping Power we trained teachers who then applied the intervention in their classes. Usually in the Italian school context prevention interventions include a psychologist/counsellor who provides behavioural consultation to teachers regarding both the high-risk children and other students, rather than a prevention intervention on whole classes. Sometimes it was difficult to promote a universal intervention due to the teachers' unfamiliarity with this type of intervention model.
In the Italian school context teachers complain about difficulties in applying interventions outside the academic curriculum.
With respect to organisational and economic context
The intervention was funded by school districts, some of those gave up the programme owing to the scarce resources of the school.
How they overcame the obstacles
With respect to individual professionals
The model includes ongoing supervision that aims to monitor the adherence to the universal intervention model outside the intervention's modules. The manual for the intervention includes several ways of integrating the programme's activities in daily school activities.
Strengths
In our educational setting, we decided to train the teachers who then applied the programme in the classroom. This implementation method is promising: teachers learn an intervention programme with a set of practices that can be integrated into the educational routines of classroom practices. This provides ample opportunity to teach and reinforce programme concepts so that the utilisation of the programme’s curriculum, along with programme-specific materials, can become a natural extension of their everyday activities. In summary, this implementation method could make CPU an intervention that is easily integrated in daily school activities. Furthermore, considering that a CPU trained teacher may apply this intervention in the future years, our current implementation method could be considered an inexpensive method that can also be sustainable in countries with fewer resources.
Weaknesses
The programme should be implemented with a brief intervention with parents.
Opportunities
We have recently developed a version of CPU for preschoolers, and this intervention model will permit the application of a similar model at the school-age level and at the pre-school-age level.
Note from the authors
Population:
Primary and nursery classes.
Number of implementations
Country
Contact details
Pietro Muratori
pmuratori[a]fsm.unipi.it
Main obstacles
With respect to individual professionals
Before Coping Power, therapists implemented interventions with psychodynamic or family orientations, and they have not agreed completely with CBT principles of the Coping Power Program. This obstacle led therapists to not completely adhere to the programme's activities, and led them to adapt some activities to the principles of psychodynamic or family orientations.
Often, therapists selected patients for Coping Power groups based only on primary DSM diagnosis; however, there are other important clinical characteristics to consider before including a child in a Coping Power group (for example comorbidity, parent's characteristics, level of Callous Unemotional traits).
With respect to social context
We implemented Coping Power in some rural area of Italy. In this area of implementation it was frequent that therapists had difficulty in engaging parents with the treatment.
With respect to organisational and economic context
In Italy, community hospitals have few resources for therapeutic activities such as Coping Power.
How they overcame the obstacles
With respect to individual professionals
We implemented supervision moments with specific discussion about therapist's doubts regarding Coping Power's principles. We encouraged therapists to adapt the programme to their personal attitude but applied the programme's activities as reported in the manual and during the training. We added specific training, in addition to the training on the programme's activities, on the evaluation of clinical characteristics associated with the main diagnosis of Disruptive Behaviour Disorders (DBD) in children and adolescents.
With respect to social context
We encouraged therapists to add individual interviews with parents who are unmotivated to treatment.
With respect to organisational and economic context
We organised a meeting with the hospital's head to explain the principles of the programme and to point out that a group format intervention, such as the CPP, in a mental health care unit could be a cost-effective procedure.
Strengths
The CPP implementation process in Italian community hospitals showed its effectiveness in reducing the extent to which children externalised behavioural problems, and improving their global functioning, reducing aggressive behavioural problems in children. It seems likely that the delivery of a group format intervention, such as the CPP, in a mental health care unit, could be a cost-effective procedure. It is a modular programme, so it could be easily adapted to the implementers' needs.
Weaknesses
Sometimes the group setting could have an iatrogenic effect; however, it is not a frequent phenomenon.
Opportunities
Disruptive Behaviour Disorders (DBD), including Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), are among the most represented clinical conditions in child and adolescent mental health settings. The Coping Power Program is an evidence-based intervention that can be implemented in a clinical setting, reducing the risk of negative outcomes in DBD children.
Recommendations
With respect to individual professionals
Train professionals in the selection of patients for Coping Power besides training in the Coping Power principles and practices.
With respect to sorganisational and economic context
Point out to hospitals' head that the group setting of Coping Power could be cost-effective.
Note from the authors
Population:
Children with Disruptive Behavior Diagnosis, and their parents.
