University of Kentucky UKnowledge Theses and Dissertations--Educational, School, Educational, School, and Counseling and Counseling Psychology Psychology 2015 THE IMPLEMENTATION OF SOLUTION-FOCUSED BRIEF THERAPY (SFBT) WITH AT-RISK YOUTH IN AN ALTERNATIVE SCHOOL ENVIRONMENT Martha C. Hinchey University of Kentucky, martha.com Right click to open a feedback form in a new tab to let us know how this document benefits you. Recommended Citation Hinchey, Martha C., "THE IMPLEMENTATION OF SOLUTION-FOCUSED BRIEF THERAPY (SFBT) WITH AT- RISK YOUTH IN AN ALTERNATIVE SCHOOL ENVIRONMENT" (2015). Theses and Dissertations-- Educational, School, and Counseling Psychology.edu/edp_etds/37 This Doctoral Dissertation is brought to you for free and open access by the Educational, School, and Counseling Psychology at UKnowledge.
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The undersigned agree to abide by the statements above. Hinchey, Student Dr. Thompson Prout, Major Professor Dr. Kenneth Tyler, Director of Graduate Studies THE IMPLEMENTATION OF SOLUTION-FOCUSED BRIEF THERAPY (SFBT) WITH AT-RISK YOUTH IN AN ALTERNATIVE SCHOOL ENVIRONMENT _______________________ DISSERTATION _______________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Education at the University of Kentucky By Martha Cord Hinchey Lexington, Kentucky Director: Dr.
Thompson Prout, Professor of School Psychology Lexington, Kentucky 2015 Copyright © Martha Cord Hinchey 2015 ABSTRACT OF DISSERTATION THE IMPLEMENTATION OF SOLUTION-FOCUSED BRIEF THERAPY (SFBT) WITH AT-RISK YOUTH IN AN ALTERNATIVE SCHOOL ENVIRONMENT Research indicates the potential utility of schools as sites for service delivery of mental health interventions. The application of solution-focused brief therapy (SFBT) within the school domain is reflected in the child psychotherapy literature. Findings on the use of SFBT in school settings suggest that it may be well suited to school contexts given its time-efficient, goal-directed, and strengths-based behavioral approach. The primary purpose of this study was to determine the effectiveness of SFBT with at-risk youth in an alternative school setting.
The researcher utilized a multiple case study design to examine the impact of a 6-session SFBT intervention on adolescent behavioral outcomes. Six students were randomized to one of three baseline conditions and received the SFBT intervention following baseline data collection. Data were obtained from multiple raters at baseline, posttest, and 6-week follow-up. In addition, students completed self-reported ratings at the beginning of each SFBT intervention session.
Data were evaluated using non-regression approaches and visual analyses. Preliminary results indicated that four out of six students exhibited reliable change (6-point increase in post-ORS mean scores), and four out of the six students demonstrated clinically significant change (baseline ORS mean scores below the adolescent clinical cutoff of <28). Results also indicated a decrease in total problem behavior scores at posttest for all informants on a normed assessment of emotional and behavioral functioning. Follow-up data were collected for four out of six students, and results suggested that this decrease in ratings was maintained or decreased further across all raters for three out of the four student participants.
Overall, preliminary results indicated the potential utility of SFBT with at-risk youth in an alternative school environment. Strengths and limitations of the current study, as well as additional research aims (e., impact of therapist alliance, fidelity monitoring in SFBT) and future research areas are also presented. KEYWORDS: Solution-Focused Brief Therapy, Alternative Schools, School-Based Psychotherapy, Single-Case Research Martha Cord Hinchey Student’s Signature 07-21-15 Date THE IMPLEMENTATION OF SOLUTION-FOCUSED BRIEF THERAPY (SFBT) WITH AT-RISK YOUTH IN AN ALTERNATIVE SCHOOL ENVIRONMENT By Martha Cord Hinchey Dr. Thompson Prout Director of Dissertation Dr.
Kenneth Tyler Director of Graduate Studies 07-21-15 Date For my parents – you are my forever cheerleaders. P3M2F ACKNOWLEDGEMENTS First, I would like to express immense gratitude to my parents for their incredible support, words of encouragement, use of laughter, and motivational voicemails. Your presence and guidance throughout my educational pursuits (or as you both dubbed “never-ending hoops and hurdles”) is remarkable, and I am a very lucky woman to be able to call you my parents. I would also like to especially thank the members of my dissertation committee.
Words cannot express how appreciative I am for your insight, challenges, and mentorship throughout my graduate school career. Thank you, Dr. Tom Prout, for guiding me in both my academic and professional endeavors. Your practicality, use of humor, and positivity undoubtedly contributed to my success.
Thank you, Dr. Alicia Fedewa, for your affirmations and contagious energy. Your enthusiasm and love for our field has impacted me greatly, and I hope to bring the same level of energy to the next chapter of my life. Thank you, Dr.
Jeff Reese, for helping me to realize my potential as a practitioner and researcher. The knowledge and experiences I gained in the Counseling Psychology program with you have influenced my present research interests and clinical behavior, and for that, I am forever grateful. Thank you, Dr. Jamie Studts, for taking me on as a graduate research assistant and for developing my “researcher skills”.
You make research fun. I have had so many memorable (i., hilarious) assistantship experiences with you, and will laugh about them for years to come. Lastly, I would like to thank Dr. Rachel Hammond, and Dr.
Thank you, Dr. Hammond, for always encouraging me, being my biggest fan, and counseling me throughout this doctoral journey. You have been an integral part of my success. I truly cannot express my gratitude enough to you for your support.
Thank you, iii Dr. Hoffman, for being my “other half” in graduate school. I am so lucky to have you as both a close friend and colleague. I honestly would not have been able to get through these past five years without you and our endless laughter.
iv TABLE OF CONTENTS Acknowledgements. iii List of Tables. viii List of Figures. ix Chapter One: Introduction and Review of Related Literature Introduction .1 Review of Related Literature .3 Youth Psychotherapy Research .3 Outcomes for Children and Adolescents .4 Influences on Therapy Outcomes .10 School Psychologists and Practice-Related Behaviors.11 Overview of Solution-Focused Brief Therapy (SFBT) .13 Comparison of SFBT to Other Psychotherapies .15 Cognitive-Behavioral Therapy (CBT).17 Family Systems Therapy .19 Definitions of Terminology.19 “Regular” School Settings .20 “Alternative” School Environments.27 Fidelity and Integrity Monitoring in SFBT .29 Literature Gaps and Future Directions in SFBT Research .32 Single-Subject Research .38 Aims, Research Questions, and Hypotheses .42 Chapter Two: Research Methodology Research Methodology .43 Therapist: Background Information .44 Participant 1: Background Information .45 Participant 2: Background Information .46 Participant 3: Background Information .47 v Participant 4: Background Information .48 Participant 5: Background Information .48 Participant 6: Background Information .50 Overview of Data.50 Brief Problem Monitor (BPM) Research .51 Outcome Rating Scale (ORS) Research .53 Therapeutic Alliance Measure .53 Session Rating Scale (SRS) Research .55 Overview of Measures Administered .57 Chapter Three: Results Results .58 Overview of Non-Regression Analyses.60 Outcome Data Analyses.83 Student Responses to “Scaling Questions” .87 Parent-Reported Concerns .88 Teacher-Reported Concerns .89 Therapeutic Alliance Data Analysis .90 Fidelity Evaluation Analysis .92 Summary of Findings .93 Overall Treatment Outcomes .95 Therapeutic Alliance Data .96 Fidelity Evaluation Data .97 Chapter Four: Discussion Summary of the Study .101 vi Additional Aims .102 Implications for Researchers .103 Implications for School-Based Practitioners .105 Appendices Appendix A: Approval Letters from the Administrative Director/ Director of Special Education and Principal .107 Appendix B: Parent/Legal Guardian Consent to Allow Minor to Participate in a Research Study.108 Appendix C: Consent to Participate in a Research Study (if 18) .110 Appendix D: Parent/Legal Guardian Consent to Participate in a Research Study .112 Appendix E: Teacher Consent to Participate in a Research Study.114 Appendix F: Minor Assent Form .116 Appendix G: Developmental History Form, Parent Version.117 Appendix H: Presenting Concerns/Issues, Parent Version (Baseline) .118 Appendix I: Presenting Concerns/Issues, Parent Version (Posttest) .119 Appendix J: Presenting Concerns/Issues, Teacher Version (Baseline).120 Appendix K: Presenting Concerns/Issues, Teacher Version (Posttest) .121 Appendix L: SFBT Intervention Protocols.122 Appendix M: SFBT Fidelity Measure .139 vii LIST OF TABLES Table 1, Summary of SFBT Studies.
24 Table 2, Measures and Frequency of Administration. 57 Table 3, Primary, Secondary, Tertiary, and Additional Aims and Research Questions. 59 Table 4, Level of Change in ORS Scores for All Student Participants. 62 Table 5, Student Responses to “Scaling Questions”.
87 Table 6, Parent-Reported Concerns and Severity Ratings (Baseline to Posttest). 88 Table 7, Teacher-Reported Concerns and Severity Ratings (Baseline to Posttest). 89 Table 8, Mean ORS Scores from Baseline to Posttest and Mean SRS Scores for Student Participants. 90 Table 9, BPM-Y T-Scores from Baseline to Posttest and Mean SRS Scores for Student Participants.
91 Table 10, Fidelity Evaluation Results. 92 viii LIST OF FIGURES Figure 1 (a), BPM Cross-Informant Bar Graphs for Andrew. 63 Figure 1 (b), BPM Cross-Informant Trajectory Graphs for Andrew. 64 Figure 2 (a), Analysis of Andrew’s ORS scores using PND.
65 Figure 2 (b), Analysis of Andrew’s ORS scores using SMD. 65 Figure 2 (c), Analysis of Andrew’s ORS scores using PEM. 66 Figure 3 (a), BPM Cross-Informant Bar Graphs for Bonnie. 67 Figure 3 (b), BPM Cross-Informant Trajectory Graphs for Bonnie.
68 Figure 4 (a), Analysis of Bonnie’s ORS scores using PND. 69 Figure 4 (b), Analysis of Bonnie’s ORS scores using SMD. 69 Figure 4 (c), Analysis of Bonnie’s ORS scores using PEM. 70 Figure 5 (a), BPM Cross-Informant Bar Graphs for Charlie.
71 Figure 5 (b), BPM Cross-Informant Trajectory Graphs for Charlie. 72 Figure 6 (a), Analysis of Charlie’s ORS scores using PND. 73 Figure 6 (b), Analysis of Charlie’s ORS scores using SMD. 73 Figure 6 (c), Analysis of Charlie’s ORS scores using PEM.
74 Figure 7 (a), BPM Cross-Informant Bar Graphs for David. 75 Figure 7 (b), BPM Cross-Informant Trajectory Graphs for David. 76 Figure 8 (a), Analysis of David’s ORS scores using PND. 77 Figure 8 (b), Analysis of David’s ORS scores using SMD.
77 Figure 8 (c), Analysis of David’s ORS scores using PEM. 78 Figure 9 (a), BPM Cross-Informant Bar Graphs for Evan. 79 Figure 9 (b), BPM Cross-Informant Trajectory Graphs for Evan. 80 Figure 10 (a), Analysis of Evan’s ORS scores using PND.
81 Figure 10 (b), Analysis of Evan’s ORS scores using SMD. 81 Figure 10 (c), Analysis of Evan’s ORS scores using PEM. 82 Figure 11 (a), BPM Cross-Informant Bar Graphs for Finn.