Resources to Enhance the Adjustment of Children (REACH)
The REACH Program is a research study funded by the National Institute of Mental Health designed to examine and improve the way that children with disruptive behavior problems (and their families) receive mental health services. REACH focuses on the success of children with conduct problems over time, following the results of their treatment over a 10-year period.
Although most kids break rules from time to time as they grow older, children with significant “conduct problems” who are constantly defiant or persistently break rules (or laws) may have a mental health issue that seriously impacts their own lives as well as the lives of their parents. The REACH Program’s goal is to find out what the best methods are for helping kids with these conduct problems by studying whether therapy in certain settings is better than others (such as therapy in a clinic vs. therapy at home), and whether the style of therapy provided in our clinic is more successful than what is already available in the community.
Kolko, D. J., Dorn, L. D., Bukstein, O. G., Burke, J.D. (2008). Clinically referred ODD children with or without CD and healthy controls: Comparisons across contextual domains. Journal of Child and Family Studies, 17, 714-734. doi: 10.1007/s10826-007-9186-6.
Dorn, L.D., Kolko, D.J., Susman, E. J., Huang, B., Stein, H., Music, E., Bukstein, O. G. (2008). Salivary Gonadal and Adrenal Hormone Differences in Boys and Girls With and Without Disruptive Behavior Disorders: Contextual Variants. Biological Psychology, 81, 31-39. doi:10.1016/j.biopsycho.2009.01.004.
Kolko, D. J., Dorn, L. D., Bukstein, O. G., Pardini, D., Holden, E. A., Hart, J. D. (2009). Community vs. clinic-based modular treatment of children with early-onset ODD or CD: A clinical trial with three-year follow-up. Journal of Abnormal Child Psychology, 37, 591-609. doi: 10.1007/s10802-009-9303-7.
Electronic copies can be made available by email.
In the fall of 1998, the REACH Program began recruitment for families interested in participating in services for their child's behavior problems. The children enrolled were ages 6-11 and were diagnosed with Oppositional Defiant Disorder (ODD) and/or Conduct Disorder (CD). The study provided treatment intervention services in one of two settings (clinic or community) and additional follow-up assessments over a longer period of time to monitor how the child and families were doing following treatment. All families enrolled in the REACH Program first received a full psychosocial evaluation by trained REACH clinicians. Of these families, 139 children and their families received the REACH specialty therapy, which occurred within the first 6 months of their participation in the study. Half of these 139 families were randomly assigned to receive the therapy in the REACH clinic at Bellefield Towers in Pittsburgh, PA, and half were assigned to receive the therapy in the community (e.g. family home, school). The specialty treatment (utilized in both clinic and community groups) consisted of a modular-based treatment intervention including 7 treatment modules:
- Child Skills Training using Cognitive Behavioral Therapy (CBT)
- Medication Consultation/Management for ADHD
- Parent Management Training (PMT)
- Parent-Child/Family Therapy
- School Programming/Teacher Consultation
- Peer/Social Network Intervention
- Case/Crisis Management.
Two other groups were recruited to serve as comparisons to the families receiving the REACH specialty therapy. Thirty-eight children also meeting the diagnostic criteria for ODD and/or CD were enrolled through existing clinics: the WPIC Center for Children and Families in Pittsburgh; the UPMC Beaver Valley Mental Health Center in Rochester, PA; and the Children's Hospital of Pittsburgh Primary Care Clinic. These 38 families received services directly from the clinic from which they were referred, otherwise known as “treatment as usual” and did not receive the REACH specialty treatment. In addition, a group of 69 children with no mental health diagnoses were also enrolled and evaluated through our collaboration with the University of Pittsburgh School of Nursing. These children received no therapy and were participants in the "healthy control" comparison group.
In early 2000, a new component of the REACH program was added that included the repeated collection and analysis of the child participant's saliva. All REACH participants, regardless of participant group, were asked to consider voluntarily participating in this unique aspect of the study. Child participants were given the option to participate in this biological component to measure specific hormone levels in an effort to learn the relation between specific hormones and behavior over time.
After their initial assessments, all families in the REACH specialty treatment and "treatment as usual" groups participated in follow-up assessments (similar to the initial evaluation) at four set intervals over the next 2 ½ years. The Healthy Control comparison group had a reduced schedule of assessment intervals which included two additional assessments. All of the families in this original REACH study (specialty treatment, treatment as usual and healthy control groups) were invited to participate in the REACH Follow-up Care study 3 ½ years after initial enrollment.
Of the original “specialty treatment” families interested in participating in the REACH Follow-up Care study, half were randomly assigned to receive Follow-Up Care "booster" sessions (in their original treatment setting: clinic or community) with a REACH clinician, and half were given a targeted referral for services in the community taking into account a family's insurance, location, and clinical needs. Those in the “treatment as usual” and “healthy control” groups did not receive further services from REACH, but participated in regularly scheduled assessments. The Follow-up Care study followed the specialty treatment and treatment as usual families for an additional 2 ½ years at five regularly scheduled assessments. Healthy control participants had two additional assessments over longer time intervals.
Recruitment ended for the original REACH Study in 2003, and families were pursued for REACH Follow-up Care participation through 2006. All assessments were completed as of December 2008, and we are pleased to report that we continued to have a high participation rate through to the end.
Currently, the staff at the REACH Program is analyzing the information we have gathered over the 10 years of the study’s operation, with plans to publish many of our findings regarding treatment effects, long term outcome of children who have conduct problems, and biological indicators as seen through careful analysis of the saliva. Using a strong scientific method and research gathered from the community, our goal has always been to show what types of intervention is more effective for children with conduct problems.