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Jaimie C. Orndorff is a 2010 graduate of the PsyD Program in Clinical Psychology at Antioch University, Santa Barbara.

Keywords

in home treatment, home based treatment, short term treatment, team cohesion, success factors, child and adolescent, emotional and behavioral disorders, hierarchical regression, quantitative, CAFAS, WES

Document Type

Dissertation

Publication Date

2010

Abstract

Background: The author pursued this area of interest due to having had a positive experience working as a therapist within a high cohesion treatment team in an in-home setting. This experience with a high cohesion team seemed to lead to more successful results than other teams that were deemed low cohesion, in the same format. This experience led to a general curiosity about why the team this author was on was more effective. Additional research allowed this author to determine the possible link between cohesion, success of treatment and reduced risk for burnout, defined as a response to chronic job related stressors (Maslach, 2003). This possible link paved the way for this research to be accomplished. The purpose of this study was to determine if treatment team cohesion is a factor in determining the success of in-home treatment for children and adolescents with emotional and behavioral diagnoses. The link between cohesion and treatment team success has not been specifically researched; however, cohesion has been related to the success of teams in various sports. It was hypothesized that a high cohesion treatment team would result in more successful in-home treatment than a low cohesion treatment team. Methods: A closed record review was completed on 26 participants, with 13 participants in each treatment team. The participants were assigned to a specific team by the Clinical Director of the family preservation services provider based upon the caseload of the clinicians at the time of assignment. The same licensed therapist completed the Work Environment Scale (WES) to determine which team had the higher level of cohesion. Demographic variables of gender, ethnicity, duration of treatment, and medication status were used, along with the CAFAS and GAF scores in two hierarchical linear regression analyses. Two hierarchical linear regressions were performed using SPSS. The first regression utilized the cohesion measure, demographic variables (gender, ethnicity, duration of treatment and medication status), and the initial Global Assessment of Functioning (GAF) score as independent variables (IVs) to determine the likelihood of prediction of the final GAF score, both individually and combined as a group. The second regression provided the cohesion measure, demographic variables (as listed above) and the initial Child and Adolescent Functional Assessment Scale (CAFAS) score as IVs to determine the likelihood of prediction of the final CAFAS score, both individually and combined as a group. Results: Hierarchical regression analyses did not support the hypothesis; however, the statistical power of the sample size was too low to determine if significant results actually existed. Due to the restraints of managed care, inclusionary and exclusionary restrictions for this particular research and the significant decrease of funding for in-home treatment programs the participants that were appropriate for the purposes of this research unexpectedly resulted in a limited sample size. Conclusions: Results implicated a relationship between the CAFAS scores and the racial background of the participants. While this relationship is unclear the majority of the participants were African American and the clinician completing the CAFAS was Caucasian. Limitations of the study indicate additional research with a larger sample size would be beneficial to determine if there is a relationship between the cohesion of the treatment team and the success of in-home therapy.

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