"TeleGroup” Adaptations to Behavior Management Training: Provider and Parent Acceptability, Comparative Outcomes, and Implementation Strategies

• In Event: Implementation and Evaluation of TeleGroup Interventions for Youth in the Wake of the COVID-19 Pandemic

Abstract

Introduction: Behavior management training (BMT) is a well-established treatment for ADHD and behavior problems in children and adolescents, which is often administered in a group format (Evans, Owens, & Bunford, 2014). This study evaluated parent and provider experiences, comparative outcomes, and intervention-level barriers and strategies for rapidly adapting and implementing group BMT via telehealth in response to the COVID-19 pandemic.

Methods: Brief parent training for ADHD (3 groups), Incredible Years (5 groups), and adolescent parent training (1 group) were adapted for telehealth components, using visuals to accompany materials. Data was collected through the externalizing disorders and early childhood specialty clinics of a children’s hospital outpatient psychiatry clinic. Both clinics had previously facilitated group BMT for parents of children with externalizing problems and transitioned to holding groups via telehealth in March 2020 in response to COVID-19. Group BMT providers within these clinics (n=9) completed questionnaires pre and post-telehealth transition assessing their impressions of the acceptability and utility of telehealth. Parent group participants (n=63) completed surveys during the course of TeleGroup treatment, assessing experiences with group participation and the telehealth format (using 0 to 5 Likert scale, where 5 indicated more favorable experiences). Finally, outcomes for in-person and telehealth groups were compared using scores from the Eyberg Child Behavior Inventory (ECBI) (n=38).

Results: Pre-transition, 88% of providers reported feeling neutral to very uncomfortable with TeleGroups. Top-rated concerns were facilitating group discussions, participant distraction, and managing technology and materials. Post-transition, all leaders indicated openness to continuing TeleGroups after distancing restrictions are lifted and observed benefits for family accessibility (100% of leaders endorsing) and ability for multiple caregivers to attend group (58% of leaders). Leader-perceived barriers included participant distraction (50% of leaders) and reduced group interaction (75% of leaders). Barriers were partially ameliorated by leaders introducing group norms and enhancing technological supports.

Most parents had experience with group video conferencing (88%), but not with telehealth (37%) prior to this group. Parents rated their overall experience positively (M = 4.31 out of 5, SD = 0.69) indicating few problems with technology or group engagement. Parents felt that they were still able to actively participate in group discussions via videoconference (M = 4.31, SD = 0.72), and also found the chat function (M = 4.19, SD = 0.86), screenshare, and slideshows helpful. However, parents also reported that while telehealth was suitable, it was less desirable than in-person groups. Qualitative analysis of free responses suggested that parents preferred an initial in-person visit to establish contact, appreciated the increased accessibility of telehealth, and struggled with childcare during tele sessions. Initial comparisons of externalizing outcomes across in-person and telehealth groups are discussed.

Conclusion: Despite initial provider reticence, the rapid shift to TeleGroup delivery of BMT in response to COVID-19 was well accepted by parents and providers and may enhance learning and reduce barriers to participation for some families. We will discuss implementation strategies to optimize participant interaction, effectiveness and acceptability of group BMT delivery.

Authors

• Michelle Kuhn, Seattle Children's
  Presenting Author

• Cindy Ola Trevino, University of Washington
  Non-Presenting Author

• Tara Rutter, Seattle Children's
  Non-Presenting Author

• Tyler Sasser, University of Washington
  Non-Presenting Author

• Erin Schoenfelder-Gonzalez, Seattle Children's
  Non-Presenting Author